This inspection took place on 7 and 22 November 2017 and was unannounced. The previous inspection was carried out August 2015 and there had been no breaches of legal requirements at that time. We had no previous concerns prior to this inspection.

Springbank provides accommodation for up to 11 adults with a learning disability. At the time of our visit there were 11 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

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.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. Information was accessible to help people make decisions and express their views about the service. Staff recognised the importance of effective communication enabling them to respond to people in a person centred way. People were very much involved and included in the running of the service with resident forums being organised. They were consulted about activities and involved in the recruitment of staff. There was a strong emphasis this was people’s home.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Springbank. Staff were proactive in recognising when a person was unwell and liaised with the GP and other health professionals.

The home continued to provide a caring service to people. People, or their representatives, were involved in decisions about the care and support they received. Staff were knowledgeable about the people they supported and very committed to providing care that was tailored to the person. People were treated with kindness and compassion.

People received an exceptionally responsive service. Care and support was personalised and person led. People were supported to take part in a variety of activities and trips out based on their interests and aspirations. End of life care was co-ordinated based on their wishes of the person.

The service was well-led. Relatives and health and social care professionals spoke extremely positively about the commitment of the registered manager and the team in supporting people. The registered manager and provider had monitoring s

This inspection took place on 12 August 2015 and was unannounced. The last inspection took place in April 2014 and no breaches of legal requirements were found at this time.

The home provides care and accommodation for 11 people with a learning disability.

There was a registered manager in place at the home. 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 in the home were supported by safe numbers of staff who were able to meet their needs and support their social activities. Staffing levels were flexible to accommodate the needs of people.

There were risk assessments in place to ensure that staff received guidance in how to support people safely. These were reviewed and updated accordingly when necessary. This included assessing people’s ability to manage their own medicines.

People received effective care that met their health needs. Staff worked with healthcare professionals to ensure that professional guidelines were followed and advice sought when necessary. Staff were aware of people’s nutritional needs and received specialist training to support those who had a PEG (Percutaneous Endoscopic Gastrostomy).

People’s rights were protected in line with the Mental Capacity Act 2005. This is legislation that protects the rights of people’s who are unable to make decisions about their own care and treatment. Where appropriate, applications to deprive a person of their liberty were made to the relevant authority.

People were supported by staff who were kind and caring and treated people with respect. People were encouraged to maintain relationships with people that were important to them.

People were involved in planning their own care where possible and the registered manager reported that they would be looking further at how they could achieve this. The services of an advocate were sought when necessary to ensure that people’s views were listened to and considered.

Staff understood and were responsive to people’s individual needs and preferences. People were able to follow their own preferred routines during the day, for example by getting up and going to bed when they wished. People were supported to follow their particular interests and to find employment if they wished to.

The service was well led by the registered manager. Staff reported feeling well supported and able to raise any concerns or issues.

There were systems in place to monitor the quality and safety of the service. This included a programme of audit that looked at medicines, the environment and people’s care plans.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, talking with four people using the service, the staff supporting them and examining records.

Is the service safe?

The evidence that we saw confirmed that there were systems in place to gain and review consent from people or their advocates; and that their decisions were respected. Where people lacked the capacity to make complex decisions then appropriate others, such as relatives and social and healthcare professionals were involved to ensure people's best interests were considered. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted by Springbank, proper policies and procedures were in place. Relevant staff had received training in relation to DoLS, mental capacity and safeguarding.

We looked at how the home managed medicines and our findings confirmed that systems were in place that ensured people received their medicines when they needed them and in a safe way. We found that people benefited from safe care, treatment and support, due to effective management of risks to their health, welfare and safety.

Is the service effective?

People living at Springbank had varying degrees of learning disability and were not all able to communicate their needs verbally. Staff had got to know people well, how they communicated and the things that they liked to do. People's individual health and care needs were assessed and recorded in support plans, which were regularly reviewed to ensure that they were a current reflection of their needs. Staff were appropriately trained and received good support from the management team in order to carry out their role effectively.

People were supported to access the local community and attend social activities. One person was supported to maintain employment. People were able to access the home's communal areas in order to experience a degree of social interaction.

Is the service caring?

We saw that people were relaxed in the company of staff, who appeared respectful and supportive. One person told us ''Yes, it's alright here'' and a visiting healthcare professional had recorded the comment 'The staff really care about the residents.' A relative had written 'Very friendly staff, lovely homely atmosphere.'

One person was receiving end of life care and staff had been trained in a specialised clinical procedure to meet the person's nutritional needs and provide appropriate support. This meant that the person could remain in their home and be cared for by familiar staff who were aware of their needs.

Is the service responsive?

Staff were aware of changes in people's health and welfare and supported them to access health and social care professionals when needed. One visiting therapist had written 'In a recent situation, staff have been brilliant in staying on top of necessary paperwork and liaison with outside professionals.'

Regular audits were carried out in order to monitor the quality of the service provided. We found that action had been taken in response to the findings of these audits, such as providing extra staff training. The home had a complaints policy and procedure, which included an easy read version. Questionnaires were also sent to advocates in order to gain feedback and where one relative had raised a concern, the manager had responded promptly and had resolved the issue.

Is the service well-led?

The home has a full time manager in place who is registered with CQC. Staff members told us that they felt supported by the manager and her deputy. We spoke to staff members and looked at training records and found that appropriate training was provided that enabled staff to provide support to those living in the home.

Annual appraisals and formal supervision sessions were held, although the latter were infrequent; however staff told us that they were able to speak to the manager at any time in order to discuss issues. Regular staff meetings were held and staff told us that they felt they were able discuss issues openly.

Comments received from advocates and visiting professionals indicated that they were happy with the way the home was managed.

There were nine people living at Springbank at the time of our inspection. People were not able to give us direct feedback about the care and support they received. However, one person chatted with us about a holiday they were due to go on and about some of the things they were supported to buy. We made observations that demonstrated people were happy and settled in the home and received the support they needed. There was a programme of activities in place and people’s views were sought to make sure that the programme met their requirements.

Care was planned and delivered in a person centred way and risks were assessed to ensure people's safety and wellbeing. People were protected from the risks of abuse because staff were trained and knowledgeable about safeguarding and told us they would feel able to act on any concerns if they had them. Information was available for people using the service on what to do if they were unhappy or concerned.

Staffing levels were sufficient to meet people's needs, and staffing levels meant that people were able to be supported to access the community regularly. We viewed rotas to check that expected staffing levels were met.

There were systems in place to monitor the quality and safety of the service and this included providing opportunity for people and their representatives to provide feedback on the support they were receiving.

We met with people who used the service but not everybody was able to express their views about the support that they received. However staff sought to involve people in their care and helped people to make decisions about their daily routines. People’s rights were being protected when they lacked capacity to make decisions about more complex issues.

During our visit, we saw people being offered choices, for example about how they wanted to spend their time and where they wanted to have their meals. One person told us that they liked going out to get a newspaper each day and they also went to a local hairdresser. Staff had got to know people at the home well and knew how individuals liked to be supported.

People received support from staff so that their medication was kept safely and they received it at the right times. Staff worked in conjunction with health care professionals to ensure that people’s individual needs were met.

There was a recruitment process which helped to ensure that new staff were suitable for the work.

We carried out an unannounced scheduled inspection of Springbank on 15 and 20 March 2012.

We spoke with some people who told us they liked living at the home, gave us examples of how they made decisions about their care and confirmed that they were spoken with and treated in a respectful way by the staff.

Some people were unable to tell us about their experiences of living at Springbank due to their individual communication needs. We carried out observations of their care and interaction with staff in the communal areas and we saw that staff engaged with people in a respectful way.

A family member spoke positively about their experience of the home. They told us the home had told them about any changes relating to their relative's care and sought support from them with making decisions about care and treatment