Ms Maisie Melanie Bell & Mr Percival Fiztroy Drummond - 40 Lewisham is a residential care home for up to three people living with learning difficulties. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there was one person using the service. The person had access to their own private bedroom for their sole use.

This service was not required to have a registered manager. This was because they were providing daily care and support to the person. There were no other employees at this service.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good. We found that the service continued to meet all relevant fundamental standards.

Staff understood how to protect people from abuse and they described the actions they would take to report any allegations of abuse. Staff received training in safeguarding adults and understood types of abuse. Staff had access to support and training that increased their knowledge and supported them in their caring role. There was enough staff available to care for people safely.

Risks to people were identified. Clear guidance was developed for staff about how to manage known risks to keep them safe. The recorded accidents and incidents that occurred at the service. Lessons were learnt from these and the outcome used to improve the service.

At the time of the inspection the person was not supported with the administration of medicines. The registered provider had a process in place for the safe management of medicines if this was required.

The registered providers had developed working relationships with external health and social care services. This helped to ensure that appropriate care was arranged and delivered to people using the service.

The environment met the needs of people that lived at the service. The design and layout of the service met the needs of people.

Staff were caring at the service and knew how to protect people’s dignity and privacy in a compassionate way. Care records were produced in a format that people with a learning difficulty were able to understand.

Assessments were completed that took into account people’s views and opinions. Care records accurately reflected people’s care and support needs.

Staff knew the person they cared for well. Staff supported them with their daily tasks, including personal care and support with meals and their nutritional needs.

People are 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.

The registered provided support to ensure that the service was managed well. The registered provider completed internal audits of the quality of care provided to people. People were asked for their opinion and feedback about the service. The registered provider had developed partnership working with external health and social care agencies.

The inspection took place on 29 September 2015 and was unannounced. Ms Maisie Melanie Bell & Mr Percival Fitzroy Drummond - 40 Lewisham provides accommodation for up to three people who have a learning disability. At the time of the inspection there was one person using the service.

At the last inspection on 5 February 2014, the service was meeting the regulations we inspected.

The service is managed by a registered provider which is made up of two partners. The provider supported the person using the service daily; therefore the service was not required to have 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 provider had safeguarding adults’ processes in place and had an awareness of how to protect people against the risk of harm and abuse.

Staff had the relevant skills, experience and knowledge to support people. There were sufficient numbers of staff caring for people and staff were appropriately recruited and supported in their caring role.

The registered provider had an understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Consent was sought from people when supporting them and staff encouraged them to make choices and decisions about the way they wanted to be cared for.

People did not need to take any medicines at the time of the inspection.

People were cared for by staff who knew them, their likes and dislikes and how they wished to be supported and cared for. Staff encouraged people to be as independent as possible and supported them to maintain relationships with people that mattered to them. People’s care needs were assessed, reviewed and care plans developed to meet those needs. People had sufficient food and drink, which met their preferences.

The manager ensured that day-to-day care and support was delivered and organised to meet people’s care and support needs. The service had monitoring systems in place which were used to improve the quality of service delivery. People and their relatives were asked for their views and their feedback was used to improve the service.

At the time of our inspection, this service offered a residential placement to one person. We met with the person who used the service. We met with the registered provider and a care worker. We spoke to one commissioning manager, an advocate and one family member. We looked at the care records of the person who used the service and personnel records of two members of staff.

We found that those who used the service were treated with respect. An advocate told us “They give them the right to be in any space around the house." One family member told us how "Staff show great respect to my relative. They make sure that they are choosing what they want."

We found that people's care needs were met. We saw that the person using the service had a care plan specific to their needs. A family member told us "My relative is well looked after. Every time I visit, they were happy and well dressed. We noted that there were procedures in place to deal with emergencies.

We found that people who used the service were protected from the risks of abuse as safeguarding procedures were in place. A member of staff told us "I go through the booklet ['Stop Abuse'] to help our service user be aware of abuse, and let them know who to tell."

We saw that there were effective recruitment procedures in place.

We were not able to speak at length with the people using the service because their learning disabilities limited their abilities to communicate with us. We observed how they were being cared for in the home and their interactions with the people looking after them. We also gathered evidence of people’s experiences of the service by reviewing their records, speaking with their advocate and their social worker.

We observed that the staff treated them with dignity and respect. They were supported to be well groomed and well dressed. They had private spaces that were kept clean and tidy, and personalised with their possessions, such as family photographs and albums.

Both people using the service had the same social worker. Their social worker had completed recent reviews of their care and support and told us they had found no concerns. The people using the service had an advocate, who was a family friend. The advocate told us, “I have huge respect for the owners and the home that they provide. They are always welcoming towards me and encourage me to participate in discussions about their care and support needs.”

Our previous inspection of 17 October 2011 found that appropriate records had not been maintained for people’s money. When we inspected on 15 December 2012, we found the records were now up to date.

We found that people living at the home experienced care that respected their privacy, dignity and independence. People also experienced effective, safe and appropriate care and support that met their needs and protected their rights. We found that staff were appropriately trained and there were suitable systems in place to assess and monitor the care being provided. However, we found that suitable arrangements were not always in place to ensure that people at the home were protected against the risk of abuse.