This inspection took place on the 18 and 22 October 2018 and was announced.

Martin’s Close is a residential home. People in residential homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

Martin’s Close is registered to provide personal care and support for up to five people living with a disability, a learning need or a physical impairment. Martin’s Close is a two storey house set in a suburban area of Basingstoke with good public transport links.

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 place. 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 our last inspection we rated the service Good with a rating of Requires Improvement in Well-Led. At this inspection we found the evidence continued to support the rating of Good and Well-Led had improved to good.

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.

At the last inspection, the registered manager told us the provider had been through a series of restructures. As a result of the restructure the registered manager had been given responsibility to manage three other services within a thirty mile radius of Martin Close. A senior support worker had been appointed to oversee the day to day management of the home. Concerns had been expressed by staff and relatives about the impact of the restructure on Martin’s Close.

At this inspection the registered manager told us their responsibilities had been reduced so they managed two registered services, including Martin’s Close. They also managed a service not registered with us. We found responsibilities for staff were clear and the registered manager was maintaining a detailed oversight of the services they were responsible for. There was no adverse impact for people or staff at Martin’s Close.

The provider had robust systems and processes in place to safeguard people. Staff were aware of their responsibilities to alert the relevant professionals if they suspected abuse and were appropriately trained. Risks to people were assessed and managed safely by appropriately trained staff.

People were supported to take part in their preferred activities and to have choice in their lives so that their independence was promoted and their freedom respected. Sufficient numbers of staff were deployed to meet people's needs. Medicines were managed safely.

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 support this practice.

People’s needs and choices were met by suitably trained staff. Care plans and risk assessments were personalised and regularly reviewed and updated.

Staff liaised effectively with healthcare professionals to support people's health and wellbeing. Staff knew people well, supported them consistently and treated them with respect. People were able to easily discuss their preferences and tell staff about how they wished to be supported.

The provider had a complaints policy in place. People knew how to compl

This inspection was carried out by a social care inspector whose focus was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

On the day of the inspection five people were living in 36, Martin Close. One of the people who use the service was away on a family holiday, whilst another was at work. We spoke with two people and were also able to find out about people’s experience of the service by observing care and talking with their families and staff. During our inspection we also spoke with the registered manager, four care workers and the relatives of three people who use the service.

This is a summary of what we found;

Is the service safe?

People's relatives told us that they trusted the manager and staff because they “really cared and put the needs of people first at all times.” One relative told us, “The manager and staff are exceptional. All of the people love being there and care about one another."

People were protected from the risk of inappropriate or unsafe care because the provider had an effective system to identify, assess and manage risks to their health, safety and welfare. We found that the provider had reviewed people's risk assessments to reflect changes in their needs.

The home was clean and tidy throughout. Staff had been provided with appropriate training and guidance to ensure that they were aware how to manage the risk of infection. One relative told us, “The home is very clean and people enjoy helping with the housework.”

We found that the provider had an effective recruitment and selection process. This meant that people were safe because their health and welfare needs had been met by staff who were fit, appropriately qualified and physically and mentally able to support them.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the service had been meeting the requirements of the DoLS and that relevant staff had been trained to understand when an application should be made, and how to submit one. Whilst no applications had been submitted, the manager was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.

Is the service effective?

We found that the service had effectively managed people’s nutritional and hydration requirements. We saw people were supported to eat a healthy balanced diet by staff who had been trained regarding nutrition and food safety. Where concerns had been identified regarding people’s nutrition we found that advice and guidance had been immediately sought from relevant health professionals.

Care practices we observed demonstrated that staff knew the needs of people and how to communicate with them. We found that people’s independence had been promoted and they had been supported to pursue their interests and activities.

Where people had the capacity to make decisions about their care they had been supported to do so. Where people lacked the capacity to make specific decisions the provider had assessed this and was following the correct legal processes to make decisions in people's best interests.

Is the service caring?

People were supported by kind and compassionate staff, who spoke with people in a caring manner. We saw that care workers gave encouragement to support people who were able to do things at their own pace.

One person told us the staff, “Are my friends and help me to do what I want.” One person’s relative told us, “The staff are excellent and really care. Most of them have been there a long time and have built up such close bonds.” Another relative told us, “The manager and staff care about the people who live in the home but also care about their families. They are always letting us know how they are.”

Is the service responsive?

People’s views about their care had been sought. Where people had made requests in relation to their care these had been met. We saw evidence that when people’s care needs had changed the service had been responsive to this. They had recognised changes in people's needs and engaged other services to ensure appropriate actions were taken to meet these.

The service had a complaints system which was readily accessible to people. This ensured staff listened to their concerns and responded to them effectively.

We saw the service had arranged appointments for people with different health professionals in swift response to health issues identified, for example when one person experienced significant weight loss.

Is the service well-led?

The service had a registered manager in place and staff told us that the service was well led. One relative told us, “I don’t think you could find a better manager. You can see they care about the people living there and have created a real team spirit and family atmosphere.”

We saw evidence that the registered manager had completed various audits in relation to the service.These included infection control, control of substances hazardous to health (COSHH), medication and health and safety. We saw evidence from the health and safety audit for example, that where issues had been identified action had been taken to address them. This meant that there were processes in place to audit the quality of the service and to take action where required.

The provider had suitable arrangements for obtaining consent from people who used the service in relation to their care and treatment. We saw that meetings had taken place to discuss best interest decisions, which were appropriately recorded within the care records.

Care plans were person centred and included clear instructions for staff on how to meet individual’s needs. They clearly detailed the support people required, how to provide it and what they were able to do for themselves.

People and their relatives made positive comments about the quality of support provided. One person said, “They listen to me and help me to do what I want.” A relative said, “You can tell the staff really care and it’s not just their job”.

We found that medicines were administered safely and that staff had recently received training from the local pharmacist.

People had their needs met by staff who had received appropriate personal development and were supported by an effective system of training and supervision.

There was a complaints system, although there had been no formal complaints made for several years. The manager said that staff made efforts to address any concerns quickly to prevent them developing into complaints.

We spoke with two people who lived in the home and two members of staff. We examined records, minutes of meetings and survey results. We saw that staff were familiar with people's needs and gave them opportunities to make choices. People told us "I love living here and the manager looks after me" and "I'd like to stay here and not move".

We found that people living at Martin Close and their representatives had been involved in planning their care and staff were familiar with people's needs.

The care plans we saw provided details of people's individual needs, wishes and preferences. The home sought advice from external healthcare professionals where necessary and this was recorded in people's care files. A range of activities were provided and people could choose whether they wished to take part.

We found that appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. Staff had also received appropriate induction training.

The provider had effective systems in place to ensure the CQC were notified of safeguarding incidents. Staff received safeguarding training which was updated annually. Safeguarding and complaints information was displayed in the home for the staff and people to refer to.

The provider had effective quality assurance systems in place to monitor the performance of the home. The views of people living there and their representatives were taken into consideration.

This unannounced inspection of Martin Close took place on 5 and 6 November 2015. The home provides accommodation and support for up to five people who have learning disabilities. At the time of the inspection there were five people living in the home. The primary aim at Martin Close is to promote people’s independence and support them to lead a full and active life within their local communities. The service is a detached house within a residential area, which has been furnished to meet individual needs.

The service had a registered manager. 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 and relatives told us they trusted the staff completely who made them feel safe. Staff had completed required safeguarding training and had access to current legislation and guidance. Staff were able to demonstrate an awareness of abuse and how concerns should be reported. There had been no safeguarding incidents since the last inspection.

Where risks to people had been identified in their care plans measures were implemented to manage these. Staff were aware of such risks and followed guidance to manage them safely. We observed people being kept safe by staff who understood their individual risk assessments and management plans.

People living at Martin Close had received care from most staff for a number of years, who demonstrated a detailed knowledge of people’s needs and aspirations. People were supported safely by sufficient numbers of staff with the necessary skills and experience. The registered manager completed a weekly staffing needs analysis with the senior support worker to ensure that any changes in people’s needs were met by enough suitable staff. Staff volunteered to cover any unforeseen absence to prevent the use of unknown agency staff and to ensure people experienced continuity of care from staff they knew.

Staff had undergone required pre-employment checks, to ensure people were protected from the risk of being supported by unsuitable staff. Staff had received an induction into their role, required training and regular supervision which prepared them to carry out their roles and responsibilities. People were cared for by sufficient numbers of well trained staff who were effectively supported by the registered manager and senior staff.

Medicines were administered safely in a way people preferred, by trained staff who had their competency regularly assessed by the provider. Medicines were stored and disposed of safely, in accordance with current legislation and guidance.

People were actively involved in making decisions about their care and were always asked for their consent before any support was provided. People were encouraged to be as independent as they were able to be, as safely as possible.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf. People were supported by staff to make day to day decisions.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had completed the required training and was aware of relevant case law. Since the last inspection the provider had made two DoLS applications which were awaiting authorisation and appropriately notified to the CQC. The registered manager had taken the necessary action to ensure people’s human rights were recognised and protected.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

Where people’s needs changed these were identified by staff and reported to relevant healthcare services promptly where required. Each person had a support plan to set their own goals and learning objectives and recorded how they wanted to be supported. This meant staff had access to information which enabled them to provide support in line with the individual’s wishes and preferences.

The activities programme ensured people were supported to pursue social activities and employment which protected them from social isolation. People were supported to maintain relationships important to them and to develop new friendships within the community.

Relatives told us they knew how to complain and that the provider encouraged them to raise concerns. No complaints had been made since the last inspection. When minor concerns were raised records showed they were investigated and action was taken by the provider to make improvements where required.

The registered manager told us that since our last inspection the provider had been through a series of restructures. As a result of the reorganisation the registered manager now also had a responsibility to manage three other services within a thirty mile radius of Martin Close. This meant they spent on average one day per week at Martin Close. A senior support worker had been appointed to oversee the day to day management of the home. People and relatives told us they had been worried about the impact of the restructure but told us the standard of care had not suffered, although they had observed an increase in the individual responsibilities of the staff.

Staff also told us they were not always clear about the management roles within the service. Staff told us clarification was required in relation to the overlapping roles of the registered manager and the senior support worker, as to who held responsibility for the day to day running of the service.

The registered manager had established systems to effectively assess and monitor the quality and safety of the service. However because they were frequently absent it was not clearly defined who was responsible for completing these processes and when. This meant there was potential for the systems not to be operated effectively to identify areas for improvement.

Records accurately reflected people’s needs and were up to date. Detailed care plans and risk assessments were fully completed and provided necessary guidance for staff to provide the required support to meet people’s needs. Other records relating to the running of the home such as audit records and health and safety maintenance records were accurate and up-to-date. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons, whilst remaining accessible to authorised staff.