SENSE 129 Neale Avenue is a ‘care home’ for people with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates up to six people in one adapted residential house in a residential area. At the time of the inspection there were six people living there. 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.

This inspection took place on the 16 and 18 October 2018 and was unannounced. We had previously inspected this service in May 2016, at that inspection the service was rated ‘Good’. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service has a positive ethos and an open culture. The registered manager is approachable, understands the needs of the people in the home, and listens to staff and relatives. There are effective systems in place to monitor the quality of the service and drive improvements.

People are consistently protected from the risk of harm and receive their prescribed medicines safely. Staff are appropriately recruited and there are enough staff to provide care and support to people to meet their needs.

The care that people receive continues to be effective. Staff have access to the support, supervision and training that they require to work effectively in their roles. People are supported to maintain good health and nutrition and live fulfilled lives.

People have developed positive relationships with the staff. The staff are friendly, passionate about their work and caring; they treat people with respect, kindness, dignity and compassion. People have detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

Staff know their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People are supported to use communication aids and information is provided to people in an accessible format to enable them to make decisions about their care and support.

People know how to raise a concern or make a complaint and the provider has effective systems in place to manage any complaints received. Information is available in various formats to meet the communication needs of the individuals.

This unannounced inspection took place on the 30 March 2016.

SENSE - 129 Neale Avenue provides accommodation with personal care for provides accommodation and personal care for up to 6 people with sensory and physical disabilities. There were six people in residence when we inspected.

A registered manager was 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 new manager in post was applying to register with CQC when we inspected.

People were safe. People were cared for by sufficient numbers of care staff that were able to meet the assessed needs of people living at the home. Care staff had received training in areas that enabled them to understand and meet the complex care needs of each person. Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe but also enabled positive risk taking. People were protected by robust recruitment procedures from receiving unsafe care from care staff that were unsuited to the job.

People were safeguarded from physical harm or psychological distress arising from poor practice or ill treatment as care staff understood their responsibilities to protect people from harm. Care staff that knew what action they needed to take if they witnessed poor practice.

People’s care needs had been assessed prior to admission and they each had an agreed care plan. Their care plans were regularly reviewed, reflected their individual needs and provided care staff with the information and guidance they needed to provide person centred care. People were enabled to do things for themselves by friendly care staff that were attentive to each person’s individual needs and understood their capabilities. Care staff encouraged and enabled people to retain as much independence as their capabilities allowed. People’s individual preferences for the way they liked to receive their care and support were respected. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005.

People’s healthcare needs were met and they received timely treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon. People had enough to eat and drink. People who needed support with eating and drinking received the help they required.

People's representatives or significant others, were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

People received care from care staff that were supported and encouraged by the provider, registered manager and senior care staff to do a good job caring for people. The quality of the service provided was regularly audited by the registered manager and the provider and improvements made when necessary.

Our inspection was carried out by one inspector who visited the service unannounced. During the inspection we sought answers to five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found:

The summary is based on our observations during the inspection, speaking with staff supporting people who used the service, the manager and area manager and from looking at records. Because of the nature of the disabilities of people living in the home they were not able to tell us about their experiences. Relatives of two people who used the service gave us their views, which helped to inform our judgement. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by the staff. Relatives of two people told us that they visited the home regularly and found that staff were caring. They had no concerns about the safety of their relation.

Risk assessments were in place which identified any specific risks for people who used the service. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We saw that staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded from unnecessary restrictions on their liberty.

The provider and registered manager carried out regular checks on staff competence and practice to make sure that the care people received was safe. Staff received training in safeguarding vulnerable adults. The registered manager had arranged additional training for staff to make sure their knowledge of safeguarding was up to date.

Is the service effective?

People’s health and care needs were assessed and plans of care developed according to their needs. Information about how people communicated their needs and wishes was clearly identified in care plans which helped ensure that new staff were able to provide appropriate care.

Is the service caring?

When asked if the service was caring, one relative said “we are lucky and couldn’t wish for better”. People were supported by staff that knew them well. Relatives and staff told us that most of the staff had worked at the home for several years. We saw that staff were kind and responsive to people’s needs. Staff were calm and patient and gave people time to express their needs through non- verbal signs and gesture. We saw that people who used the service were relaxed in the presence of staff and responded positively to them. People’s preferences, interests, and diverse needs had been recorded and care and support had been provided accordingly.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Relatives told us that the activities arranged were based on individual needs and interests. Relatives told us that any concerns were listened to, taken seriously and acted on. We saw that staff were available to support people who used the service and that they were responsive to signs that they may need assistance.

Is the service well-led?

We found that the service was well managed and systems were in place to identify and make improvements where necessary. Relatives told us that they had confidence in the manager who acted promptly on any concerns. Staff were supported in their roles by colleagues and managers. They received training; however we found that refresher training had not always been arranged promptly. The manager acted quickly on our findings and implemented systems to identify staff training needs more quickly.

Because of the nature of people's disabilities, we were not able to speak to any people living in the home.

We spoke with the relatives of three people. They told us that they had been fully satisfied with the care their relatives received.

One relative said; ‘staff are brilliant. They are always quick to get the GP involved if needed. The manager is excellent at her job’.

We observed the relationship between staff and people who lived in the home. This was friendly, encouraging and helpful.

This was a positive inspection. All the relatives we spoke with said that they had no concerns. The essential standards we inspected were found to have been met.

As people had communication difficulties, we only spoke very briefly to one person the service they received. She confirmed that she was happy living in the home.

We spoke with five relatives. They were all happy with the support their relatives received. One relative told us the staff were "always friendly and helpful".

Three relatives told us that they were concerned that there did not appear to be the staff numbers available to be able to take people out at weekends. Management may wish to know that in order to fully meet the individual needs of people, more staff are needed to arrange trips out. Management later sent us information to state that staffing levels would be increased.

Another relative said the service should ensure there is a properly operating front door bell so people can be let in quickly and protected from the weather.