About the service: Our House is a residential care home for people with a learning disability and/or autism. The service also provides respite care. The care home accommodates a maximum of eight people with learning disabilities and/or autism. At the time of inspection four people were living at the service permanently. On the first day of the inspection two people were staying at the service for respite care. The accommodation included a self-contained flat which could be used by people who were more independent. All rooms were en-suite.

People’s experience of using this service:

¿ Staff told us the service was well managed and the management team was approachable. Changes to the management structure were planned and the registered manager had taken a step back. The deputy manager was overseeing the service on a day to day basis with a view to taking over the registered manager position in the future. They had completed the relevant training and told us they were well-supported by the registered manager who was always available for advice and support.

¿ The registered manager was continuing to work at the service two days a week on opposite shifts to the deputy manager to help ensure a manager was always available. They also worked additional shifts to support the running of the service and the deputy manager. The rest of the week they were based in an office away from the service to enable them to concentrate on paperwork and updating records associated with the management of the service.

¿ One person was having medicines administered without their knowledge or consent. The correct processes had not been followed to ensure this was proportionate, necessary and safe. Policies and procedures were not regularly reviewed. Please see the action we have told the provider to take’ section towards the end of the report.

¿ Systems for the management of medicines were not robust, we discussed this with the management and they took action to address the concerns.

¿ The registered manager had failed to notify CQC of a specific event and we have made a recommendation about this in the report.

¿ There were enough staff to meet people’s diverse needs and preferences. Staff were flexible when organising the day to enable people to take spend time doing things they enjoyed and mattered to them. Staff told us they worked well together and with the management team.

¿ The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service were able to organise their daily routines in a way which suited their own preferences. Adaptations to bedrooms enabled people to have privacy and spend time alone if they wished. People were supported to have choice and control in their lives and staff supported them to do this.

¿ People’s preferred ways of communicating were well known to staff. Staff and people engaged with each other and we observed this was meaningful and positive. People were comfortable approaching staff and frequently entered the office to speak with staff. This was clearly something they were used to doing.

¿ The management team were open and responsive when concerns identified during the inspection were highlighted. They told us they were keen to make improvements and some changes were immediately implemented following the first day of the inspection.

Rating at last inspection: At the previous inspection the service was rated Good. (Report published 5 January 2018)

Why we inspected: This inspection was brought forward due to information of concern received by the Care Quality Commission (CQC). The concerns were around the management and oversight of the service. The registered manager had taken a step back from the day to day running of the service and

This announced comprehensive inspection took place on 18 December 2017. The last inspection took place on 9 & 13 October 2015 when the service were meeting the legal requirements. The service was rated as Good at that time. Following this inspection the service remains Good.

Our House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Our House provides accommodation, support and personal care for up to eight adults with learning disabilities, moderate to severe autism, communication difficulties and/or mental health conditions. At the time of the inspection four people were living at the service. The service also provides a respite care service. People accessed this service on a regular basis, when we visited two people were using the respite service.

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.

We spent some time talking with people and staff. Staff were respectful and caring in their approach. They knew people well and had an understanding of their needs and preferences. Staff supported people to take part in a range of meaningful activities. There was an evident person-centred approach to supporting people. The registered manager and deputy manager had a clear set of values and these were known and shared by the wider staff team.

Risks to people’s safety and well-being were clearly identified and well managed. Staff used risk assessments to enable people to live full and meaningful lives. Staff were confident about providing support at any time including any period when people were distressed.

People received their medicines as prescribed. They were supported to understand what medicines were for and the consequences of not taking them. Systems for recording and auditing medicines were not robust. We have made a recommendation about this in the report.

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.

Care plans identified people’s communication needs and this was shared with other agencies when necessary. Where necessary, communication tools were used such as sequence strips and easy read information.

Staff understood the Mental Capacity Act and associated Deprivation of Liberty safeguards. Any restrictive practices in place to keep people safe were regularly reviewed to ensure they remained the least restrictive option. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Some people were able to make decisions about how they lived their life. Others lacked the capacity to make some decisions and this was done on their behalf and in their best interest. Written documentation around decision making was not always available. We have made a recommendation about this in the report.

The registered manager took an active role within the home. Staff told us they were approachable and available for advice and support. There were clear lines of accountability and res

This inspection took place on 9 and 13 September 2015 and was unannounced.

Our House provides accommodation, support and personal care for up to six younger adults with learning disabilities, moderate to severe autism, communication difficulties and mental health. Some people receive continuous one to one support from staff and needed to be supervised whenever they went out. Our House was registered with the Care Quality Commission in February 2015. At the time of our inspection two people were living at the care home.

The home was on one level. Bedrooms have en-suite facilities and patio doors which open out onto a garden area. There is a shared toilet. Communal areas include a kitchen, dining room, two lounges, garden and outside seating area. Work was in process to develop an art room, and a games and computer room.

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.

People told us and we observed staff were kind and caring. People were treated with dignity, respect and their independence was promoted. There was enough staff to meet people’s needs and people who required a specific number of staff to support them, received this. People received care from staff who had previous experience and a qualification relating to their role. Staff received training and ongoing support. Staff were encouraged to follow their interests and empowered to develop their knowledge base.

People were encouraged to be independent with meal preparations. People ate and drank enough and maintained a balanced diet. People, who required assistance, were supported with dignity and their involvement valued. People’s care plans provided details to staff about how to meet people’s individual nutritional needs.

People felt safe living at Our House. The registered manager and staff understood their safeguarding responsibilities. People were protected by safe recruitment procedures as all employees were subject to necessary checks which determined they were suitable to work with vulnerable people.

People were protected from risks associated with their care because staff had guidance and direction about how to meet people’s individual care needs. Staff, had policy and procedures in place to respond to emergencies relating to people’s care and were confident about the action they would take. The environment was regularly assessed and monitored to ensure it was safe at all times.

People’s mental capacity was assessed, which meant care being provided by staff was in line with people’s wishes. The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which protected people to ensure their freedom was supported and respected.

People were encouraged to maintain and develop relationships with friends and families. People were also supported to be part of the community, participate in social activities and to develop their skills and knowledge. People had care plans in place to address their individual health and social care needs. People were involved in the creation and review of their care plan. People’s medicines were managed safely.

People’s confidential and personal information was stored securely and the registered manager and staff were mindful of the importance of confidentiality when speaking about people’s care and support needs. People had a lock on their bedroom door to protect their privacy and the security of their belongings.

The environment was designed to empower people living with learning or physical disabilities. People’s bedrooms were personalised. People were protected by effective infection control procedures.

People knew who to speak with if they had any concerns or complaints. People felt confident their concerns would be addressed. Staff felt the registered manager was supportive. Staff felt confident about whistleblowing and told us the registered manager would take action to address any concerns. The registered manager took an active role in the running of the service. In the absence of the registered manager, there was a deputy manager who took responsibility. People and staff were aware of the management structure and who to speak with.

The registered manager had systems and processes in place to ensure people received a high quality of care and people’s needs were being met. There were opportunities for people to provide their feedback about the service, to help ensure the service was meeting their needs as well as assisting with continuous improvement. External professionals were complimentary of the recently registered service, the registered manager and of staff. Words such as “enthusiastic”, “positive” and a “refreshing approach” were used to describe the provider and the management of the service.