Honeybourne House provides residential and nursing care for a maximum of 21 people with a learning disability and associated conditions, such as Autism. The service is situated on a residential street and is divided into two parts; a purpose built nursing unit known as the Bungalow, and the residential service referred to by people as, The House. For the purpose of this report we will refer to the whole service as Honeybourne House but may also refer specifically to the nursing or residential unit. At the time of the inspection eight people were being supported in the nursing unit and 11 people in the residential part of the home.

Honeybourne 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safe living at the home and with the staff supporting them. We saw people were happy and trusted the staff. There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. There were adequate numbers of staff available to meet people's needs in a timely manner.

People received effective care from staff who knew them well, and had the skills and knowledge to meet their needs. Staff monitored people's health and wellbeing and made sure they had access to healthcare professionals according to their individual needs. Registered nurses were available to support people’s day to day nursing needs.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and understood the importance of safe administration of medicines. Staff said they undertook regular competency checks to test their knowledge and to help ensure their skills were up to date, and in line with best practice.

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People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible, and the policies and systems in the service support this practice.

People were supported by staff who were kind and caring. Where people were distressed or found it difficult to express themselves, staff showed patience and understanding. People's privacy and dignity was mainly promoted and respected. It had been noted that the layout of people’s bedrooms and bathrooms in the unit could mean people’s privacy and dignity was compromised. However, the registered manager and provider were prompt to address this matter during the inspection.

The service was responsive to people's needs and people were able to make choices about their daily routines and how support was delivered. People had access to a range of organised and informal activities. Relatives were welcomed in the home and their views and feedback were taken into account, when planning care.

Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The registered manager and provider treated complaints as an opportunity to learn and improve.

The home was well led by an experienced registered manager and management team. The provider had systems in place to monitor the quality of the service, seek people's views and make on-going improvements.

Further information is in the detailed findings below

The inspection took place on 2 January 2016 and was unannounced. Honeybourne House is a nursing home providing care and accommodation for up to 21 people with learning disabilities and accommodation is provided within the main house and a purpose build bungalow in the grounds. On the day we visited there were 11 people in the main house and eight people in the bungalow.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were not able to fully verbalise their views and staff supported us when we spoke to people. We met and spoke to most people during our visits and spent time observing people and staff in each other’s company. We observed a happy, friendly lively atmosphere within the service. People and staff were relaxed in each other’s company. One comment included; “I’m going out on a trip today I enjoy going out with staff.” A thank you card recorded; “Our daughter has been happy and well looked after in her home.” People who were able to said; “yes” when asked if they were happy in the home.

People and their relatives were happy with the care staff provided. Professionals and relatives said the service knew people well and the staff were knowledgeable and competent to meet people’s needs.

People were encouraged and supported to make decisions and choices whenever possible in their day to day lives. People were observed to have their privacy and dignity maintained. Staff were observed supporting people with kindness and patience.

People were protected by safe recruitment procedures. Staff were supported to complete an induction and ongoing training was provided to develop their skills and staff competency was assessed. All staff we spoke with agreed the service had sufficient staff on duty. Staff told us they had enough time to support people and didn’t need to rush them.

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as GPs and consultant psychiatrics. Staff ensured guidance provided by professionals was followed. This ensured people received the care they needed to remain safe and well, for example people had one to one staff support when needed.

People’s medicines were managed safely. Medicines were managed, stored and disposed of safely. Senior staff and nurses administered medicines and had been appropriately trained and confirmed they understood the importance of safe administration and management of medicines.

The registered manager had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Applications were made and advice sought to help safeguard people and respect their human rights. Staff had completed safeguarding training; they clearly understood how to report concerns and were able to describe the action they would take to protect people against harm. Staff were confident any incidents or allegations would be fully investigated.

People were supported to maintain a healthy, balanced diet. People were observed enjoying their meals and one person told us their meals were nice. An observed mealtime was not rushed and staff supported people appropriately and discreetly.

People’s care records were very comprehensive and detailed people’s preferences. People’s methods of communication and preferences were taken into account and respected by staff.

People’s risks were considered, well-managed and regularly reviewed to keep people safe. Where possible, people had choice and control over their lives and were supported to engage in activities within the home and outside where po

We used a number of different methods to help us understand the experiences of people using the service because the people had complex needs which meant they were not able to tell us their experiences. None of the people living in the home were able to inform us about the care they received.

Honeybourne House is divided into two: Honeybourne House had ten people living there on the day or our visit. The second home, The Bungalow, is in the grounds of Honeybourne House and had eight people living there.

We met all eighteen people who used the service and one visiting relative. We spoke to the deputy manager and eight staff members on duty and checked the provider's records. We spoke to staff about the care given, looked at the care records of four people, two from Honeybourne House and two from The Bungalow. We looked at other records pertaining to them and observed staff working with them.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. They took time to work at people's own pace.

We saw that staff treated people with consideration and respect. For example, we observed staff knocking on doors; they supported people to meet with us, and introduced us to people living in the home. We observed that the staff responded to people with patience and understanding at all times.

The staff demonstrated they had a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with most of the staff working during our visit. Some of the staff had only been employed for a short time and one said, “I am really enjoying the job”.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine if they were able to make particular decisions about their lives.

One relative spoken with said, “Very happy with the care provided”.

All the people living at Honeybourne House had communication needs which meant we had difficulty finding out about their experiences by talking with them. Therefore, we spoke with two people who lived at the home but also observed some of the support that people received and how they spent their day.This helped us get a sense of their experiences and their state of wellbeing. We also spoke with a visitor, four care staff and the registered manager, as well as looking at records related to care and the management of the home.

People’s privacy, dignity and independence were respected. Their views and experiences were taken into account in the way the service was delivered in relation to their care. For example, we observed staff offer a choice of drinks to someone who showed interest when a cup of tea was mentioned, rather than assuming the person wanted tea. People experienced care that met their needs and protected their rights. Other people were appropriately involved in decision-making in the best interests of those who did not have the mental ability to make decisions themselves.

People were cared for by suitably qualified and experienced staff who were supported to deliver care safely and to an appropriate standard. This included having sufficient numbers of staff to meet people's needs.

The provider had effective systems to monitor the quality of the service and manage risks to the health and welfare of people who used the service and others.

People living in Honeybourne House and The Bungalow had very limited communication and were unable to communicate with us. However we did meet with the people living in both homes and observed the interaction between them and the staff working in the home. Information about people's experiences in the home were given to us by the staff and management of the homes.

During our visit we observed people enjoying their activities, going about their everyday routines, and interacting positively with the staff supporting them.

One family member’s survey returned to the home recorded, “always a nice welcome from the staff”.