We carried out an unannounced comprehensive inspection on 23 June 2018.

IOTA (Independence Opportunity and Transition into Adulthood) Care provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. The service were also supporting a person in a separate flat on a respite basis. IOTA Care provides care for people with a learning disability and associated conditions such as autism.

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 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post, who was also the joint provider. 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, on 5 March 2016, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found the service had improved to outstanding in two domains and therefore had improved to an overall rating of outstanding.

Why the service is rated outstanding.

People living at IOTA Care had complex care needs and required a high level of support with daily care needs inside and outside the home. We met with both people during our visit and observed some interaction between them and the staff. People were not able to verbalise their views and staff used other methods of communication, for example sign language or visual choices.

When we arrived people were still in bed before they started their planned routines. These planned routines helped provide reassurance to people who were living with autism. People were living a full life and there was a busy and relaxed atmosphere during the day. As the day went on people were either enjoying time on their own, with staff interaction when they needed it or going out on a planned activity. One staff member said; “[Are they] safe?-Definitely. If I had a child I wouldn’t hesitate to let them live there. I think they are very safe.”

People were encouraged to live active lives and were supported to participate in community life where possible. Activities were developed for people who perhaps had not tried certain activities before. Other activities reflected people’s interests. The environment and the outside spaces had been designed for people living with autism to allow people to safely be on their own in the garden in most weathers and to have sensory equipment to entertain them.

The provider and registered manager had taken innovative steps to develop technology to improve the quality of people's care, communication with family members but most of all for the people who used the service. They had designed a programme call ‘Scrapbook Circle’ which was an instant private social media network for family, friends and staff and people who used the service. This allowed all parties to see what each other were doing and mostly to keep in touch with each other which was particularly useful if family and friends lived some distance away. The provider described the ‘Scrapbook Circle’ as “Provides a safe, supportive place for people to communicate with the people they really care about.” One staff member said; “I love it. Such a good way to enable them to communicate with family as they are not able to communicate themselves [verbal

The inspection took place on the 5 March 2016 and was unannounced. IOTA Care provides care and accommodation for up to three people with learning disabilities. On the day of our inspection two people were living in the service and one person was staying for respite care. This was the first inspection of IOTA Care since the registration of the service. IOTA Care Limited owns another service in the Plymouth area.

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 with all three people during our visit. Due to people's complex needs people were not able to comment on all aspects of their care and support. However we were able to meet them and observed staff as they provided support. People used other methods of communication, for example pictures. A relative said; They provide individual care for these young adults.”

People’s mental capacity had been assessed which meant care being provided by staff was in line with people’s best interest. Staff understood their role with regards to ensuring people’s human and legal rights were respected. Staff had completed safeguarding training and understood what constituted abuse and how to report concerns. Staff described what action they would take to protect people against harm.

People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff completed training and understood what people’s medicines were for. Staff 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 speech and language therapist. People had access to healthcare professionals to make sure they received appropriate treatment to meet their health care needs such as epilepsy nurses. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

People were relaxed and observed to be happy with the staff supporting them. Care records were detailed and personalised to meet each person’s needs. People and / or their relatives were involved as much as possible with their care records to say how they liked to be supported. People were offered choice and their preferences were respected.

People’s risks were documented and well managed. People lived active lives and were supported to try a range of activities, for example walking in the park opposite the service and regular day trips to local areas.

People enjoyed the meals offered and had access to snacks and drinks at any time. People were involved in planning menus, food shopping and preparing meals as much as possible. People were supported to say if meals were not to their liking.

People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities. Staff received an induction programme. Staff had completed training and had the right skills and knowledge to meet people’s needs.

Staff said the registered manager and registered provider were supportive and approachable and worked in the home regularly. Staff talked positively about their roles. A comment included; “I love coming into work.”

There were effective quality assurance systems in place. Any significant events were appropriately recorded 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 was sought from relative