This inspection took place on 7 November 2017 and was unannounced. We also visited the home again on 15 November 2017 to look at staff files.

Norwood - 60 Carlton Avenue is registered to provide care and accommodation for up to eight people with learning disabilities. At the time of our inspection, there were seven people using the service.

At our last inspection on 13 and 19 November 2015 we found that the service met regulations and we rated the service as “good”.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. On the day of our inspection we observed that people were well cared for and appeared relaxed and comfortable in the presence of care staff. We saw positive engagement between staff and people using the service. Staff were respectful to people and showed a good understanding of each person’s needs and abilities.

There were systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.

Risk to people who used the service had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Medicines were managed safely and staff were appropriately trained. Appropriate infection control procedures were followed to minimise the risk of spreading infection. Accidents and incidents were documented and audited by the registered manager to find trends and prevent future incidents from happening.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff we spoke with confirmed that there were sufficient numbers of staff to safely care for people.

People’s needs were assessed to ensure that the home was able to provide treatment or care appropriate to people’s needs. Staff were provided with ongoing training and regularly planned supervisions and appraisals ensured their performance was monitored and they were supported to care for people using the service and meet their assessed needs.

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 support this practice. The service operated within the principles of the Mental Capacity Act 2005 (MCA).

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

Suitable arrangements were in place to ensure that the nutritional needs of people were met. People's nutritional needs had been assessed and care workers were knowledgeable regarding the dietary needs of people.

The home had a varied activities programme and each person had their own activities timetable which was devised based on their individual interests. Activities included rebound therapy [this is also known as trampoline exercise therapy which uses trampolines to provide movement, therapeutic exercise an

We found that people who used the service were respected by staff and they were encouraged and supported to be independent. Shopping trips and activities, such as walks and picnics, were arranged for people and we saw that people were encouraged to participate in cooking meals.

People had plans in place that supported their individual care needs. However, we found that these were not reviewed in accordance with the providers own guidelines. Although we felt that people were safe and well cared for, the provider did not have arrangements to always ensure people's safety and welfare in foreseeable emergency situations. The home took into account people's views when arranging care and the decor of their rooms.

The provider had appropriate arrangements in place to ensure that people were safeguarded from the risk of abuse. The provider had policies and procedures in place to identify, assess and manage the risk to peoples general safety and welfare and sought the views of people and their relatives about the service they delivered.

Personal information was kept securely and was appropriate and relevant. The staff were aware of the need to keep personal data secure.

People told us they liked living at the home and relatives said they were always invited to attend people's care plan reviews.

We spoke with one person using the service who told us, "the staff are good here, they help me with cooking cleaning, planning activities and” l am safe here". Other people using the service were not able to verbally communicate but we were able to use communication aids they were familiar with and sign language to obtain their views. People were able to tell us they were happy with the service and were well cared for.

We found that people were engaged in decisions about their care and people had regular reviews that they participated in. The service had developed communication methods so people could actively participate in discussions about their care and about the way in which the service was delivered.

We found that people had comprehensive care plans that identified their health care needs and where there was an identified change in people's needs,care plans were implemented and updated. We found that staff working with people had a good understanding of people's needs and had been appropriately trained to ensure people received effective care in accordance with their care plans.

We looked at the physical environment of the home and found it to be of a good standard. All rooms in the home were clean and appropriate hand gels and soaps around the home to prevent the spread infection. The home had a cleaning rota and domestic staff ensured the home was cleaned on a regular basis.

This inspection took place on 13 November 2015 and was unannounced. We also visited Norwood’s head office on 19 November 2015 to look at staff files. Norwood - 60 Carlton Avenue is registered to provide care and accommodation for up to eight people with learning disabilities. At the time of our inspection, there were seven people using the service.

At our last inspection on 10 and 24 July 2014 the service met the regulations inspected.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. On the day of our inspection we observed that people were well cared for and appropriately dressed. One person who used the service told us they felt safe in the home and around staff. Relatives of people who used the service and one healthcare professional we spoke with said that they were confident that people were safe in the home and around staff.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm. Staff were knowledgeable regarding care issues and the needs of people with learning disabilities. They knew the triggers and warning signs which indicated that people were upset and how to support people appropriately.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff we spoke with confirmed that there were sufficient numbers of staff to safely care for people. The registered manager explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, first aid and moving and handling. Staff demonstrated that they had the knowledge and skills they needed to perform their roles.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people’s needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had made the necessary applications for DoLS and we saw evidence that authorisations had been granted, with the exception of one which the home was waiting for from the local authority.

Food looked appetising and was freshly prepared. and presented well. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented.

There was a homely atmosphere in the home. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

Relatives told us that there were sufficient activities available. Activities available included attending the local leisure centre, going to the library and park. During the inspection we saw some people go out to the local leisure centre and some people getting involved with a sing-along.

The home had carried out a satisfaction survey in 2015 and the feedback was positive. Relatives spoke positively about the registered manager and staff. They said that the registered manager was approachable and willing to listen.

There was a management structure in place with a team of care staff, two assistant managers and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred monthly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a comprehensive quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. The service also carried out spot checks and observations to ensure that the home was running well and that there was good interaction between staff and people who used the service.