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.

Smythe House provides accommodation and care for seven people. This is a service that specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS). This is a genetic condition that predominantly manifests with early years onset of hyperphagia which is an abnormal unrelenting great desire for food driving the person towards excessive eating and, left unchecked, life threatening obesity. Other characteristics of PWS include, for example, learning disabilities that may range in severity. There were six people in residence when we inspected.

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 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 met all relevant fundamental standards related to staff recruitment, training and the care people received. People’s care was regularly reviewed with them so they received the timely care they needed. 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.

Staff were friendly, kind and compassionate. They had insight into people’s capabilities and aspirations as well as their dependencies and need for support. They respected people's diverse individual preferences for the way they liked to receive their care and participate in activities they enjoyed.

The goal of the provider was to enable people with PWS to make positive life changes and the staff team were successful in to supporting each individual to achieve this.

People’s healthcare needs were met. They had access to community based healthcare professionals, such as GP’s and nurses, and had regular check-ups. They received timely medical attention when needed. Medicines were safely managed.

People's individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals with expertise in PWS. People were supported to have a balanced diet and they had enough to eat and drink.

The provider and registered manager led staff by example and enabled the staff team to deliver individualised care that consistently achieved good outcomes for all people using the service. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong so that the quality of care across the service was improved.

This unannounced inspection took place on 6 January 2016. Smythe House is registered to provide accommodation and personal care for up to 7 people and there were seven people living at the home at the time of this inspection The service specialises in providing support for people living with Prader-Willi Syndrome (PWS) This is a condition where people have a chronic feeling of hunger that can lead to excessive eating and sometimes life threatening obesity.

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.

People felt safe in the house and relatives said that they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

Staffing levels ensured that people received the support they required at the times they needed it. The recruitment practices protected people from being cared for by staff that were unsuitable to work at the service.

Care records contained individual risk assessments to protect people from identified risks and help keep them safe. They provided information to staff about actions to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were in place detailing how people wished to be supported and wherever possible people were involved in making decisions about their support. People participated in a range of planned activities in the community and received the support they needed to help them to do this.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed.

Wherever possible people were actively involved in decision about their care and support needs. Where required there were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people who lived at the house. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people living in the house were confident that any concerns they had would be listened to.

The registered manager was visible and accessible and staff and people had confidence in the way the service was run.

We spoke with six people living in the home at the time of the inspection. They all told us that care was good and staff were friendly and helpful.

A person told us that staff were there to help her when she had needed them. She said; ‘’staff here are all good’’.

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

One relative said; ‘’Staff are all excellent. They know how to work with my son’’.

We observed the interaction between staff and people who lived in the home. This was carried out in a friendly way. We saw that staff were interested in asking people about what they had been doing activities that day.

This was a generally positive inspection. People we spoke with told us they were satisfied with the care provided. All their relatives we spoke with also said that they had no concerns. The essential standards we inspected were found to have been met.

There were some suggestions made; for the amount of paper work staff had to do, to be cut down so that they had more time to spend with people; for the holiday that had been largely provided by the company to be reinstated, and for front windows to be replaced by double glazed windows so that bedrooms were always warm enough for people.

We spoke with six people who lived in the home at the time of the inspection. They said that they were satisfied or mainly satisfied with the care that they received.

A person told us that staff were helpful; ‘’staff will make time for me‘’.

Of the six people we spoke with, two people said that some staff were very friendly and helpful. However, other staff could sometimes be curt to them.

We spoke with five relatives. They all told us that the care staff provided was of a high standard.

One relative said; ‘’staff are friendly and professional’’.

We received a small number of comments of concern: there was too much paperwork for staff to complete which took them a way from spending time with people.

Two people said that they were often not warm enough, as there were old windows to the front of the house that let in cold drafts.

One relative said that she thought there was too much pressure exerted by staff, for people to have relationships, rather than being friends.

This was generally a positive inspection. People living in the home and their relatives said that they were satisfied or mainly satisfied with the care they were supplied with. Most essential standards inspected were met. However, not all standards had been fully followed up from last inspection. Heating levels prevented some people from being warm. Also, that some issues identified in quality assurance checks had not been fully followed up.

We were accompanied on this visit by someone called an expert by experience. An expert by experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service. We take an expert by experience to inspections so they can talk to the people using the service to help us gain a good understanding of the experience people have in living there.

The expert by experience spoke with four people who live in the home. We also spoke with three relatives about their views of the care provided.

The people the expert by experience spoke with all said that they were satisfied with the home’s care. Staff were seen as friendly and caring. There were only a small number of issues they had. These concerned new mattresses being too hard and curtains letting light in which disturbed some people's sleep because the curtains were not thick enough. One person also did not know how to make a complaint.

One person said: ‘’ I have lived here a long time. This is my home and everything about it is good.’’ Another person said: ‘’Staff always have time to help you if you need them.’’

Their relatives all praised the service: '’Staff could not be better’’. ‘' All staff are friendly and approachable’’. ‘’Staff always inform me if my son is unwell or goes to a medical appointment.’’