This inspection was carried out on the 10 November 2016 and was announced.

Swerford House is registered to provide accommodation and personal care for up to five people. People living at the service had a range of learning disabilities. Some people were living with autism and everyone required support with behaviours that challenged.

The service was in a rural location, with large, safe grounds surrounding the property. Downstairs there was a kitchen, dining room, lounge and quiet room. Each person had their own bedroom.

The service had a registered manager in post. A registered manager is a person who is 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 kept their medicines in a locked safe in their bedrooms and staff supported them to take their medicines safely. Some people were prescribed creams to keep their skin healthy. There were no body maps to show staff where to apply the cream. This was an area for improvement.

People were encouraged to be as independent as possible. People had accessed new activities and were doing things that they had never done before. One person had recently been to see their favourite band in concert and another person had been on holiday for the first time. There were pictures displayed all around the service showing people out in the community and having fun. People’s relatives told us they were pleased and proud of their achievements.

Detailed assessments were carried out before people moved into the service and people’s care plans were accurate and up to date, reflecting the care and support people needed. People became distressed if there was a change in their routine so there was step by step guidance in place for staff telling them how people liked to get up in the morning, and the different routes they liked to walk when out.

People were relaxed in the company of staff and their relatives told us that staff were kind and caring. Staff knew people well and offered people reassurance and support throughout our inspection. People were treated with dignity and respect.

People met monthly with staff they knew well to review their care and support and what they had achieved that month. During these meetings staff asked people if they were happy and documented their responses to ensure people’s views on the service were taken into account. Some people needed support with their communication but staff used signs and symbols to help them make their needs known.

The registered manager documented and investigated any complaints. Relatives told us that they could raise any concerns with staff or the registered manager and they were confident they would be dealt with appropriately.

Staff and relatives told us they thought the service was well led. Staff told us they were well supported by the registered manager and there was an open and inclusive ethos within the service. The registered manager told us, “We want…to increase people’s independence...We want to encourage them to participate in more activities.”

Risks relating to people’s care and support had been assessed and minimised when possible. Some people displayed behaviours that challenged, particularly when they were anxious or upset. There were clear guidelines in place for staff, on how to manage these behaviours and how to help people remain calm.

Staff completed incident forms when any accident or incident occurred. The registered manager analysed these for any trends to see if any adjustment was needed to people’s support. Staff regularly had the opportunity to discuss incidents after they occurred to look if they could have managed a situation differently.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities rega

Many of the people who used the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. Through observation however, during the inspection we were able to observe staff supporting people who used the service in a respectful way and observed staff taking time to explain where possible, the options available and involving people in making choices.

Through direct observation, discussions with staff and records we, viewed we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills. Daily reports were written showing things such as, what a person had done that day, what support they had and what they had eaten

During the inspection we were able to observe people who used the service being supported with their hobbies and interests. People also took part in many every day activities. These included going for a walk and shopping. People were also supported to carry out household chores such as hoovering and laundry.

People who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. Through observation however during the inspection we were able to observe staff supporting people who use the service in a respectful way and observed staff taking time to explain where possible the options available and involving people in making choices.

To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spoke with relatives of people living within the service. All spoken with expressed a positive view of the service and were happy with the quality of care given and future opportunities for their relative.

We carried out this review and brought forward the scheduled planned site visit because we had received anonymous information with regard to concerns about the safety and welfare of people who use services at Swerford House.

We joined people who live at the service at 9:00am while they were getting ready for the day ahead and having their breakfast. We observed people expressing their opinions and planning activities for the day with staff. We were unable to directly talk to the people who use the service due to their communication difficulties but could observe that they were happy with the care and support being offered and that their independence was encouraged.