The inspection took place on 18 and 25 May 2018 and was announced.

Moss Cottage is registered to provide accommodation for up to four people who have a complex learning disability and a physical disability. At the time of our inspection there were four people living in the service. There are two floors in the building which is in a suburban area of Liss. A car was provided to transport people living in the home.

At our last inspection we rated the service as good overall, and requires improvement in well-led. At this inspection we found the evidence continued to support the rating of good and required improvements had been made to achieve a rating of good in well-led. 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.

The service had a registered manager. A registered manager is a person who has registered with the 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.

Systems were in place to protect people from avoidable harm and abuse. Staff were aware of their responsibilities and had received the required safeguarding training. There were sufficient numbers of staff to support people's needs and keep them safe. There were safe recruitment processes in place to make sure the provider only employed staff who were suitable to work in a care setting. Risks to people were assessed and recorded in their care plans. Records showed that these were managed safely

There were arrangements in place to store, record and administer medicines safely. People received care from skilled staff who had received the appropriate supervision and training to help develop their knowledge. People were protected from the risk of acquiring an infection. The registered manager recorded accidents and incidents and supported staff to reflect on these to prevent recurrences.

Staff were aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support and implemented them in their practice.

People were supported to maintain a balanced diet. They prepared meals and made choices about food they wished to eat.

People had access to care from relevant health and social care professionals.

Staff had respectful, caring relationships with the people they provided support to. Staff encouraged people to express themselves and promoted their independence, privacy and dignity. Care plans were written in partnership with people and their families where appropriate. They reflected care and support that people required and were regularly updated.

The provider had processes in place for investigating and responding to complaints and concerns. A complaints policy was available to people in an easy read format. People and their relatives told us they knew how to raise a complaint.

People who lived in the home were not receiving end of life care, however, staff had held sensitive discussions with people and their relatives about what they would like to happen as they approached the end of their lives and after they passed away.

Robust systems were in place for monitoring the quality within the service to drive improvements.

Staff worked effectively in partnership with health and social care professionals to improve the service drive improvements in the service and meet people’s needs.

We inspected Moss Cottage on 22 September 2015. This was an unannounced inspection.

Moss Cottage provides accommodation and personal care for a maximum of four people who have a learning disability. The ground floor of the house is wheelchair accessible. There is a car for staff to take people out into the community.

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.

There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support. The registered manager had a clear vision for the service which had been formulated into a service improvement plan that focussed on driving improvement. Though checks had identified the service improvements required, these had not always been acted on within the required timescales to ensure the service people received would continue to improve.

There was a positive atmosphere and staff put people at the heart of the service. People and their relatives were encouraged to be involved in the planning of their care. Staff were motivated and flexible which ensured people’s plans were realised so that they had meaningful and enjoyable lives.

The service responded to people’s needs and supported people to develop their skills and independence. We heard many examples of how people had been supported to develop their communication skills, self-care abilities and to have increased enjoyment in the community.

Staff had a positive approach to keeping people safe. Staff had received training in safeguarding and were able to demonstrate an awareness of abuse and how concerns should be reported. People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. Systems were in place to protect people from the risks associated with medicines.

There were enough staff to keep people safe and support people to do the things they liked. The provider was employing new staff and had increased the use of agency and bank staff to manage a staff vacancy, to ensure people’s care needs were met. The provider’s recruitment process had been effective at identifying applicants who were suitable to work with people.

People living at Moss Cottage received care from knowledgeable and experienced staff. Many of the staff had supported people living at Moss Cottage for many years and demonstrated an in-depth knowledge of people’s needs and aspirations. Staff were supported to undertake training to support them in their role, including nationally recognised qualifications. Staff received regular supervision and appraisal to support them to develop their understanding of good practice and to fulfil their roles effectively.

Staff sought people’s consent before they provided their care and support. Where some people were unable to make certain decisions about their care the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. Where people had restrictions placed upon them to keep them safe, the staff continued to ensure people’s care preferences were respected and met in the least restrictive way.

People were supported to have their health needs met by health and social care professionals including their GP and dentist. People were supported to have a healthy balanced diet and when people required support to eat and drink this was provided in line with professional’s guidance.

The culture of the service was positive, people were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. The staff were highly committed to enhancing people’s lives and provided people with positive care experiences. They ensured people’s care preferences were met and gave people opportunities to try new experiences.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Two of the three people who lived at Moss Cottage were able to share their experiences with us. We also spoke with the registered manager and two care staff. We observed how people's care was provided. We reviewed records relating to the management of the home which included, three care plans and daily care records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

The home was clean throughout. Staff had been provided with appropriate training and guidance to ensure that they were aware of how to manage the risk of infection.

We saw that the outside of the building had been adapted to enable wheelchair access if required. There was a programme in place to ensure that the building was maintained and re-decorating works were being completed.

Is the service effective?

Where people had the capacity to make decisions about their care they had been supported to do so. Staff sought people’s verbal permission to provide their care. 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 peoples’ best interests.

People had care plans and risk assessments in place that identified their needs and provided staff with guidance on how they were to be met.

People’s independence had been promoted and they had been supported to pursue their interests and activities.

Is the service caring?

Staff were observed to be caring, they demonstrated a good understanding of people’s care needs. People were relaxed and confident to express themselves to staff where they were able to. One person told us “Yes, staff are nice.” Staff were sensitive to people’s non-verbal communication.

Is the service responsive?

We saw evidence that when people’s care needs had changed the service had been responsive to this. They had recognised changes in people and engaged other services to ensure that people’s changing needs had been met.

People’s views about their care had been sought. Where people had made requests in relation to their care these had been met.

Is the service well-led?

The service had a registered manager in place and staff told us that the service was well led. There were processes and systems in place to monitor the quality of the service provided.

We spoke with all three people who were living at Moss Cottage at the time of the inspection, but only one person was able to share with us some of their views about living at the home. This person told us they were ‘happy’ and enjoyed ‘going out’ and ‘making bacon sandwiches’. They confirmed they felt well looked after.

We observed people and staff at various times throughout the day and found that the care workers had a good understanding of the needs of people who used the service and provided care and support in a relaxed and person centred manner. We observed that people were involved in helping in the kitchen and were assisted to make their own hot drinks and undertake other domestic tasks as independently as possible.

We observed that people were asked for their consent and that care workers acted in accordance with their wishes. However it was not clear that where people lacked capacity to consent; that staff acted in accordance with legal requirements.

We viewed the care records of two people who used the service. We found that there were support plans and risk assessments in place which provided information about their care, health and support needs. However we noted that the support plans were arranged in a manner that meant it was not always easy to identify the most current information. We saw that people attended a range of activities outside the home including day services, college and trips out to church or for lunch.

The home had policies and procedures in place regarding the safeguarding of people. This included an easy read version available for people who used the service. Care Workers were trained in safeguarding vulnerable adults and they were informed about the service’s whistle-blowing procedures.

A training programme was in place which included training specifically tailored to the needs of people who used the service. Care workers told us they received regular supervision, although full records of this were not available to view on the day of the inspection.

The service had adequate arrangements in place to assess and monitor the quality of the service.

We chatted with all four people who were residing at the service and all confirmed to us that staff treated them well. We spoke in depth with two people. One person showed us their room which was warm, spacious and well ventilated. They showed us that staff had supported them to visit the shops in order to purchase personal items, including towels, clothing, skin creams and soaps of their choice. This person said that they were able to go out if they wanted to and that staff would drive them in a car to visit the shops. They told us that they preferred not to go out too often, particularly when the weather was cold. We spoke with another person who was waiting for their lunch. They said that the food provided was always good and that they had enjoyed attending college that morning. They said, "Staff are good. They help me. I trust them."

We found that the service was aware of people's individual needs. Specific guidance was made available to staff around how to best promote people's health and wellbeing. This included physical and mental health needs, social interaction and community involvement. Staff were knowledgable about people's interests and how to support their independence and their right to choose. Medication was stored safely and each person's medication needs were managed closely by staff in conjunction with regular review by their GP.

People at Moss Cottage did have verbal skills, although some responses were limited due to individual levels of comprehension.

One person was able to show us the things that mean a lot to them and to use photographs as a means of communication.