The inspection was carried out on 11 December 2017, and was an unannounced inspection.

St Leonards Place provides accommodation, with personal care and support for three people. Accommodation is provided in a large house that has been divided into three flats. One of these can be accessed by its own entrance at the rear of the property. At this inspection, there were three people living in the home. The service is able to offer support for people who may have a learning disabilities, autistic spectrum disorder (ASD) and/or mental health issues.

A registered manager at the home is also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

At the last Care Quality Commission (CQC) inspection on the 8 and 12 October 2015 the service was rated Good overall although they were rated Requires Improvement for the Safe domain. At this inspection, we found the home was Good across all domains.

Staff had received suitable training, which was provided to reflect the individual needs of the people living in the home.

Policies and procedures were available and had been up dated for staff to view.

Staff we spoke with understood their responsibility in keeping people safe, they confirmed they had received safeguarding training. They knew who to contact if they saw or suspected abuse, and the outside agency’s to contact if their suspicions were not taken seriously.

Medication administration had been risk assessed and one person was now self-administering medicines with minimal support from staff. Staff had received relevant training and their competency had been checked. Medicine was supplied in a dosage system. Currently the staff complete a medicine administration record (MAR) which was not supplied by a pharmacy. We made a recommendation about this.

People’s needs were assessed and reviewed on a regular basis. Care plans were detailed and these had been written with the person, and their family member if appropriate. Care plans were person centred and included things that were important to people as individuals. For example, one person liked regular contact with their mother, the staff facilitated time when they could spend it together by liaising with mum and making the arrangements.

Risk assessments contained detailed information and clear guidance about all any risks to the person’s safety. The staff knew people very well and were able to describe peoples care in great detail. Changes to care plans were made when necessary with the involvement of people’s families, health professionals and the person’s funding authority when appropriate.

Recruitment procedures were followed and appropriate checks were carried out to make sure staff were suitable to work with vulnerable people. Staff received induction training and day to day support to ensure they did their job safely.

There was a very low staff turnover with most staff having been there many years. There were sufficient skilled staff employed to keep the rota covered at all times without the use of agency staff.

Most meals were homemade and took into account peoples likes and dislikes. There was no regular menu as the two people who needed support with meals chose items they liked when out shopp

St Leonards Place provided support for three people who lived at the home when we visited and one person who was supported with day care five days a week. We saw that people were supported with day-to-day activities such as personal care, medication, internal and external activities.

During our inspection visit we spent time with two people and spoke with another person. However, all three were not able to communicate verbally and staff were able to explain the non-verbal signs used when each person was happy or when they were not. We saw that people were content in the home and there was a calm, inclusive atmosphere. We saw that staff interacted well with each person and had established effective means communication with the people who lived in the home.

Care and treatment was planned and delivered in a way that was intended to meet people’s individual needs and ensured people's safety and welfare. Staff made sure that people received the medication they had been prescribed.

Staff had received the skills and knowledge they needed to support the people that lived at the home.

We saw that there were effective quality systems in place to make sure people received their care and support in a safe and consistent way.

During our visit we saw that staff treated people with dignity and respect, were seen to knock on doors before entering and provided personal assistance in a kind and discreet manner. People we spoke to were very positive about the staff team and comments included, “great respect for him, a good bloke," "she's lovely", and “the support is really good."

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assisted them to make choices and maintain as much independence as possible. A member of staff told us we encourage people to do as much for themselves as possible "just as if they were in their own homes"

People who used the service told us how they were supported to maintain their independence with "independence evenings" but staff were always available if needed.

In order to protect the people who used the service, we saw that the home carried out a rigorous staff recruitment process.

We saw that staff were knowledgeable about people's needs and preferences, were observed to treat people as individuals and delivered care in a personalised way. This was particularly noted when a person who used the service was supported to have a bath in a dignified and respectful manner and at a pace directed by the person.

There were processes in place to monitor the quality of service being provided and we saw that people who used the service were involved through reviews and one to one discussions.

This inspection was carried out on the 8 and 12 October 2015, and was unannounced.

St. Leonards Place provides a supported living type service in that it is divided into three self-contained flats where people are supported to be as independent as possible. The flats each have separate and spacious kitchen/dining and living areas, as well as separate bedrooms and bathrooms. One of the flats has its own entrance to the rear of the property. The service is situated in Chatham and provides accommodation for three people with learning disabilities, autistic spectrum disorder (ASD) and mental health issues. The service also provides a day care service for one person. There were three people living at the service at the time of the inspection.

There was a registered manager who was also the provider of the service. 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 and their relatives indicated that they felt the service offered a safe and effective service to their relatives. Each person was cared for in a safe and well maintained environment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The registered manager understood their responsibilities under the Mental Capacity Act 2005 and DoLS. Mental capacity assessments and decisions made in people’s best interest were recorded. At the time of the inspection the registered manager had not needed to apply for a DoLS authorisation for anyone as it was not required.

People received appropriate support with their medicines and there were policies and procedures in place for the safe administration of medicines. Staff had been trained to administer medicines in line with people’s prescriptions.

Staff had received training in protecting people from abuse. They knew the action to take if they suspected abuse. The management team had access to, and understood the safeguarding policies of the local authority. However, the staff did not have easy access to the telephone numbers for the local authority safeguarding team should they need them. We have made a recommendation about this.

People’s needs were assessed and reviewed on a regular basis. Changes were made with the involvement of people’s families, health professionals and the person’s funding authority. Risk assessments contained detailed information and clear guidance about all any risks to the person’s safety. The staff knew people very well and were able to describe peoples care in great detail.

There were sufficient staff to meet people’s assessed needs. People were encouraged and supported to engage in activities within the service and in the community.

Recruitment practices were robust and appropriate checks carried out to make sure staff were suitable to work with people. Staff received induction training and day to day support to ensure they did their job safely. Staff received support from the registered manager through supervision and an annual appraisal.

Staff supported people with their nutrition and health care needs. People were enabled and encouraged to make decisions about their care every day.

Staff were considerate and respectful when speaking about people. Staff knew people very well, including their personal histories, hobbies and interests. There was a relaxed atmosphere in the service between people and staff.

Systems were in place for people and their relatives to raise their concerns or complaints knowing they would be responded to quickly and to their satisfaction.

There were systems in place to review accident and incidents, with risk assessments being developed as a result. The registered manager kept appropriate authorities informed of any changes to peoples care and support through regular reports.

The management of the service was stable and staff felt supported by the registered manager. The registered manager undertook regular audits and took action when changes or improvements were needed.