We inspected this service on 4 September 2018.

HF Trust – Gaston House and Dolphin House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is delivered from two semi-detached homes in a rural area. The homes are treated as two separate households which meant the service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The service provides accommodation and personal care for up to nine people with a learning disability or autistic spectrum disorder. Eight people lived at the home on the day of our inspection visit.

There was a registered manager in post at the service. 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.

At the last inspection in February 2016 the service was rated as Good. At this inspection we found people continued to receive a service that was safe, caring and effective. However, we found pressures on staffing levels and people's differing needs meant staff could not always be responsive to the needs of those people who benefitted from more involvement and engagement in the local community. The rating remains 'Good' overall, but the responsiveness of the service is now 'Requires Improvement'.

Risks were identified and risk management plans were in place to support staff to mitigate the risks of harm people may face at home and in the community. The provider analysed accidents and incidents to ensure appropriate action had been taken to keep people safe. Staff understood their responsibility to report any concerns they had about people's health or wellbeing.

There were enough staff to keep people safe, although staff vacancies meant some staff were regularly working extra hours to maintain safe staffing levels. Staff received an induction and training to ensure they had the appropriate knowledge and skills. Further training was being arranged so staff worked consistently to meet the complex needs of people living with autism. The principles of the Mental Capacity Act (MCA) were followed by the registered manager and staff.

People were supported to access health services when needed. Staff regularly worked with other health and social care professionals to develop care plans to ensure they met people's changing needs. Each person had information in their care plans about their diet and nutritional support which staff were aware of. Staff managed medicines safely and people received their medicines as prescribed.

People had developed positive relationships with the staff supporting them. Staff knew people’s favourite activities and how they liked to be communicated with. Relatives were kept up to date with the wellbeing of their family member. The provider had an accessible complaints procedure, but relatives told us they had no cause to complain.

The home was clean and tidy and suitable to meet people's individual needs. The provider had quality audit systems to identify where improvements were needed to improve the service.

We inspected Gaston House & Dolphin House on 19 and 22 February 2016. The first day of our inspection visit was unannounced.

The service provides accommodation and personal care for up to nine people with learning disabilities including autistic spectrum disorder. Care and support is provided from two adjoined houses and at the time of our visit there were four people living in Gaston House and three people living in Dolphin House.

A requirement of the service’s registration is that they have a registered manager. 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection.

Gaston House and Dolphin House provided homely environments where people appeared relaxed. Relatives were happy with the caring attitude of staff who took time to understand their family member’s needs. Staff were patient and kind in their approach towards people and communicated effectively with them. Staff supported people to maintain relationships with their relatives who felt fully informed and consulted about their family members' care.

There were enough staff to support people safely in the home and outside in the community. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs safely and effectively. Identified risks associated with people's care were assessed and managed in a way that supported people’s independence and safety. Staff understood their responsibilities to keep people safe and report any concerns they had about people's health or wellbeing.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) to ensure people were looked after in a way that did not inappropriately restrict their freedom. This included authorisation by the relevant authority for any restrictions to people's freedom deemed necessary to keep them safe; known as Deprivation of Liberty Safeguards (DoLS).

People were supported to choose what they wanted to eat and staff had a good understanding of any identified risks around people's nutritional needs.

People were encouraged to participate in activities and care was planned to meet people’s individual needs, abilities and preferences. Staff told us communication amongst the team was good so they were able to respond to any changes in people's needs. Staff referred people to other health professionals for advice and support when their health needs changed. People received their medicines as prescribed.

There was a stable management team who staff said were approachable and supportive. Staff were given opportunities to discuss the needs of the people living in the home in regular meetings.

The provider had processes to monitor the quality of the service provided through a system of regular checks and asking for people's views on the quality of care. Relatives felt they were listened to and any queries were responded to promptly.