The inspection took place on 27 April 2017 and was unannounced. The service provides care and accommodation for up to four people with learning disabilities. On the day of the inspection two people were using the service.

Iota Care occupies a large house and offers residential care without nursing. There were shared bathrooms, a communal kitchen and a communal lounge. There was an outside garden area.

The service had a registered manager in post. 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.

Staff and relatives all described the management in exceptional terms. Staff talked positively about their jobs and their shared commitment to people achieving their best. Care was based on best practice and the staff team highly motivated to achieve excellent care. The provider and registered manager were proactive and determined, they ensured effective and close monitoring of all aspects of the service to ensure ongoing improvement across all areas.

On the day of the inspection staff within the service were relaxed, there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People had limited verbal communication but we observed they felt comfortable with staff, were warm, tactile and engaged in their interactions with staff. Care records were exceptionally personalised and gave people as much control over aspects of their lives as possible. Staff responded quickly to people’s change in needs and were sensitive to their moods. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified, known by staff and respected. People’s cultural needs were met.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted to live full and active lives. Staff were highly motivated and creative in finding ways to overcome obstacles that restricted people’s independence.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers and the local learning disability team.

People we observed were as safe as possible. The environment was uncluttered and clear for people to move freely around the home, equipment was well maintained and outings to external venues risk assessed. Staff discreetly monitored people’s behaviour and interactions to ensure the safety of all the people and staff at the service. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. Families were involved in decision making and advocacy services were used when required. The service followed the laws and processes in place which protect

The inspection took place on 6 March 2015 and was unannounced. IOTA Care provides care and accommodation for up to four people with learning disabilities. On the day we visited three people were living in 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. The registered manager is also the joint provider of the service.

People were not able to fully verbalise their views and used other methods of communication, for example pictures and symbols. During the inspection we observed people and staff relaxed in each other’s company and there was a pleasant atmosphere. A relative commented; “I can’t praise them (the service) highly enough.”

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriately training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as GPs and dentists. People were supported by the local behavioural support teams for people with learning disabilities.

People’s care records were comprehensive and personalised to meet each person’s complex needs. Staff understood people’s individual needs and responded quickly when needed. People were involved as much as possible with their care records to say how they liked to be supported. People’s preferences were sought and respected.

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 had input to planning menus and their feedback had been listened to and acted on.

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as hospital consultants and GPs. Staff acted on the information given to them by professionals to ensure people received the care they needed to maintain their health and social care needs.

Staff knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

Staff described the registered manager and provider as being very supportive, very approachable and very hands on. Staff talked positively about their roles. Comments included; “Brilliant place to work.” And “Can’t fault either (The joint owners) of them - they work alongside us.”

People needed one to one staffing at all times and staff agreed there were always sufficient staff to meet this requirement. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received a comprehensive induction programme. People were protected by safe recruitment procedures.

There were effective quality assurance systems in place. All significant events and incidences 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, relatives, professionals and staff. Relatives were confident that any concern or complaint raised would be handled appropriately.

We met the people who used the service. Due to their needs we were unable to ask for details about the care they received. We met and spoke with the registered provider and registered manager. We also spoke to the staff on duty and checked the provider's records. We looked at the yearly surveys completed by the relatives of the people who used the service for further information. One relative said, "The work and dedication that all the staff put in is amazing”.

Due to the limited communication needs of people living in the home we spent time observing and listening to the interaction between them and the staff. We saw and heard people's privacy and dignity were respected at all times. We saw and heard that staff spoke to people in a way that demonstrated respect for the people they cared for.

One person who used the service, when asked if they were happy living in the home said, "Yes”.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people who received care at the home. People living in IOTA Care could be challenging at times, a higher staff ratio was needed both within the home and when people accessed the community. Safeguarding procedures were in place, staff had completed training and understood how to safeguard the people they supported from abuse.

Staff training records contained all mandatory courses as required. For example, staff had completed training in Mental Capacity and Medication. This meant the provider could demonstrate that the staff employed to work at the home, had the skills and experience needed to support the people who used the service.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS apply to care homes and hospitals. We saw from the care plans we looked at that the home had completed an application to assess one person’s mental capacity to use a social media web site.

Is the service effective?

Health and care needs were assessed with people where appropriate and where possible people were involved in writing and signing their agreements to the care plans. Specialist learning disability and challenging behaviour advisors had been identified to assist with care plans when required.

The staff spoken with had a clear understanding of the care and support needs of the people living in the home. A relatives quality assurance survey, recorded, “We appreciate the effort, initiative and understanding IOTA Care has in fulfilling our son’s needs”. The home had involved an advocate service to assist people when needed.

Is the service caring?

We observed that people were supported by kind and attentive staff. We observed that the staff showed patience when supporting people, particularly if people became challenging or demanding.

People who used the service had relatives who completed questionnaires on the satisfaction of the service provided. Residents' meetings were unable to be held due to the needs of people living in the home, but the provider and manager were around to observe any shortfall in the service. One relative survey said, “I am absolutely delighted with the care that my son received”.

We observed and listened to, interaction between the staff and people who used the service. We saw that people appeared happy with the care and support they received and that people’s needs had been met.

Is the service responsive?

Regular activities were arranged within the home and out in the community, which included trips out. On the day of our inspection one person was going to go to the local shops. We saw people’s activities programme and saw the wide variety of places people had visited, including a hydro pool. Other activities within the home promoted independent living skills. For example, budgeting and cooking.

Is the service well-led?

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

The Registered Provider was in the home most days and was actively involved in how the home ran, including working with people in the home.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities. All the people we observed looked happy with the staff working alongside of them.

IOTA (Independent Opportunity Transition into Adulthood) Care was first registered with us in October 2012 and this was the first inspection by the CQC.

Due to people’s complex needs we were unable to spend long periods with people but we were able to meet them and observed staff as they provided care and support. We also spent time looking at records, speaking to staff and speaking to the registered provider of IOTA Care. We also saw surveys returned to the home from relatives of people living in the home. This helped us gain a better understanding about people's support needs and experiences of the service.

We obtained from discussions with the staff and listening to and observing staff talking with people that people were treated respectfully and their choices and independence promoted. The interactions and relationships we observed were positive and this helped to create a safe and homely environment for the people using the service.

Care plans were detailed and reviewed with regular updates included. The staff had a good understanding of issues relating to abuse and systems were in place to ensure that any incidents of abuse were recognised, reported and acted upon to keep people safe.

Sufficient staff were in place and staff received a range of training opportunities to ensure they could meet people's individual needs.