Mirabeau is a care home providing intensive support for up to ten people who have a learning disability or who are autistic and have complex support needs. The service does not provide nursing care. At the time of our inspection there were ten people using the service, seven people lived in the main building and three people in a linked annexe called “The Garden Room.”

When we last visited the service it was rated good.

At this inspection we found the service remained good.

People were supported to stay safe and staff were provided with detailed guidance to effectively minimise risks to people’s safety. There were sufficient, safely recruited staff to meet people’s needs both in the service and out in the community. Medicines were safely administered by appropriately trained staff.

Staff were well supported and received specialist training to meet people’s individual needs. Staff supported people to maintain good health and wellbeing and enabled them to access other health and social care professionals when required. People were able to choose what they ate and drank in line with their preferences.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. Management and staff understood their responsibility in this area. Staff were committed to ensuring all decisions were made in people’s best interest.

Staff knew people well and treated them with kindness, good humour and respect. There was advice in place to enable staff to communicate with people and support them to make decisions about the care they received.

Care at the service was highly person centred. Detailed assessments had been carried out and personalised care plans were in place. Staff carried out on-going observation and recording which was analysed to ensure support met people’s individual needs. People were supported to have an active and enjoyable life and to maintain communication and relationships with family members. There was a complaints process in place and the manager welcomed feedback and open communication with families.

The manager promoted stable leadership and a calm, positive atmosphere which benefitted people who used the service. People were not enabled to make decisions about the way the service was run. We have made a recommendation about greater involvement of people. The provider had systems in place to check the quality of the service and made improvements, where necessary.

Further information is in the detailed findings below.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The service was last inspected on 22 July 2013 and at the time no breaches of legal requirements were identified. Mirabeau provides accommodation and care for up to a maximum of 10 men only adults with learning disabilities. There were 10 people living at the service when we visited.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The previous registered manager had resigned in July 2014 and an area manager from within the organisation was managing the service on an interim basis. The area manager informed us that the provider was in the process of recruiting a new manager.

People experienced a good quality of life because staff received training that gave them the skills and knowledge to meet their assessed needs. A core team of staff had worked at Mirabeau since it opened in October 2006 and had developed good relationships with people living at the service. Staff talked passionately about the people they supported and knew their care needs well.

Systems were in place to manage risks to people using the service, including safeguarding matters and medication, which protected them from harm. Risk assessments were detailed and gave staff clear direction as to what action to take to minimise risk. This focussed on what the individual could do, and the support they needed so that activities were carried out safely and sensibly. This showed that the provider had a positive attitude towards managing risk and keeping people safe.

Specific care plans had been developed where people displayed behaviour that was challenging to themselves and others. These provided guidance to staff so that they managed people’s behaviours in a consistent and positive way and which protected their dignity and rights. Staff told us they had been trained to recognise what could cause people’s behaviour to change and techniques to manage these behaviours. Discussion with staff, and records showed that appropriate decisions were being made about how and when restraint was used and these were being regularly reviewed. Incident reports confirmed that restraint was used on rare occasions and only as a last resort.

The interim manager had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The interim manager had made appropriate DoLS applications to the local authority to ensure that restrictions on people’s ability to leave the service and for occasions when restraint was used were appropriate.

A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service. Staff told us, and rotas showed that there was consistently enough staff on duty to keep people safe.

People were involved in determining the kind of support they needed. Staff offered people choices, for example, how they spent their day and what they wanted to eat, and these choices were respected. People were observed carrying on with their usual routines, going to work, shopping and accessing places of interest in the community.

We saw that people had a choice of meals and were able to eat their meal where they wanted. Nutritional assessments were in place which identified what food and drink people needed to keep them well and what they liked to eat.

People told us that they had access to health care professionals, when they needed them. Each person had a health action plan which detailed how they were being supported to manage and maintain their health. Different methods, including easy read health action plans had been used to support people with communication difficulties, so that they were able to understand information about their care.

There was a strong emphasis on promoting good practice in the service. The interim manager told us they worked alongside staff so that they were able to assess and monitor the culture of the service. Staff told us the interim manager was very knowledgeable and inspired confidence in the staff team, and led by example.

Systems were in place, including a ‘Speaking out’ document for people to raise concerns or complaints. Concerns and complaints were responded to promptly and used to improve the service. Additionally, the provider was a member of good practice schemes and initiatives, including the Challenging Behaviour Charter and The Social Care Commitment. This commitment ensured people who need care and support services would always be supported by skilled people who treat them with dignity and respect. This was observed during our inspection.

We found that people were mostly treated with respect. We observed some positive and supportive interactions between staff and people who used the service.

We found that the provider had systems in place to maintain the safety and welfare of service users. The service provides staff with specilaised training to ensure the safety of people with specific medical needs. The service provided people with appropriate levels of nutrition and hydration and encouraged people to drink during the spell of hot weather.

We found that the service had appropriate arrangements in place to protect people from the risk of abuse. Staff received regular training on safeguarding vulnerable adults and people with learning disabilities. The provider had appropriate arrangements in place for the use of physical interventions and restraint and monitored all incidents closely to ensure people were protected from the risk of inappropriate restraint.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff, the clinical psychologist and the area manager. The provider ensured the operation of the service continued uninterrupted in the absence of the registered manager.

We found that there was a sufficient number of staff on duty to provide care. The service was recruiting additional staff at the time of our inspection and did not use agency. Staff received regular supervision and an annual appraisal.

People using the service had complex needs which meant they were not able to were not able to communicate with us verbally. We talked with a number of staff in detail about people who used the service and how they liaised with relatives. We found that care was provided according to very detailed care plans, behavioural action plans and risk assessments of the people living in the service.

We observed people being cared for by staff during our visit. People who used the service shared their views through gestures, facial expressions and body language wherever possible. People were engaged in a range of activities, relaxed and comfortable with staff and people around them.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The service was well supported by the provider through extensive training for staff, clear policies and procedures, and regular refurbishment and maintenance.

We talked with a number of people who use the service and staff, this included observing them together at the time of our visit.

Some people using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible. People were engaged in a range of activities, relaxed and comfortable with staff and people around them.