Independence Homes Limited - 14 Cranley Gardens is a ‘care home’. People in care homes receive accommodation and 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.

Independence Homes Limited - 14 Cranley Gardens accommodates six people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. At the time of this inspection there were 6 people using the service.

This inspection took place on 21 March 2018. At our last inspection of the service we rated the service ‘good’. At this inspection we found the evidence not only continued to support the rating of good, we also found for the key question ‘is the service caring?’ the service had improved to ‘outstanding’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Staff had formed open and honest relationships with people and their relatives to gain their trust and build confidence that the care and support provided would be caring, considerate and reflective of people’s specific needs and preferences. Staff dealt with any tensions and conflicts that arose with empathy and compassion and went the extra mile to enable people to express their views so that their preferences and choices would be understood by everyone supporting them. They encouraged people to explore different options with regard their care.

People and relatives praised staff for their care and kindness. Staff were considerate and attentive to people’s needs, spoke about people with great respect and affection and clearly knew people well and what was important to them in terms of their day to day support. Staff respected people’s right to privacy and to be treated with dignity. They were warm and welcoming towards people’s relatives when they visited the service.

People were safe living at Independence Homes Limited - 14 Cranley Gardens. Staff understood how to safeguard people from the risk of abuse. Staff followed current guidance on how to minimise identified risks to people to keep them safe from injury or harm.

Risks posed to people by the premises were appropriately managed. The provider maintained a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people. The premises was kept clean and clear of slip and trip hazards. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food. Medicines were stored safely and securely and people received them as prescribed.

There were sufficient numbers of staff to keep people safe. The provider maintained recruitment checks to assure themselves of staff's suitability and fitness to support people. Staff had regular and relevant training to keep their knowledge and skills up to date with best practice.

Staff adhered to current best practice, legislation and standards in the delivery of people's care and support needs to help them achieve positive outcomes in relation to their physical, emotional and mental health and wellbeing. People were actively involved in planning and making decisions about their care and support needs so that they would continue to receive highly personalised care and support, tailored to meet their individual needs. People’s care and support needs were discussed and reviewed with them regularly to ensure the support provided continued to meet these.

People were encouraged to keep healthy and well, to eat and drink enough to meet their needs and helped to access healthcare services when

We undertook an unannounced inspection of this service on 30 November 2015. At our previous inspection on 23 August 2013 the service was meeting the regulations inspected.

14 Cranley Gardens provides accommodation, care and support to up to six people with epilepsy and learning disabilities. At the time of our inspection six women were using the service.

The service had 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 2008 and associated Regulations about how the service is run.

A safe environment was provided which was suitable to people’s needs. People were able to express their opinion about the environment and were involved in decorating decisions.

Staff had the knowledge and skills to keep people safe. They were aware of the reporting procedures if they had concerns a person was being harmed and ensured they shared their concerns with a member of the management team so appropriate action could be taken to support the person.

Staff were aware of the risks to people’s safety, including any risks associated with their epilepsy. Staff maintained a balance between giving people their independence whilst maintaining their safety. We saw that staff worked with people to identify risks to their safety and how people could self-manage those risks.

Staff supported people to self-medicate and progress towards self-management of their medicines. Safe medicines management processes were followed and people received their medicines as prescribed.

People were supported in line with the Mental Capacity Act 2005 and were involved in all decisions about their care. If staff had concerns about a person’s capacity to make a decision they arranged for a mental capacity assessment to be undertaken to identify what support would be in the person’s best interests.

People were supported to be as independent as possible, this included participating in paid employment, using public transport, and undertaking household tasks. People were offered choice about how they received the support they required and staff respected people’s opinions. Staff were respectful of people’s privacy and maintained their dignity.

Detailed care plans were developed in discussion with people and their families to identify what support people required and how staff could help them to lead fulfilled lives. People were supported to access local amenities and participated in activities they enjoyed.

There was a stable staff team who worked well together. People knew the staff and the staff knew people’s preferences and their interests. Staff had the knowledge and skills to support people. They undertook regular training and completed relevant qualifications to ensure they were aware of good practice guidance.

People, their relatives and staff were invited and encouraged to share their views and opinions about the service. We saw that feedback received was used to improve service delivery.

The staff team and the senior management team reviewed the quality of the service, and implemented the required actions to improve service delivery. Incidents, accidents and complaints were learnt from to further improve the support provided.

We spoke with people who use the service. One person told us, “I like it here, the staff are really nice.” Another person said, “I like my room and I like the staff.” One person told us, “It’s really great here.”

We found that people were involved in their care and treatment and were encouraged to be as independent as possible. Care and treatment was provided in line with person centred care plans by qualified and appropriately trained staff.

We found that medicines were correctly stored and administered. We also found that there was a system in place to record and deal with complaints even though none had been received in the preceding 12 months.

We spoke to all of the six residents who told us that they liked living at Cranley Gardens. They told us about their lives, their activities and their part time work. They said that the staff were supportive and helped them to do the things they wanted to do.

People living at Cranley Gardens are well cared for; the house is well maintained and feels like a real home. The staff were well informed and very capable. They spoke well about Independence Homes as a company and praised the training and support provided. The systems of management and quality control were exemplary as were the systems in place for obtaining service users feedback as well as that of other stakeholders.

All six people who use the service gave complimentary feedback about Cranley Gardens. People told us they are treated with respect, make decisions about the care they receive, and are able to influence how their home is run. A relative said that they were pleased with the standard of care and that the service was very good.

People are supported to achieve their personal ambitions through ongoing person centred care planning. They told us that they can choose what they want to do regarding how they spend their time and organise their lives. The staff and registered manager have worked at Cranley Gardens for a long time and know each person well. Staff told us that they felt well supported and had good training to meet the needs of people who have epilepsy.

Please refer to each essential outcome below, for more detailed comments about specific aspects of the service.