We carried out this announced inspection on 15 September 2017. We gave the service a short period of notice. This was because the people who lived there had complex needs for care and benefited from knowing in advance that we would be calling.

SENSE – 54 Monks Dyke Road is registered to provide accommodation and care for six people who have a learning disability and/or a sensory disability. It can also accommodate people who live with a physical disability. At the time of our inspection visit there were four people living in the service. Some of the people lived with reduced sight and/or hearing. In addition, all of them had special communication needs and used personal forms of sign assisted language.

The service was run by a charitable body that was the registered provider. 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. In this report when we speak about both the charitable body who ran the service and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 24 September 2015 the service was rated, ‘Good’.

At this inspection we found the service remained, ‘Good’.

Care staff knew how to keep people safe from the risk of abuse including financial mistreatment. People had been supported to take reasonable risks while also being helped to avoid preventable accidents. Medicines were safely managed and there were enough care staff on duty. Background checks had been completed before new care staff had been appointed to ensure that they were suitable people to be employed in the service.

Care staff had received introductory and on-going training. In addition, they had been given guidance and they knew how to care for people in the right way. People enjoyed their meals and were supported to eat and drink enough. In addition, they had been helped to obtain all of the healthcare assistance they needed.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People were treated with compassion and respect. Care staff recognised people’s right to privacy and promoted their dignity. People had been supported to access independent lay advocates when necessary and confidential information was kept private.

Care staff had involved people and their relatives in making decisions about the care that was provided. People had been supported to be as independent as possible. In addition, they had been helped to pursue a wide range of hobbies and interests. There were arrangements for quickly and fairly resolving complaints.

People had been consulted about the development of their home and quality checks had been completed. Good team working was promoted and care staff had been enabled to speak out if they had any concerns.

Further information is in the detailed findings below.

This was an announced inspection carried out on 24 September 2015.

SENSE – 54 Monks Dyke Road can provide accommodation and personal care for up to six people who have a learning disability and who live with reduced vision and hearing.

There were six people living in the service at the time of our inspection.

There was a registered manager. 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.

Staff knew how to recognise and report any concerns so that people were kept safe from harm. People were helped to avoid having accidents. Medicines were safely managed, there were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received the training and guidance they needed to assist people in the right way including helping them to eat and drink enough. People had received all of the healthcare assistance they needed. Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had consulted with the relevant local authorities to ensure that people only received lawful care and that their rights were protected.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

People had received all of the care they needed including people who had special communication needs or who could become distressed. People had been consulted about the care they wanted to receive and they were supported to celebrate their diversity. Staff had offered people the opportunity to pursue their interests and hobbies and there was a system for resolving complaints.

Regular quality checks had been completed and people had been consulted about the development of the service. The service was run in an open and inclusive way and people had benefited from staff receiving good practice guidance.

We saw records of reviews of care plans every two months. This protected people living at the home from harm by ensuring each care plan was current and still relevant to people’s individual needs.

People’s rooms were personalised and people were surrounded by their own possessions. We saw people attended a local day centre during the week. They also had home days were they would receive one to one attention from a member of staff.

Each person’s care plan contained a food and fluid log which we saw was completed at the same time people were eating and drinking. We saw one person’s eating and drinking support plan contained information about how the person would communicate to the staff that they wanted a drink. It said, “XXX shakes his beaker to communicate that he would like a drink.”

We looked around the home and observed a high standard of cleanliness. We saw people’s rooms were clean and communal areas were clean and tidy.

Our conversations with staff showed infection control was given a high priority and there were clear procedures to follow. Members of staff told us they had the personal protective equipment (PPE) they needed. We observed staff wearing appropriate clothing when undertaking care and cleaning tasks.

We were able to confirm levels of staffing were based upon levels of occupancy and the dependency of people living at the home. The registered manager told us the home did not use agency staff routinely.

At our last inspection 23 August 2012 we reviewed three care plans and were unable to find adequate and appropriate risk assessments in a number of cases.

We viewed other risk assessments that stated they had been reviewed each month. There was no evidence of what evaluation took place, how the risk assessment had been changed, or, how it related to the care plan. The absence of a risk assessment posed a risk to the person's welfare and that of staff.

At this inspection we saw all care plans had been reviewed and updated. Each care plan now included relevant and appropriate risk assessments.

We saw the registered manager had put a new care plan and risk assessment evaluation system in place. We were shown new forms placed in each person’s file which required members of staff to write an evaluation of each section of the care plan and each risk assessment every month.

People told us that they like living in the home and they like the staff. One staff member said, "We know the residents very well indeed." When one member of staff told us about how they communicated effectively, they said, "We use objects of reference. With xxxx we show him a coat when asking him if he wants to go out."