Andlaw House is a residential care home for people who are deafblind living in Exeter. The home comprises two flats with separate staff teams. At the time of the inspection there were four people living in each flat. People who live there may also have additional complex and diverse needs, a learning disability, and/or a physical disability. The provider is Sense, a national charity organisation for people who are deafblind. Sense use the term 'deafblind' to cover a wide range of people, some of whom may or may not be totally deaf and blind.

At our last inspection we rated the service 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 ongoing 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.

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Why the service is rated Good with an outstanding rating in caring.

The service provided exceptional ways to enable people to communicate effectively to ensure they were involved in decisions. There was an extremely positive approach to human rights to ensure equality and diversity was embedded into practice. 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.

People were at the heart of the service and supported to make decisions about every aspect of their care and support. Staff were creative and innovative in helping people to express their views and participate fully in the world around them. We observed that staff were kind and patient and treated people with dignity and respect. The service was proactive in ensuring people would be treated and cared for equally regardless of their sexual orientation, culture or religion. People were able to maintain ongoing relationships with their families, who were made to feel welcome and kept fully informed about the wellbeing of their family member.

People remained safe at the service. There were adequate numbers of suitable staff to meet their needs and support them to live their lives as they wished. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People continued to be protected by staff who understood what to do if they suspected anyone was at risk of harm or abuse. People received their medicines safely.

People continued to receive effective care because staff had the skills and knowledge required to support them. Good communication in line with people’s assessed needs was key to the support people received at Andlaw House, and the service was compliant with the Accessible Information Standards. People’s healthcare was monitored by the staff and people had access to a range of healthcare professionals according to their individual requirements .

The service remained responsive to people’s individual needs. Care plans were comprehensive, person centred and easy to follow. This meant they provided clear guidance for staff, enabling them to meet people’s needs according to their preferences. People could choose to participate in a range of activities. There was a clear complaints process in place. People’s end of life wishes had not been documented, but action was being taken to ensure this sensitive issue was discussed with people and their relatives at their annual review.

The service was well led. There had been significant changes at the service since the last inspection. 80 per cent of the staff team had left and the provider and registered manager had been working closely with local authority quality assurance and improvement team to address the issues that had undermined the quality and safety of the service. There had been a change in the culture of the service, which had improv

The inspection took place on 20 and 21 June 2016. It was carried out by one adult social care inspector. Andlaw House is a residential care home for deafblind people in Exeter. The home comprises two flats with separate staff teams. People who live there may also have complex and diverse needs, a learning disability, and/or a physical disability. The provider is Sense, a national charity organisation for people who are deafblind. Sense use the term 'deafblind' to cover a wide range of people, some of whom may or may not be totally deaf and blind.

We visited both flats where seven people lived and received support. We took a British Sign Language interpreter with us and had limited conversations with three of the people living there. Other people did not use sign language or communicate verbally, so we observed their interaction with staff and talked with their relatives and care workers to gain a better understanding of their experience of the service.

The service had a newly 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.

The registered manager was on annual leave during the week of our inspection. We therefore met with the area manager who knew the service well. They told us the ethos of the service was to ensure people were supported to have the opportunity to participate and be active members of the community. They wanted to support people to make choices, build confidence and self-esteem, to be healthy and happy and enjoy life.

At the time of the inspection Andlaw House was in the process of significant change. There had been a high turnover of managers, a restructure in the organisation and policies and procedures had been revised. There had been a stable staff team for a long time but staff told us they were feeling unsupported and concerned by the use of agency staff and changes to the rota system. Managers acknowledged and understood how staff were feeling and were working to address their concerns and support them through the changes.

Policies and procedures were in place to protect people from the risk of abuse and avoidable harm. Staff had received a range of training and information, including safeguarding adults, and they were confident they knew how to recognise and report potential abuse. Safeguarding concerns related to agency staff had been managed appropriately and action taken to minimise risks.

People’s rights were protected, because the service acted in line with current legislation and guidance where people lacked the mental capacity to consent to aspects of their care or treatment.

Systems were in place to ensure people received their prescribed medicines safely. People were also supported to access other health and social care professionals to maintain good health and well-being.

A comprehensive induction and training programme aimed to develop and maintain staff’s skills and knowledge, and to meet people’s individual needs. Additional training was being planned in response to the changing needs of the people using the service. Staff received regular one-to-one supervision and attended monthly staff meetings. They were kept informed and up to date via staff publications, briefings and Sense’s intranet site, where there was an area dedicated to practice sharing and recognising best practice.

Several members of staff had worked at the service for many years, which meant they were extremely knowledgeable about people’s individual needs and preferences. The area manager told us,” The level of care the team offer to those with complex health needs in my opinion is admirable, and they are responsive to any small changes in health to ensure the best support and care is given”.

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There were seven people living in the home on the day of the inspection. We met all seven of the people living there and spoke with four people. To assist our communication with people in the home we took a British Sign Language interpreter with us as most people could not communicate verbally. We also spoke with two family members after our inspection of the home to gain their views about the care provided.

We observed people's care and staff interactions in the communal areas of both flats. We spoke with seven staff about people's care needs and looked at four people's care records. We talked with staff about their development and support needs and looked at the training records for all staff employed in the home.

One person told us about their recent trip to a music concert held locally and also about performing in a music event. It was clear from their smiles, gestures and the photographs they showed us that it had been a very positive experience for them. Two of the people in the home were going away on a camping holiday on the day of our inspection, staff told us of the detailed preparations they had made to ensure the trip went smoothly.

Throughout the home, we observed how staff demonstrated positive regard for people, offered person centred care, praised people for their achievements and supported them to fulfil their potential and be as independent as possible. People’s privacy and dignity was respected both within the home and whilst out in the community.

We found that the home was clean and met the guidance standards for hygiene and infection control. The provider had appropriate quality assurance processes in place to ensure that the service was maintained and improved and standards of care were maintained.

We carried out an inspection of Andlaw House to review improvements on the compliance actions we issued following our inspection of this care home on 13 March 2012 in relation to management of medicines, supporting workers and quality monitoring. There were seven people living in the home on the day of the inspection.

We met six of the people living there and spoke with one person. Several people could not communicate with us so we observed people's care and staff interactions in communal areas of both flats. We spoke with seven staff about people's care needs, looked at three people's care records. We talked with staff about their development and support needs, and looked at training, appraisal and supervision in six staff records. One person told us about their recent trip to the paralympics. It was clear from their smiles, gestures and the photographs they showed us that it had been a really special experience for them. Staff we spoke with told us of the detailed preparations they had made to ensure the trip went smoothly. Throughout the home, we observed how staff demonstrated positive regard for people, offered person centred care, praised people for their achievements and supported them to fulfil their potential and be as independent as possible.

We found the required improvements had been made and the provider was compliant with the five standards we inspected.

We (the Care Quality Commission) carried out an unannounced inspection on 13 March 2012 at Andlaw House, Exeter. The home was divided into two flats with separate staff teams. We spent a day at the service and met six of the people who lived there. We talked to five care workers and the registered managers of both flats about how they met people’s needs. Some of the people we met were unable to communicate with us so in order to help us to understand the experiences of people who lived there we were accompanied by an expert by experience. This is someone who has personal experience of using or caring for someone who uses a health, mental health and/or social care service.

We also used our Short Observational Framework for Inspection (SOFI) tool. This tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they get and whether they had positive experiences.

We spoke to two health professionals who visited Andlaw House regularly to support staff with a number of people with health care needs. One said that staff at Andlaw house were “brilliant”. They told us how they were always made to feel welcome when they visited and described the atmosphere in the home as “lively and happy”.

We found that care workers treated people with dignity and respect and had a detailed knowledge about people’s care needs.The home undertook monthly meetings with key workers and individuals (as appropriate to their abilities) to be involved in planning their care for the forthcoming month. This included planning activities, reviewing care and health needs and making any changes required.

We observed staff interactions with people and saw that people’s views were listened to, respected and were supported to be as independent as possible. One person told us how they look after their own room, tidying up and cleaning it but sometimes asked for help. They said “sometimes I am lazy, staff do my ironing for me”.

We heard how several people enjoyed using the hot tub situated outside on the balcony throughout the year. Everyone who lived at the home was supported to go on holiday regularly and to keep in touch with friends and family members.

Care workers knew how to safeguard vulnerable adults from abuse and appropriate policies and systems were in place to support this. Where significant decisions needed to be made about people’s care, we saw that family members and other health professionals were consulted about making a decision in that person’s best interest.

Andlaw House had detailed risks assessments to minimise the risks to people and keep them safe, some of which were overdue for review. We identified that monthly health and safety systems had lapsed in recent months. We also identified safety and security of medicines management as an area for improvement. We found that not all care workers staff had the opportunity to receive regular supervision and annual appraisal, as several were overdue.