31 Balfour Road is a two story terraced house located in Birkenhead. It is registered to provide accommodation and personal care for up to four people who have a learning disability. At the time of this inspection four people were living at the home.

The house is a traditional terraced house with a front living room, back kitchen with dining area and back yard with seating. There is also an en-suite bedroom located on the ground floor.

Upstairs there are three bedrooms and a shared bathroom with a smaller room used as an office and sleep in room for staff.

At the last inspection, the home was rated good. At this inspection we found the home remained good.

People living at the home told us that they felt safe living there and were confident to raise any concerns or complaints that they had. Concerns raised were listened to and acted upon by staff.

People liked and trusted the staff team who supported them. Staff had a person centred approach to their work and sent time interacting with people and meeting their social needs as well as their care needs.

Robust recruitment checks were in place to check staff were suitable to work with people who may be vulnerable. Staff received training and support to enable them to carry out their role effectively. Sufficient staff were available to provide the support people required.

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 supported this practice.

Support was provided to people to be as independent as possible. This included maintaining daily living skills. People also received support to take part in a number of activities they enjoyed and to occupy their time.

Staff had a good knowledge of individuals and their differing support needs. This was backed up by clear information within people's care plans that provided guidance for staff to follow.

People received the support they needed with their personal care and their health care. Staff worked well with healthcare professionals to ensure people got the support they required.

A number of systems were in place to check the quality of the service and ensure people received a good service. This included a number of ways of obtaining people’s views and acting upon them.

Further information is in the detailed findings below.

The inspection took place on 9 February 2015 and was unannounced. The care home is a domestic style property in a residential area, but close to the centre of Birkenhead. The home is a large terraced property that blends in with its neighbours and is not identified as a care home. On the ground floor there was one bedroom, a comfortable lounge, a combined kitchen and dining room, and a shower room. On the first floor there were three bedrooms, an office, and a bathroom. At the back of the house there was an enclosed yard with a storage shed, plants in pots, and a smoking shelter.

The service is registered to provide accommodation and personal care for up to four people. The people accommodated were women who had a learning disability and/or mental health needs and required 24 hour support from staff. The home is part of the range of services provided by the Wirral-based company Potensial Limited and had a manager who was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

At the time of the inspection, four people lived at 31 Balfour Road and had lived there between two and fifteen years. There was a small team of eight staff, including the manager and a team leader. The staff we spoke with had good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a calm and caring manner.

The staff we spoke with were able to tell us how they ensured that people were protected from abuse. All staff had received training about safeguarding and this was updated every year. There were enough qualified and experienced staff to meet people’s needs.

We found that the home was clean and well-maintained. Records we looked at showed that the required health and safety checks were carried out.

We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People we spoke with confirmed that they had choices in all aspects of daily living. Menus were planned weekly to suit the choices of the people who lived at the home and alternatives were always available.

People were all registered with a local GP practice and had an annual health check. The care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. A 'health action plan' was in place for each person and there was a record of medical appointments people had attended.

People were encouraged to complete satisfaction surveys and we saw that people who lived at the home, staff, and stakeholders had done this. A programme of quality audits was in place to monitor the quality of the service.

Four women lived at the home and required 24 hour support from staff due to learning disability and, in some cases, mental health issues. A ‘health action plan’ was in place for each person and there was a record of medical appointments people had attended. Care records identified people's needs and the support required to meet their needs. Care plans were written in the first person and included details about people’s interests and hobbies. Risks associated with daily living, life style choices and hobbies had been assessed and actions put in place to minimise identified risks. Each person’s care file had a ‘consent’ section which contained a number of forms that had been signed by the person. The team leader told us that all of the people who lived at the home had capacity to make decisions and were able to communicate them.

All parts of the home were clean, tidy and well maintained. People’s bedrooms were furnished and decorated to their taste. Services and equipment were tested and serviced regularly.

The home had a small team of staff who had good knowledge of the support needs of the people living at the home and had attended relevant training. The staff we met had a calm and caring manner.

People were protected from the risks of unsafe or inappropriate care and treatment by a very good standard of record keeping in all areas.

We spoke with all the people living in the home, they told us that they liked living there and liked the staff who worked with them. We saw that service user meetings were held so that people could have input into how the home was organised and ran. One person said, it was the best place they had lived and they felt safe. We found that care plans were person centered and had included the individual in the planning of their care. People living in the home were supported by a staff team who knew them well as they had worked there for many years. Staff told us they received regular support and training to enable them to fulfill their role. There was an effective complaints procedure for service users, families and visiting professionals.

The following information was gained through discussion with relatives / carers of the people using the service, health care professionals and observations made during the visit to the service.

Limited information was obtained from the people living at the home due to communication difficulties. However, people said they like the staff and they got on well together. They said staff are always available and talk to them about how they are each day. One person said ‘The girls are good and kind’. Another person said ‘The staff are lovely’. They said the staff are always available and they would speak to one of the staff if they were unhappy. One person said ‘I would talk to the manager if I was upset or worried’. The people using the service said they are happy with care they receive. One person said ‘I like living here’. Another person said ‘I can watch the television when I want and go to bed when I want’. We observed the way staff interacted with the people using the service. Staff had a friendly and professional manner and the people using the service appeared comfortable in their company.

Relatives of the people using the service said they were very happy with the standard of the care provided. One person said ‘My relative is very well looked after’ and ‘The staff are always professional and friendly’. Another person said ‘This is my sister’s home and she is very happy’. Both relatives said the staff respond quickly to their relatives’ health care needs and the doctor is called when necessary. Relatives said they are always kept informed about their relatives’ welfare. Both relatives are aware of the home’s complaint procedure and neither had seen any signs of abuse or neglect.

The relatives said they are always made welcome at the home. Both said the home is very well managed. One person said ‘The home has very good management’.

The health care professionals spoken to had no concerns to raise about the management of the home or the care of the people using the service. One person said the staff are knowledgeable about peoples’ individual care needs and they are kept informed of any problems that arise. They said their patients appeared well cared for and they had never seen any signs of abuse or neglect. One person said she was very impressed with the way staff had supported her patient. She commented that her patient appeared comfortable in the carers company. She said ‘The carer was lovely and aware of my patient’s care needs’. Another healthcare professional said ‘The manager is excellent and the staff are knowledgably about my client’s care needs’. She said the staff are very thorough and conscientious and always take advice is they are unsure about matters.