This announced comprehensive inspection took place on 6 January 2018. The last inspection took place on 8, 10 & 15 December 2015. The service was rated as Good at that time. Following this inspection the service rating remains Good.

No. 18 is a ‘care home’. 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.

No. 18 provides accommodation, support and personal care for up to three adults with learning disabilities and/or autism. The service is based in two separate houses. At the time of the inspection two people were living at the service, one in each house.

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 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. No. 18 is part of Bowden Derra Park, a complex of residential accommodation. The registered manager was also responsible for the other Bowden Derra Park services. There was a deputy manager based in each house who oversaw the day to day running of the service.

We spent some time talking with people and staff and watching them spending time together. Staff were respectful and caring in their approach. They knew people well and had an understanding of their needs and preferences. People were clearly at ease and were able to decide if they met with us and how long for. They were able to express this to staff who respected their choices.

Risks to people’s safety and well-being were clearly identified and well managed. Staff used risk assessments to enable people to take part in activities. Staff were confident about providing support at any time including any period when people were distressed.

When staff identified people might benefit from additional support from external healthcare professionals they made appropriate referrals. Staff had encountered difficulties in this respect and were clearly frustrated by this but continued to make referrals. This showed they worked to improve people's experiences.

Staff were supported through a system of induction, training, supervision and staff meetings. This meant they developed the necessary skills to carry out their roles. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. The deputy manager spoke of the importance of providing an open culture where staff were able to voice their opinions.

Care plans were detailed, informative and well organised. They covered a range of areas including details of people’s social needs as well as any health needs. Descriptions of routines that were important to people were comprehensive. Parts of the care plan were written using minimal text and pictures to support the information to make them more accessible for people. Health care passports had been developed to share with other healthcare professionals if people needed to access health services.

Staff understood the Mental Capacity Act and associated Deprivation of Liberty safeguards. Any conditions attached to DoLS were complied with. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There were clear lines of accountability within the staff team. The management team were supported by experienced senior care workers who had

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

We spent time talking to people who lived at No. 18 and observing the interactions between them and staff. A comment included: “It’s nice here.” During our visit, we saw that people appeared relaxed and contented. For example, we saw staff reading a favourite book with a person.

Staff demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have. Staff we spoke with felt confident about responding to changing needs and knew what signs of abuse to look out for during their daily practice.

Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people’s health and wellbeing.

Staff at No. 18 recognised the importance of people’s personal details being protected to preserve confidentiality.

The inspection took place on8,10 and 15December 2015 and was unannounced.

No.18 provides accommodation and care across two houses, to three adults with a learning disability. On the day of the inspection three people were using the service.

The service had 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.

No. 18 is part of Bowden Derra Park, a complex of residential accommodation. The registered manager was also responsible for the other Bowden Derra Park services. No. 18 had a deputy manager who oversaw the day to day running of the service.

People and staff were relaxed throughout our inspection. There was a calm, friendly and homely atmosphere. People’s records were personalised and were being updated to reflect people's needs more accurately and how they wanted them to be met. There were sufficient staff to meet people’s needs.

Staff responded quickly to people’s changing needs. Relatives were involved in reviewing people's needs and how they would like to be supported and the service planned to involve people more fully also.

People’s preferences were identified and respected. Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and staff focused on people rather than on tasks.

Staff received a comprehensive induction programme and were trained to carry out their roles effectively. Staff were knowledgeable about the people they were supporting and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity. People’s risks were managed well and monitored.

People were supported to take part in a range of activities which reflected their interests. However, staff, relatives and a healthcare professional we spoke with felt people could be supported to do more activities at home and in the local community based on their needs and interests.

People’s medicines were managed safely. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, learning disability nurses and occupational therapists.

All staff had undertaken training on safeguarding vulnerable adults from abuse and demonstrated a good knowledge of how to identify and report any concerns. Staff described what action they would take to protect people from harm. Staff felt confident any incidents or allegations would be fully investigated.

People were protected by safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Relatives and friends were made to feel welcome and people were supported to maintain relationships with those who mattered to them. People and those who mattered to them knew how to raise concerns and make complaints. Complaints had been recorded, investigated and the outcome fed back to the complainant.

Staff understood their role with regards to the Mental Capacity Act (MCA) (2005) and the associated Deprivation of Liberty Safeguards (DoLs). The MCA aims to empower and protect people who may not be able to make some decisions for themselves. DoLS are used to protect the rights of people who lack the ability to make certain decisions for themselves and make sure that their freedom is not inappropriately restricted.

There were effective quality assurance systems in place. The registered manager followed a monthly and annual cycle of quality assurance activities. Staff described the management as supportive and approachable.