We carried out an unannounced comprehensive inspection on 25 March 2018.

Inglenook House provides care and accommodation for up to ten people with learning disabilities. On the days of our inspection there were seven people living at the care home. In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

People in care homes receive accommodation and nursing or personal care as 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 did not have a registered manager; however the recently appointed manager was in the process of submitting their application to the Commission. 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.

At the last inspection on the 19 December 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

People were not able to verbalise their views and staff used other methods of communication, for example pictures or sign language. We met and spoke with all the people during our visit and observed the interaction between them and the staff.

The Provider Information Return (PIR) states; “Our Director has owned the business for 30 years and has always promoted a positive culture that is open and person centred.”

People remained safe at the service. People were protected from abuse because staff knew what action to take if they suspected someone was being abused, mistreated or neglected. Staff, were recruited safely, and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults. People had their needs met by suitable numbers of staff.

The Provider Information Record (PIR) states; “We hold monthly service user forums where we discuss abuse and bullying ensuring our service users know what the term "abuse" or "bullying" means and if they felt comfortable telling us if they felt they were being bullied.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe.

Risk assessments were in place to help support risk taking, and help reduce risks from occurring. People who had behaviour that may challenge staff or others had risk assessments in place which gave good guidance and direction to staff about how to support the person, whilst taking account of everyone’s safety. People received their medicines safely by suitably trained staff.

People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staffs practice and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training included a section on the Equality and Diversity needs of people.

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

People's health was monitored by the staff and they had access to a variety of healthcare professionals. The provider worked closely with external health and social care professionals, to help ensure a coordinate approach to people’s care.

People’s end of life wishes were not currently documented, however the manager had plans to discuss this issue with

The inspection took place on 19 December 2015 and was unannounced. Inglenook House provides care and accommodation for up to ten people with learning disabilities. On the day of our inspection seven people were living in the service.

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.

We met and spoke to everyone living at Inglenook during our visits and spent time observing people and staff in each other’s company. Some people were not able to fully verbalise their views and staff supported us when we spoke to people. We observed people and staff relaxed in each other’s company and there was a friendly lively atmosphere.

People who were able told us they felt safe and secure. People’s personal possessions and their money were kept safely. Comments included “Yes, I feel safe here.”

People’s care records were comprehensive and personalised to meet individual needs. Staff understood people’s needs and responded accordingly. People were involved as much as possible with their care plans and with how they liked to be supported. People’s preferences were sought and respected and people were offered choice.

People’s mental capacity was assessed which meant care being provided by staff was in line with people’s wishes. Staff had a clear understanding of their role with regards to ensuring people’s human rights and legal rights were respected. Staff had undertaken safeguarding training and had knowledge of what constituted abuse and when and how to report concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

People had their medicines managed safely and received them in a way they chose and preferred. Staff told us they undertook training and understood the importance of safe administration of medicines.

People were supported to maintain a healthy and balanced diet and any needs associated with their diet and health were understood by the staff supporting them.

People had access to healthcare professionals, such as epilepsy nurses, to make sure they received appropriate treatment to meet their health care needs. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

People’s risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies.

People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People were involved in planning menus, shopping and cooking and their feedback had been listened to and acted on.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles and some staff had worked for the company for a number of years.

People were protected by safe recruitment procedures. Staff received a comprehensive induction programme and the Care Certificate (a new staff induction programme) had been implemented within the home. There were sufficient staff to meet people’s needs. Staff were very kind, caring and thoughtful. Staff had completed training and had the right skills and knowledge to meet people’s needs.

All significant events and incidents were document and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support, provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, professionals and staff.

People using the service had complex care needs. This meant that it was difficult for people to tell us what they thought of the home and the care they received.

During our visit we saw that staff treated people respectfully at all times, promoting choice and independence when possible.

Staff we spoke to had a good understanding of people's care needs. Some of the records relating to people's care were not up to date and did not in all cases demonstrate that people were involved in the planning or review of their care arrangements.

Staff we spoke to were able to tell us about different types of abuse and what they would do to protect people, however, written policies and procedures were not in place to ensure that any incidents of abuse were dealt with promptly and consistently.

Staff were aware of recent guidelines to manage difficult behaviours, however the information recorded in incident forms did not demonstrate that procedures were followed to ensure that all people in the home were kept safe and protected.

We found that people engaged in a range of activities. One person said " I like going swimming and playing football"

The provider undertook regular checks of the environment, and gathered feedback about the quality of the service from relatives and health professionals. Feedback included " The staff are excellent"

The provider did not have a clear overview of incidents in the home and did not regularly check to ensure records were up to date.

People we spent time with during our visit communicated either with words or physical signs. People communicated that they were comfortable and happy living at the home.

All of the people that lived in the home had significant though varied care needs. We saw that the service cared for people and supported everyone that lived at the home to have a good quality of life.

The staff delivered care that supported people’s human rights, privacy and dignity. For example we saw staff talking with people in a respectful manner and we saw support being offered with sensitivity and care. The people that lived at the home were routinely offered choice in all aspects of their daily lives.

We saw and heard that people’s personal care and health care needs were met and supported by the service. We heard about people’s daily activities and about how people that lived in the home went out of the home to enjoy their community and had entertainments available in the home. People that used the service had a fulfilling and active lifestyle. People’s care planning and risk assessment were basic but were being further developed by the service. We saw that the home was clean and hygienic.

The staff that are employed by the provider were receiving training. This training helped staff to deliver good quality care, safely. Though staff were receiving occasional supervision it was not taking place often enough to support the delivery of care.

At the time of our inspection there were seven people living in the home. We were able to meet all of the people using the service. Some people had limited verbal communication so we spent time in the communal area observing people as they were being cared for and supported by staff.

The information for staff about people’s care needs was well written and included detail about how people chose and preferred to be supported. When people’s care needs were more complex clear guidelines were in place to ensure that support was consistent and safe.

People had been included in discussions about their care and their views and opinions had been taken into account.

We saw that people had a well- balanced and varied diet. The service had recently appointed a chef, which had further improved the quality and variety of food available to people.

People were supported to manage their health needs. Consideration had been given to the environment and staff skills to support one person’s needs due to the onset of Dementia. This demonstrated that the service adapted their support arrangements to meet people's changing care needs.

Staff had been provided with updated, clear information about procedures to safeguard people who used the service.

The service regularly reviewed the quality of the service and had made improvements to the way incidents were reported to ensure that appropriate action had been taken.