We carried out an unannounced comprehensive inspection on 18 November 2017.

46 Grenville Road provides care and accommodation for up to three people with learning disabilities. On the days of our inspection there were two people living at the care home. Each person had their own living area.

There was 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. At the last inspection on the 8 October 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

We met and spoke to both people during our visit and observed the interaction between them and the staff. People were not able to fully verbalise their views and used other methods of communication, for example electronic tablets and symbols.

People were asked if they felt safe. One person said; “Yes, because I’m happy.” Staff said; “People are safe because there is always enough staff and staff know people well.”

People remained safe at the service. People had one to one staffing at all times. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff confirmed there was sufficient numbers of staff to meet people’s needs and support them with activities and trips out.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff had also completed the Care Certificate (a nationally recognised training course for staff new to care). Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company.

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 end of life wishes were not currently documented, however the provider had arranged end of life training for staff. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with people. People's privacy was respected. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received would be fully investigated and responded to.

The service continued to be well led. People lived in a service where the registered manager’s values and vision were embedded into the service, staff and culture. Staff told us the registered manag

The inspection took place on 8 October 2015 and was unannounced. 46 Grenville Road provides care and accommodation for up to three people with learning disabilities. On the day we visited two people were living in the service. Michael Batt Foundation owns 46 Grenville Road and owns other services in Devon.

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, to share their views with us for example pictures and electronic equipment. During the inspection we observed people and staff relaxed in each other’s company and there was a pleasant atmosphere.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate 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. People were supported by the local learning disabilities service, for example learning disability nurses.

People’s care records were comprehensive and personalised to meet individual needs. Staff understood people’s needs and responded when needed. 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.

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, shopping and cooking and their feedback had been listened to and acted on.

Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. 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 as being very approachable and supportive. Staff talked positively about their roles and many staff had worked for the company for a number of years.

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.

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, professionals and staff.

During the inspection we met all of the people who used the service. People who lived at Grenville Road required a high level of care and support and were not in all cases able to tell us about their experiences of the service.

We spent time in the communal parts of the home speaking to staff and observing the care being provided. We observed that staff had a good understanding of people’s needs and had formed positive relationships with the people they supported.

Records and discussion with staff confirmed that people’s rights and ability to consent was considered when planning and providing care and support. Correct procedures were followed to protect people’s rights when they were unable to consent and make choices about their care and lifestyle.

The support plans we looked at provided staff with clear and up to date information about people’s needs and how they should be met. The staff we spoke to had a good understanding of this information and were able to tell us in detail about how people who used the service needed and preferred to be supported.

We found that the environment was clean and well maintained throughout.

Systems were in place to ensure that medication was stored and administered in a way that was appropriate and safe.

Records relating to people using the service were well organised and safely stored.

During our inspection we were able to meet and speak to the people who used the service. We also spoke with the staff on duty and observed the care and support being provided.

We spoke to one person who lived in the home. They told us about their plans for the day and was very excited about planning a birthday celebration. All of the people we met appeared relaxed, happy and contented within their home.

People were kept well informed of any changes to the services and information was provided in a way that people could access and understand.

We saw staff treating people in a dignified and respectful manner. Staff told people what they were doing as they provided support and also encouraged people to be independent whenever possible.

People were able to access a range of health care services and specialist advice was sought when needed.

Staff were aware of issues relating to abuse and were aware of what they needed to do to keep people safe.

We spoke to staff during our inspection. One staff member had only worked in the home a short time, but had a good understanding of people’s needs and the running of the home. They said that they had had a thorough induction, which had given them the opportunity to work alongside other staff members as well as read documents relating to the service and people’s care arrangements.

Systems were in place to regularly review the quality of the service, and changes had been made when improvements were identified.

People that live at Grenville Road either have no speech or it is very limited. People are highly dependent on the support given to them by the service both to meet their personal care needs and to have a good quality of life

As people could not generally tell us about their experience of the home we relied largely on the activity we saw in the home on the day of the visit and on the information given to us by the staff and the management about people’s experiences on living in this care home. We also spoke to other professionals who have been involved with the people who use the service such as Health professionals and advocacy services and spoke with relatives about their views and experiences of this home.

During our visit we observed people laughing and smiling and interacting positively with the staff supporting them.

One person said that they liked living in the home and enjoyed visiting their family and going to the Social club each week.

We were told by the Plymouth Learning Disability Service that the home provides ‘excellent care’ and the organisation is always willing to adapt the service to meet the specific needs of people they support.