St Bonaventures is a residential care home for up to seven people with learning difficulties and autism. The service is located in a large adapted detached house; accommodation is provided on the ground and first floors. The service does not have a passenger lift.

At our last inspection in February 2016 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 atmosphere at St Bonaventures was comfortable and homely. People appeared happy and comfortable in their surroundings and with the entire staff team.

People told us they felt safe living at St Bonaventures and from our observations, speaking with staff and the records we looked at during our inspection confirmed this. The provider ensured there were adequate systems in place to help ensure people were safeguarded. For example, we saw recruitment processes were robust, enough staff were deployed to support people’s needs, medications were stored and administered appropriately and regular environmental and equipment checks were carried out.

The service worked within the principles of the Mental Capacity Act and made appropriate applications for Deprivation of Liberty Safeguards. The registered manager was awaiting the outcome of their most recent applications from the local authority. 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 personnel and training records showed that staff had the relevant skills and experience to carry out their role effectively and received regular support from their line manager in the form of supervisions and staff meetings.

From our observations, we found that people were well cared for by a well-established staff team who knew them well and understood their support needs. People told us they liked the staff and we saw they had good relationships with them. Staff’s approach was very caring and empathetic and we saw that they carried out their duties in a friendly yet professional way.

The service responded to people’s needs by ensuring care plans were person-centred and contained relevant and up-to-date information. Information was communicated to people in a format that they could understand and people were able to engage in activities within the home and in the community that were meaningful and enjoyable to them.

While we saw no complaints had been recorded we saw the service had procedures in place to ensure any concern or complaint raised would be dealt with appropriately.

The staff team worked well together. Staff were very complimentary about the registered manager and the board of trustees. The registered manager felt supported by the trustees and staff.

There were policies and procedures in place and regular staff meetings were held to help ensure staff were supported to undertake their role effectively.

Further information is in the detailed findings below.

This was an unannounced inspection of St Bonaventure on the 10 February 2016. We last inspected St Bonaventure in July 2014. All the regulations we reviewed at that time were met.

St Bonaventures is a residential care home providing care and support for a maximum of seven adults with a learning disability. The home is situated in the Northenden area of Manchester, within easy reach of shops and community amenities. The home was fully occupied at the time of our inspection.

The registered manager was available at the time of the inspection. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We found a breach in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. Appropriate action had not been taken with regards to the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. You can see what action we have told the provider to take at the back of the full version of the report.

People were involved and consulted with about their needs and wishes. Care records provided good information to direct staff in the support people wanted and needed. Where risks had been identified, plans had been put in place to help protect people. Information was stored securely ensuring confidentiality was maintained.

We found the system for managing medicines was safe. Staff worked closely with healthcare agencies so that people received the care and treatment they needed. Information was shared with other services, where necessary, so that people continued to receive safe and effective care.

Sufficient numbers of staff were available to support people in meeting their emotional, social and physical needs so their health and well-being was maintained. Recruitment procedures were thorough so that only suitable applicants were appointed.

Staff received on-going training and development. This helped to ensure staff had the knowledge and skills needed to meet the specific needs of people.

During our inspection we saw staff treating people with respect and dignity. People living at the home and their relatives were complimentary about their experiences and the support staff provided.

Social and recreational activities were provided considering people’s individual wishes and preferences. Interactions between staff and the people who used the service were warm, friendly and relaxed.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

People were offered a good standard of accommodation that was clean and well maintained. Checks were made to the premises and servicing of equipment. This helps to ensure the safety and well-being of everybody living, working and visiting the home.

Systems to monitor and review the quality of service provided were in place to check that people received a quality service. People told us the manager and staff were approachable and felt confident they would listen and respond if any concerns were raised.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We spoke with people who lived at the home and the manager about how we write our reports and people told us they wanted to be referred to as residents within this report.

We used the information to answer the five 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?

This is a summary of what we found-

Is the service safe?

We looked at the support plans of three residents. We saw they contained a mental capacity assessment. No applications had been made to deprive any of the residents of their liberty.

CQC has a duty to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and the staff we spoke with had been trained to understand their responsibilities under the DoLS Codes of Practice. We saw documentary evidence to show staff had completed training in the MCA and DoLS.

We looked at a sample of two staff recruitment files this included the most recently appointed member of staff. We saw appropriate safety checks had been carried out such as; Disclosure and Barring Scheme (DBS) check to make sure the applicant was not barred from working with vulnerable people. We saw references had been obtained from previous employers. We spoke with four members of staff who all confirmed they had to provide references and have a DBS check.

We saw safeguarding incidents had been referred to the local authority safeguarding team in accordance with local safeguarding policies and procedures. The staff we spoke with had a clear understanding of their responsibilities in relation to safeguarding people from abuse.

Is the service effective?

The manager told us they supported residents to have as much control over their lives as possible. The manager told us they put the residents at the centre of the planning process and where possible involved family and friends. The support plans we looked at confirmed that the resident and or their representative had provided information about their life and their preferences.

We spoke with four residents who told us: “I am happy here.” “I can do what I want; I like to go out to Manchester or Stockport.” “I go to the hairdressers and to have my nails done.”

We spoke with four people’s relatives who told us: “I am 100% satisfied with the support (my relative) receives.” "The home is spotless." "They have been very caring."

We looked at the complaints log and saw there had been no complaints received since the last inspection. During our inspection the residents we spoke with told us they were happy and had no complaints about the care they received. We looked at historic complaints and saw the nature of the complaints any investigation and the outcome had been recorded.

Staff prepared meals and residents were offered a choice of meals. There were no set menus and people decided on the day what they would like to eat. During our inspection we observed residents informing staff what they would like to eat at lunch. Most residents were having home-made soup for lunch we saw one person told staff they did not fancy soup for lunch and instead would prefer a cheese sandwich. We later saw the person eating their sandwich. This demonstrated that residents were encouraged to express choice.

We spoke with residents who told us; "I can have whatever I choose to eat." "I like the meals." We saw evidence to show specialists such as; dieticians and speech and language therapists had been involved in residents support. We saw where specialist advice had been given this was recorded in the support plan and any advice put into practice. This was to ensure the changing needs of the residents were identified and planned for.

Is the service caring?

We spoke with the relatives of four of the residents who told us; "I have no worries about the care." "They are brilliant with (my relative) they let me know right away if anything happens." "(My relative) went to hospital and a member of staff stayed with them overnight." "There is a new member of staff and (my relative) has really taken to them." "Never had any concerns (my relative) would let me know if they were upset about anything." "The staff are all nice and (my relative) has everything they need." "(My relative) has a full life here." "(My relative) is able to go out to the hairdressers or the shops and is very happy with that."

We spoke with staff and spent time observing their interactions with residents. We saw staff approached people in a sensitive way and worked in a way that maintained residents’ dignity. We saw residents were encouraged to be as independent as possible and participate in the local community. One resident told us; "I am able to go to church on Sunday." "I get the bus into Manchester and go to Affleck's Palace, I like it there." "I sometimes go out in the car with staff."

Is the service responsive?

We looked at the support plans of three residents. We saw needs assessments and risk assessments had been completed to make sure people were safe and had the right level of support.

The support plans we looked at contained: 'My life my plan' ‘What is important to me’ ‘Traffic light passport’ and ‘Health action plan’. This demonstrated the service was responsive to resident’s needs.

We saw documentary evidence to demonstrate supports plans had been kept under monthly review and where necessary amended to reflect residents changing needs.

We saw each resident had an individual weekly activity program so they could maintain their preferred daily routines and activities such as; shopping trips, work placements, college and sports.

Is the service well- led?

There was a manager in post who was registered with the care quality commission (CQC). The manager provided leadership, support and direction to the staff team.

There was a quality assurance system in place that included audit of the medication system the environments and support plans. There was also an annual quality monitoring survey in the form of the questionnaire sent to relatives to gather feedback about the service provided. The information provided from the questionnaire was used by the provider to further improve the service.

We spoke with staff who told us they felt well supported by the manager and the provider. We spoke with relatives who told us; "(the manager) is very good and keeps me informed, all the staff are good and there is always someone to speak to about my relative."

We saw documentary evidence to show regular resident and staff meetings were held. The staff files we looked at contained documentary evidence to demonstrate staff received regular formal supervision. The staff we spoke with confirmed they had regular supervision meetings with the manager.

We saw documentary evidence to show equipment and services were maintained. Fire safety drills were carried out on a regular basis and a fire risk assessment was in place.

People using the service told us that staff encouraged them make their own choices in their daily lives. People living at the home told us that the staff looked after them well. Comments made included;

”The staff are very nice and kind.”

”I am very happy here.”

"I like it here.”

They also told us about all the different outings and events (including regular holiday breaks) they were enabled to participate in.

We found that people were being cared for in a suitable environment by adequate numbers of appropriately trained staff. A suitable system was in place to deal with people’s comments and complaints.

Not everyone who lived at the home was able to tell us about their experiences or give us their views of the service they received. People who were able did however tell us that they were very happy with the care and support they received.

We saw people’s preferences and choices were supported by the staff. People told us they decided how their rooms were decorated and what they wanted to furnish their rooms with. They also told us they planned the menus and decided what they wanted to eat and drink. They also went shopping to choose the style of clothes they liked and to pursue their hobbies and interest.

We observed staff supporting and interacting with people who used the service, and saw good standards of care being provided. Staff provided appropriate care to people and it was clear they knew the people they were supporting very well.

We looked at staffing levels at the home and found that whilst staffing levels were good during the day the staffing levels at night should be revised in terms of increased risk and the changing needs of people throughout the night.

We found staff were also well supported and received regular training to help keep their skills up to date. We saw there were regular meetings taking place to review staff practice and the performance of the service.

We also found the service had good systems in place to ensure the building and the equipment were safe and that the important areas of the service were regularly monitored.

People told us that they were they were being cared for and supported well. Comments made included;

“I like it here, I like them (the staff) and they help me do things I like to do”.

“I go to see the doctor if I am not well”.

“We go shopping and to lots of different places that I like. I like going to the caravan (owned by the home) in Wales”.