The inspection took place on the 12 and 13 May 2016 and was unannounced. Rawlyn House provides care and accommodation for up to 16 people with learning disabilities. On the day of our inspection 15 people were living in the service. Rawlyn House is divided into two separate buildings. The main house provides accommodation for ten people. The other unit is purpose built and accommodates six people who require wheelchair access.

The service had a registered manager in post. 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. The service had two registered managers, both working in the service most days.

We met and introduced ourselves with 14 people during our visit. Due to their complex needs people were not able to comment on all aspects of their care and support. However we were able to meet them and observed staff as they provided support. People used other methods of communication, for example pictures. A relative said; “I’m very impressed with the care.” A survey stated; “Very impressed with the quality of care you provide.”

The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. The interactions between people and staff were positive. We heard and saw people laughing and smiling. People looked relaxed and were observed to be happy with the interaction between them and the staff supporting them. Care records were detailed and personalised to meet each person’s needs. People and/or their relatives were involved as much as possible with their care records to say how they liked to be supported. People were offered as much choice as possible and their preferences were sought and respected. Care records were focused on giving people control and encouraging people to maintain their independence. Staff responded quickly to changes in people’s needs, for example if their behaviour changed. People’s life histories, disabilities and abilities were taken into account, communicated and recorded, so staff provided consistent personalised care, treatment and support.

Due to people’s learning disability we saw a range of personalised communication methods and tools being used to support people. Communication aids were specific to people’s needs and were detailed as part of their support plan. We saw that people used this information and referred to these visual prompts to assist them when performing a certain activity or planning their day. We saw many examples of how the staff had really thought about people’s communication needs and ensured they were not a barrier to them achieving their goals and aspirations. We saw people being supported to use their individual communications methods and tools to help reduce anxiety and have greater control about their care and lifestyle.

People were supported to maintain good health through regular access to health and social care professionals, such as epilepsy nurses. Staff acted on the information given to them by professionals to help ensure people received the care they needed to remain safe.

People’s medicines were managed safely. All medicines were locked away. There were medicines policies and procedures in place. However, medicines audits completed had not picked up some minor issues. Action was taken on the day to update records and prevent reoccurrence.

People’s health and well-being needs were well monitored. The registered managers and staff responded promptly to any concerns in relation to people’s health and also encouraged people to attend health checks recommended for their age group and gender. People enjoyed the meals offered and had access to snacks and drinks at any time. People were involved in food shopping, planning a

There were 16 people with complex needs who used the service on the day of our visit; ten people lived in the main house and six people lived in the adjoining lodge. None of the people who used the service were able to communicate verbally; some people had profound and multiple disabilities. We observed that staff respected people’s privacy and dignity during the inspection, through the way staff knocked on doors before entering rooms, spoke with people and assisted them with their care needs. Staff we spoke with were able to give examples of how they promoted and ensured dignity and respect for all people.

We watched the interaction between the staff on duty and people living in the home. People appeared very relaxed in the company of the staff and there was a good rapport between them. Staff were offering people choice, encouraging them to undertake tasks independently where possible and supporting them where needed.

Staff were observed working in a calm, unhurried way and knew the communication needs of people, responding to gestures and limited verbal responses. Staff we spoke with explained the various techniques people used to communicate, including body language and verbal responses. Staff spoke to people before doing anything, explained what was happening around them and made sure that people were safe as they walked around.

None of the people who lived at this home were able to verbally communicate with us. We observed staff and residents interacting in a relaxed, friendly manner. Staff were aware of how to meet people's specific needs. For example staff respected some people’s need for wide personal space and responded to other people’s need for reassurance given in close proximity. People who lived at the home engaged in activities in the home and in the community, including music, horse riding and swimming.

Relatives of people who lived at the home were all very positive about the care the home provided. They felt their family member was safe and well cared for. Relatives told us that that they were involved in discussions and decisions about care. One person said “We talk it through together. They value my experience.” Another person told us, “We are always kept informed of what is happening. I have been really impressed with the care”.

Health professionals who visited the home regularly told us that they observed good care by staff. When health professionals gave feedback to the home they responded to it. Staff at the home were positive about their work. They felt well supported by the management at the home and confident that they could get advice and support. Staff were supervised and supported well on a day to day basis. An appraisal system was being developed. Staff had identified additional training that would be beneficial and the home were responding to this.