The inspection took place on 12 April 2016 and was unannounced. HF Trust - 1 & 2 Clementi Court Houses provides accommodation for up to eight people with learning disabilities or autistic spectrum disorder care needs. There were eight people living at the two homes at the time of our inspection.

The accommodation comprises of two houses. People had their own rooms and the use of a number of comfortable communal areas including a large reception area in each houses, with sensory equipment for people to enjoy using. Other facilities at each houses included a lounge, kitchen and dining room areas, conservatory and gardens.

We had the opportunity to spend time with people who lived at the homes on the day of the inspection. People were not able to communicate with us directly, so we contacted their relatives after the inspections to find out what they thought about the care their family members received.

A registered manager was in post at the time of our inspection. 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.

The registered manager and staff team had developed ways of working with people so their safety needs were taken into account. Risks to people's safety were understood by staff. Staff took action so people were able to do things they enjoyed and go to places they liked in ways which promoted their safety as their needs changed. There were enough staff available to support people so their care needs would be met. Staff understood what actions to take if they had any concerns for people's safety or wellbeing. People were supported to take their medicines so they would remain well.

Staff used their knowledge and skills when caring for people so people would enjoy a good quality of life. Staff worked with other organisations and relatives so people's right to make decisions and their freedom was protected. People were supported by staff to enjoy a range of food and drinks so they would remain well. People were supported to attend specialist health appointments. Staff followed the advice of specialist health services so people would receive the care they needed.

People's need for independence and privacy was understood and acted upon by staff. People were given encouragement and reassurance when they needed it and we saw caring relationships had been built with the staff and registered manager. Staff supported people so they were able to make their own choices about what daily care they wanted.

Staff understood people’s individual care and support needs and their preferences. People benefited from living in a home where staff took action when people's needs changed. Relatives had not needed to raise any complaints about the service, but were confident staff would take action if complaints were raised.

There was open communication between the registered manager, relatives and staff. Relatives and staff were comfortable to make suggestions for improving people's individual care and were listened to. Staff understood what was expected of them and were supported through training and discussions with their managers. Regular checks were undertaken on the quality of the care by the provider and registered manager and actions were taken to develop the home further.

This inspection was undertaken by one inspector. The registered manager was on leave, and so we spoke with the deputy manager, the staff team on duty, and family members who visited on the day. We spent time observing the interactions between

staff and the people they were caring for. We read the care documentation.

We asked the following questions about the service as detailed below:

Is the service safe?

There were safeguarding policies and procedures available and accessible for staff. These included the local authority guidance and contact details. Staff were able to tell us about the different types of abuse, and what they would do if they suspected that a person was being abused.

We saw that people were supported to make decisions, and they had agreed who was to be involved if they needed support with decision making. This was clearly documented.

We saw that medications were managed appropriately for people. Medications were safely stored, and each person had a medication plan. The plans provided detail and guidance about each of the medications prescribed. For example, we saw that where people required emergency medications such as those required to control seizures, there were detailed instructions about the medication, how it should be given, and the desired effect it should have. There were accurate recordings on the medication charts to confirm that medications had been given. This meant that people could be confident that they would be given their medication safely and when they needed them.

Is the service effective?

We spoke with staff who told us that they were supervised and had annual appraisals. We were told: "I feel very supported, the managers walk around and will tell us if there is a way to do something better for the clients."

People had been supported to understand their health action plans, care plans and risk assessments. Communication skills guidelines provided clear directions about how each person could be most effectively communicated with. This included use of pictures, simple signing and large print. Everyone who lived in the home had family members who were involved with their care and decision making and this was documented in the care records.

Family members told us about their involvement in decision making about care and treatment and that told us that they attended care reviews. We saw that external health care professionals were involved and contributed to care and treatment decisions.

Is the service caring?

We spoke with staff who were all very positive and enthusiastic about their roles. They told us: "I think we provide a high standard of care and we are always looking to improve," "We give fantastic care" and: "I feel very supported, the managers walk around and will tell us if there is a way to do something better for the clients."

We observed that staff acknowledged people even if they were passing by to support someone else. Sometimes they gave reassuring touches, and spoke to people as they passed by. We saw that people responded positively to the communication and often friendly 'banter' that they had with the staff.

Is the service responsive?

Health action plans were completed and these were detailed and comprehensive. They contained clear guidelines for staff to follow to ensure all aspects of people's health care needs were met. We also saw that copies of emergency plans for each person were kept attached to the back of their wheelchairs.This meant that people could be confident that their health care needs would be met in the event of an emergency.

We saw that feedback was obtained from people who used the service and their families and the senior staff spoke with families on a regular basis. One family member told us: "We are very involved and we can discuss any issues or suggestions we have".

Is the service well led?

We spoke with staff and families who told us that the quality of the service had improved since the current manager had been in post. We were told that there was more communication with families, and that staff felt more supported because the management team were more visible in the care home to provide direction and support.

The manager was on leave when we inspected the care home. However, we found that there were suitable arrangements in place to ensure that the quality of the service was monitored in their absence.

We found that staff meetings, supervisions and appraisals were completed and recorded. We were told by staff how their managers checked on their work, and supported them to improve if there was a better way of providing care and support to people. One staff told us: "We meet with management on a weekly basis, there is a lot of communication between us".

We looked at the audits that had been completed by the provider's quality assurance team. For April and May 2014, these audits had included reviews of support and quality of life, health and well being and environment. We saw that recommended actions were documented and the manager was required to provide updates prior to the next audit. This meant that people could be confident that the service they received would be monitored, reviewed and improved when needed.

We were not able to speak with people during our inspection because people who used the service had limited communication. We spoke with the manager and three staff members.

People received care and support as planned according to their needs. Staff understood people’s needs and how to give the support that they required.

We found people were involved in making choices regarding meals and drinks they received throughout the day. Staff provided support and encouragement to people when they were eating and drinking.

People were cared for in a safe and clean environment. The premises were suitable for people who required wheelchair access and people were able to access all parts of the home and garden.

We last inspected the service on 18 February 2013 and found that audit processes were not adequate. During this inspection we found that improvements had been made and the provider had an effective system in place to monitor the quality of the service provided.

The provider had a system in place that dealt with complaints in line with their policies and procedures. People knew how to make a complaint and received support from staff when they needed to make a complaint.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We were not able to speak with people during our inspection because they were not able to communicate with us due to their complex needs. We observed how care workers interacted with people to support them in making decisions about their day to day care needs. We saw people responded in a positive way to care workers suggestions.

We saw care workers provide one to one care throughout the day, consistently supporting and providing comfort and positive interaction.

We observed people taking part in personal activities and we heard engaging conversations with people that provided constant reassurance. We found care workers respected people as individuals and knew about their personal lives, background, families and personal preferences.

People’s changing needs were regularly assessed and reviewed with the delivery of care in line with any amendments to care plans. Care workers knew people’s current care needs and provided appropriate levels of support.

People were safeguarded as the provider had taken steps to ensure any potential instances of abuse could be identified and reported. Care workers we spoke with told us they felt supported to take the appropriate action where required.

The provider had a system in place to make sure care workers had the required levels of training to meet people’s individual care needs.

We checked the provider had systems in place to measure the quality of the service, however we found some areas required improvement.

People who use the service experience safe and appropriate care and support that meets their identified needs.

We were unable to speak directly with people who use this service. We did however review the home's own quality surveys that show people were very happy with the care and support they are receiving.