The inspection was carried out on 11 August 2017 by one inspector and an expert by experience. It was an announced inspection. Forty-eight hours’ notice of the inspection was given to ensure that the people who lived in the service were available and prepared to receive unfamiliar visitors. Some people needed support to communicate. Gresham House provides support and accommodation for up to 12 adults with a learning disability. There were twelve people living there at the time of our inspection including one person who was away.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained: Good in regard to the questions: Is the service safe, effective, and well-led? And was: Outstanding in regard to the questions: is the service caring, and responsive?

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks for people while their independence was actively promoted.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

People were appropriately supported with the administration of their medicines, with attending appointments and were promptly referred to health care professionals when needed. People were supported with their nutritional needs to maintain good health.

The service was exceptional at helping people to express their views so they understood things from their point of view. They used creative ways to make sure that people had tailored and inclusive methods of communication. Clear information was provided to people about the service, in a format that was suitable for people’s needs.

Staff went ‘the extra mile’ to enhance people’s experience in the service. Staff promoted people’s independence, encouraged them to do as much as possible for themselves and make their own decisions.

People received care and support that was thoroughly personalised. Staff used innovative and individual ways of involving people so that they feel consulted, empowered, listened to and valued. The arrangements for social activities were flexible and met people’s individual needs. People’s care and support was planned proactively in partnership with them.

The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was an effective system of monitoring checks and audits to identify any improvements that needed to be made and maintain compliance with regulations. The registered manager and deputy manager acted on the results of these checks to improve the quality of the service and support.

Further information is in the detailed findings below.

This inspection was carried out on 07 July 2015 by one inspector and an Expert by Experience. It was an announced inspection. Forty-eight hours’ notice of the inspection was given to ensure that the people who lived in the service were prepared to receive unfamiliar visitors. Not all the people living at the service were able to express themselves verbally. Some people used specialised equipment to express themselves and others used body language.

Gresham House provides support and accommodation for up to ten adults with a learning disability. There were ten people living there at the time of our inspection.

There was a manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were trained in how to protect people from abuse and harm. They were aware of the procedures to follow in case of abuse or suspicion of abuse, whistle blowing and bullying.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs and ensured continuity of one to one support. Thorough recruitment practice was followed to ensure staff were suitable for their role.

Staff were trained in the safe administration of medicines. Records relevant to the administration of medicines or the supervision of medicines were monitored. This ensured they were accurately kept and medicines were administered to people and taken by people safely according to their individual needs.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before care was provided and were continually reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff had completed the training they needed to support people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions to ensure they were supported while they carried out their role. They received an annual appraisal of their performance and training needs.

All care staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). They were knowledgeable about the requirements of the legislation. People’s mental capacity was assessed and meetings were held in their best interest when appropriate.

Staff sought and obtained people’s consent before they provided support. When people declined or changed their mind, their wishes were respected.

Staff supported people with their planning of menus, activities and holidays. They ensured people made informed choices that promoted their health. Staff knew about people’s dietary preferences and restrictions.

People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their support was delivered. Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of care, likes and dislikes and preferred activities.

The registered manager and the staff’s approach promoted people’s independence and encouraged them to do as much as possible for themselves and make their own decisions. Comments from relatives included, “There is such a family feel about this place, and the staff make it home.”

People’s privacy was respected and people were assisted in a way that respected their dignity and individuality.

People’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. People’s care plans were updated when their needs changed to make sure people received the support they needed.

The provider took account of people’s views and these were acted upon. The provider sent questionnaires regularly to people’s legal representatives. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued and supported under the manager’s leadership. The manager notified the Care Quality Commission of any significant events that affected people or the service. Comprehensive quality assurance audits were carried out to identify how the service could improve and action was taken to implement improvements.

People experienced support that met their personal, social and health care needs and ensured their safety and welfare. We saw that staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Care plans were centred on the person and tailored to their individual needs and preferences.

People were protected from the risk of abuse. There was a system in place that supported people with their financial affairs.

People benefitted from safe and comfortable accommodation, which was suitably designed and maintained to meet their needs. People’s health and safety was protected from risks associated with the environment in which they lived.

People who used the service were supported by enough qualified and trained staff who knew how to meet people’s needs.

People who used the service and their relatives and/or representatives were asked for their views about the service provided. We saw that people were able to communicate their wishes to staff, who listened and took action.

People expressed their views and, where possible, were involved in making decisions about their care and treatment. We saw that staff treated people with respect, maintained people's dignity and encouraged independence.

People’s needs were assessed with the aim to plan and deliver care and treatment according to individual needs. The welfare of people who used the service was promoted by the provision of activities, people’s interests and life skills. People had access to health care professionals, to make sure their health care needs were met.

Care and treatment was planned and delivered with the aim to ensure people’s safety and welfare. The provider had taken steps to identify the possibility of abuse, which aimed to prevent abuse from happening. During the course of the inspection, we were informed of safeguarding matters, which were currently being looked into by the local authority safeguarding team

Staff received ongoing training, which helped them to support the needs of people who used the service. Staff were able, from time to time, to obtain further relevant qualifications, which were appropriate for their role. Staff received support, which enabled them to provide care for people who used the service.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted upon. There were systems in place to monitor and assess the quality of the service provided.