The inspection took place on 30 October 2017. The inspection was unannounced.

Middleton Avenue provides care for people with physical and learning disabilities or broad spectrum autism. The service is located in a purpose built bungalow in a residential area of Thornaby. The service is registered to provide support to six people and on the day of our inspection there were five people using the service.

The service had a registered manager in place. 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. On the day of our inspection the registered manager was on annual leave and another manager from a neighbouring Mencap service was made available to assist us with our inspection.

We last inspected the service in August 2015 and rated the service as ‘Good.’ and ‘Outstanding’ in responsive. At this inspection we found the service remained ‘Good’ overall and had sustained ‘Outstanding’ in responsive.

The atmosphere of the home was very homely, warm and welcoming. People who used the service were relaxed in their own home environment.

Without exception people were continually empowered on a daily basis to have choice and control over their own lives from being supported by sustained person centred approaches. Person centred care is when the person is central to their support and their preferences are respected.

The home continued to sustain their ability to be extremely person centred and inclusive and this was by offering intense one to one support where needed, adapting situations to suit people while being creative and this was underpinned by a genuine desire to offer a quality personalised service.

People were continually empowered to forward plan and were also supported to achieve personal goals in their lives that contributed to improving their mental health, wellbeing and general health that lead to an enhanced quality of life.

We spent time observing the person centred support that took place in the service. We saw that people were always respected by staff and treated with upmost kindness. We saw staff being respectful, considerate and communicating exceptionally well with people and supporting people who were distressed.

People’s support plans were exceptionally person centred. They included targets that people wanted to achieve and a ‘one page profile’ that referenced people’s personal histories and described their individual support needs. These were regularly reviewed and people were always at the centre of the process.

People were empowered on a regular basis to shape the service they received to meet their needs and their preferences and responsive changes were made when needed.

People were supported to play an active role within their local community by making regular use of local resources including the local park.

Support plans contained person centred risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm to enable them to do the things they wanted to live their lives fully. The support plans we viewed also showed us that people’s health was monitored and referrals were made to other health support professionals where necessary, for example their GP, community nurse or optician.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

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 servi

The inspection visit took place on the 4th August 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service in 2013 and found the service was not in breach of any regulations at that time.

71 Middleton Avenue provides care and support for up to six people who live with a learning disability. The home does not provide nursing care. The detached bungalow is situated in Thornaby, close to all amenities and transport links.

There is 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 spoke with three people who lived at the home who had a range of communication skills, people had some verbal communication whilst other people used signs or gestures which staff interpreted. Two people were out at their day activities during the course of our visit and one person was experiencing anxiety difficulties so we did not seek their views. Comments we received included; “I like it here” and “I like my room.”

We observed people were encouraged to participate in activities that were meaningful to them. For example, one person had gone shopping and to collect some professional photographs they had taken.

We found there were policies in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and staff were fully aware of what these meant and the implications for people living at the service. All paperwork in relation to the six authorisations for people were in place and were well managed to ensure any updates or new renewals were flagged up as requiring action before they expired. People also had best interests decisions in place and these had been undertaken with the person and others close to them such as family and other professionals. This meant peoples’ rights were upheld.

There were some areas of the service that required decorating and the registered manager informed us they had gained funding to do this. Staff told us about how they planned to involve everyone who used the service in making choices around this décor.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as positive behaviour support. There were sufficient staff on duty to meet the needs of the people and the staff team were very supportive of the registered manager and of each other.

Medicines were stored and administered in a safe manner although the service was working with their pharmacy provider to address some concerns they had around the blister packs system the pharmacy provided.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify and support their personal and professional development.

We saw people’s care plans were person centred and had been well assessed. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the service, from going to day services to helping plan the décor. One person had recently transitioned into the home and we saw this had been planned and assessed so it was as smooth as possible.

The service was exceptional in enabling people to maintain their independence. The service was using innovative programmes to support people into the community via an awards scheme and staff were also encouraged to develop themselves personally and professionally. The service actively supported people to be involved in the local community as much as possible and were supported to use public transport and accessing regular facilities such as the local G.P, shops and leisure facilities.

We also saw a regular programme of staff meetings where issues where shared and raised and staff told us how they felt supported and supported each other well. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people and have developed and sustained a positive culture. Staff told us how they felt valued and had been given opportunities to develop themselves within the service such as delivering coaching and training.

We carried out this inspection because the last time we inspected 71 Middleton Avenue we identified some concerns with the standard of record keeping. There were gaps in the daily records and some care plans had not been reviewed regularly. At this inspection we found that care plans had been reviewed regularly and amended when the needs of people had changed.

We spoke with two members of staff about the care and support people needed. What they told us accurately reflected what was written in the care plans. We also observed the people who lived at the service, and care plans accurately reflected their behaviours and needs.

We did not speak with people who used the service. This was because the majority of people who used the service were unable to communicate verbally or did not wish to talk with the inspector at the time of the visit.

We were able to speak with two relatives. One person told us that they were happy with the care their family member was receiving. They said that they had noticed a difference in their relative who seemed to have “flourished since he moved to Middleton Avenue”. Another relative told us that each time they left their family member, they felt reassured that they were leaving them in safe hands.

We spent time with all of the people using the service. Most people experienced significant difficulty expressing their opinions and talking about complex ideas such as their opinion on staff behaviour so we also observed how staff interacted with people. Throughout the visit we saw staff include people in their conversations and discuss what was happening both in the home and in general. There was a sense that the home operated like a family setting and all of the people were valued and cared about. One person did tell us they liked the home and the staff. They talked about activities they did and what they did during the day. They said they were happy at the home. Overall staff were seen to be respectful towards people and constantly endeavoured to retain people's dignity and our observations showed care was delivered in a sensitive, caring manner and with a genuine sense of warmth.

During our visit we spoke to one person who told us they enjoyed making cakes and choosing what they ate. However, the majority of people who used the service were not able to verbally communicate or did not wish to talk with the inspector at the time of the visit.

Interactions between staff and people who used the service were observed as part of the inspection.

People who used the service were either unable or unwilling to express their opinion to us because of their physical and mental health conditions however we observed that they were content and on the whole appeared to be relaxed in the company of staff. We also observed that they received care in line with their support plans.

Care records were detailed, reviewed regularly and contained enough information to ensure that people were safe and received the care and support they needed in the way they preferred.

There was evidence that people who used the service received coordinated care because there were good channels of communication between staff and other professionals involved in their care and support.

The provider had taken appropriate action to protect people from the risk of abuse and there were policies and systems in place to support people who used the service and staff should any concerns be raised.

The provider had an appropriate recruitment system in place that made sure people were supported by staff who had the appropriate skills and knowledge to meet their needs.

There were quality assurance systems in place that made sure people who used the service were able to express their opinion of the care they received. Additionally, quality assurance checks were carried out regularly by the manager to identify any areas for improvement. We saw evidence that accidents and incidents were learned from and action taken to reduce the risk of recurrence.