St Anne’s Community Services – Greenacres is a residential care home and provides support for up to five people with learning disabilities. 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.

The service is provided in a large bungalow and located on a residential road close to a range of community amenities and facilities in Ripon. At the time of our inspection there were four 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.

A registered manager was 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.

At our last inspection we rated the service as 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.

People were protected from abuse as staff understood how to recognise the signs and report concerns. Staff were recruited safely and people were supported by enough staff to meet their needs. People had their medicines as prescribed and these were managed safely. The provider had systems in place to learn when things went wrong.

Risks to individuals had been assessed and were regularly reviewed. They provided staff with guidance on how to manage identified risks to ensure people's safety. When accident and incidents occurred, these were recorded and investigated by the registered manager to prevent similar incidents reoccurring. The service ensured that people received effective care that met their needs and wishes.

People were protected from discrimination and harassment. Staff had received training and were aware of their responsibilities to ensure people were not disadvantaged because of their disability. People are 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 supported to eat a well-balanced diet and make healthy eating choices. The service responded quickly to people's changing needs and appropriate action was taken to ensure people's wellbeing was protected.

The provider had a complaints policy in place and the registered manager and staff knew what they should do if anyone made a complaint.

There were regular opportunities for people, relatives and staff to give their feedback on the service and the provider had systems in place to monitor the quality of people's care and make improvements.

Further information is in the detailed findings below.

The inspection took place on 21 January 2016 and was unannounced. At the last inspection on the 25 June 2014 the service was meeting all of the regulations we looked at.

Greenacres is registered to provide residential, personal and social care for up to five people with learning disabilities. Greenacres is a large detached bungalow a main road outside of Ripon. The immediate local area has a number of services and amenities. The registered provider is St Anne’s Community Services.

At the time of our inspection there were five people living there.

The service had 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.

People were provided with safe care and support. Staff understood the needs of people who lived at the service. They told us about the risk assessments and risk management plans which were in place to support people to stay safe. These were detailed and person centred. Where appropriate they had been developed by the service and supporting health and social care professionals.

There were sufficient staff to meet people’s needs. The service had a stable staff team and they did not have any vacancies. The registered manager told us they did not use agency staff which ensured people had continuity for their support.

Medicines were safely managed. The service reviewed accidents and incidents to make sure action had been taken to keep people safe. Staff we spoke with were able to tell us about the procedure they would follow if they had any concerns about suspected or actual abuse. The service had an up to date safeguarding and whistleblowing policy to support staff.

Staff were supported to deliver effective care. There was access to regular training and we were told staff received a thorough induction which they found helpful.

The service worked within the principles of the Mental Capacity Act (2005). Staff and the registered manager demonstrated a good understanding of the legislation and we saw consent was sought routinely throughout our visit. People were supported to make their own choices.

People told us the food was good, meals were varied and nutritious and people were involved in the planning and shopping for meals. We did not see any concerns regarding weight loss or gain.

The service ensured people had access to routine and more specialist healthcare as required. Each person had a health action plan and a hospital VIP card which demonstrated the service took people’s health needs seriously and ensured these were met.

People were well cared for by a staff team who were kind and warm. Care plans were detailed and provided staff with the guidance they needed to ensure people received the care and support they needed. They were written based on people’s strengths and contained information about the support they needed to achieve their goals.

Care was planned and reviewed with people who lived at the service and their relatives. Care plans contained information which was individual to the person and they were up to date.

People knew how to make a complaint and the service had not received any complaints in the last twelve months.

The service was well-led and staff morale was good. The registered manager and the provider had systems in place to evaluate the care provided.

Our inspection team was made up of a lead inspector. During the inspection we asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

On the day of the inspection we met three people living at Greenacres and talked with them about their experience of care. Following the inspection we spoke with the relatives of two people by telephone. We talked with one staff member on the day of the inspection and subsequently talked with the manager and another staff member by telephone. We spent time observing the interactions between the staff member and people living at Greenacres and we looked at records. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. We saw that staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve. The service had policies and procedures in place for assessment of people under the Mental Capacity Act and for Deprivation of Liberty safeguards. On the day of the inspection, all of the people who were living at Greenacres were assessed as having capacity.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. We were not able to examine staff personnel records as the manager was away and these were kept in a locked cabinet but we talked with the staff member on duty and subsequently with the manager about the recruitment process and the ways in which the service ensured that staff were skilled and supported to undertake their job. We found that the provider was able to demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living at Greenacres.

Is the service effective?

People told us that they were happy with the care they received. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their support plans. Staff spoke with pride about the progress that individual people had made whilst they had been living at Greenacres. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives and the impact that this had had on their daily life. They told us that their relatives were involved with decisions about the care provided and that the manager kept them informed of any changes. One relative told us that they had visited whilst people were having their tea and had observed. "A warm, positive relationship between everyone."

Is the service caring?

We saw that people were supported by kind and attentive staff. The staff member who was on duty throughout the inspection was patient and gave encouragement when supporting people. We observed that people were able to do things at their own pace and were supported to be as independent as possible. People who used the service were invited to complete an annual survey. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. One relative told us, "I have absolutely no concerns, they all go the extra mile, they give the kind of attention that goes way beyond the call of duty."

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community, which included visiting local places of interest and shopping. At the time of the inspection two people were on holiday and another person who had been due to go had changed their mind about going. We found, from talking with staff and relatives, that this decision had been respected and supported by staff to ensure that this was exactly what the person had wanted to do.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. Records seen by us showed that there was a complaints process in place. People who lived in the service, staff and relatives were asked for their views. We saw that regular audits were undertaken by the area manager and we observed from records that any identified shortfalls were addressed promptly. As a result the service was constantly improving. Staff told us that they felt well supported by the manager.

You can see our judgements on the front page of this report.

We used a number of different methods to help us understand the experiences of people using the service including talking to people who lived at the home and observing the care provided. We saw staff supporting individuals in a reassuring and caring way. People appeared relaxed and comfortable in their surroundings.

People told us told us that they decided what they wanted to do from day to day and were happy living at the home. We confirmed that people were involved in making decisions about their care wherever possible. Where people did not have capacity or needed support to make decisions, appropriate arrangements had been put in place.

We found that the systems for helping people to manage their medication were safe and well organised.

We also found that staff were trained and supported to do their jobs well. This included specialised training, regular supervision and staff meetings. Staff also had regular opportunities to air their opinions and had team meetings.

We saw that regular checks were carried out by senior management, to monitor the quality of the service and that the service annually reviewed people’s ‘satisfaction’ of the service. We also saw that there was an effective complaints system.

During our visit we talked and spent time with four of the people who live at the service. Unfortunately the fifth person was not at home during our visit.

People who use the service told us that they were happy living at the home. They said that they liked the staff, liked the home and couldn’t think of anything that they wanted to change. Comments made to us included ‘wouldn’t change a thing’ and ‘I like it’.

We found that people were involved in making decisions about their care wherever possible. Where people did not have capacity or needed support to make decisions appropriate arrangements had been put in place. Suitable arrangements for planning and reviewing the care people needed were in place. The systems for helping people to manage their medication were safe and well organised.

We also found that staff were trained and supported to do their jobs well. This included varied training, regular supervision and staff meetings. Regular checks were carried out by senior management, to monitor the quality of the service.

People in the service told us that they like living at Greenacres and that they think the staff are very good. They also said they can do what they want to and that staff help them keep up contact with their families. One person said 'I am very happy with the help I get from staff'