We carried out this announced inspection on 23 March and 03 April 2018. At our last inspection, on 25 February 2016 the service was rated Good. At this inspection, we found the service remained Good in Safe, Effective and Caring. The service had progressed to Outstanding in Responsive and Well-led giving it an overall rating of Outstanding.

Tabs @ 42 is a care home. 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.

This service provides accommodation and personal care for up to five adults. People living at the service have complex needs that include Autism spectrum disorder, learning and physical disabilities. It is situated in Northampton and the premises had been adapted to provide people with individual flats. The service also has a secluded garden.

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.’

At the time of our inspection, two people were using the service.

The home has a registered manager. This 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 management team were highly committed to ensuring people lived fulfilling lives. The whole focus of peoples care was person centred and focused on promoting their independence and social inclusion. Staff and the management team were exceptional at empowering people to have as much control over their lives as possible and to achieve their maximum potential. The staff were passionate about the person-centred approach of the service and it was clear it was run with and for people. It was obvious that the culture within the service valued the uniqueness of all individuals.

The service had taken inventive steps to meet people’s communication needs and we saw extensive communication plans and tools that were in use. These had been tailored to each individual and ensured effective communication took place. Staff empowered people with complex needs and behaviours to feel a part of their community, and to achieve their goals. People took part in activities at the service and in the wider community. Each person had a personalised pictorial activity plan and were supported to take part in activities of their choosing. Staff supported people by responding to their communication methods and body language to understand if they were unhappy or dissatisfied with any elements of the service.

We found a progressive and highly positive staff team that placed people and their relatives firmly at the heart of their care. The service was led by a dedicated and passionate management team who had embedded a culture and ethos within the service that was open, encouraging and empowering. Staff were openly proud to work for the service and wanted it to be the very best it could be. Staff and the management team were very committed to their work and faced up to any challenges and used these to improve the support for people using the service.

Staff attended a variety of meetings that gave them an opportunity to share ideas, and exchange information about possible areas for improvements. Ideas for change were welcomed, and used to drive improvements and make positive changes for people. Quality monitoring systems and processes were used robustly to make positive changes, drive future improvement and identify where action needed to be taken. All staff, irrespective of their role,

This unannounced inspection took place on 25 February 2016. This residential care home is registered to provide accommodation and personal care for up to five people with learning disabilities.

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.

Improvements were required to ensure the provider had robust procedures in place to identify where improvements needed to be made. For example, by ensuring all risk assessments were current and reviewed at appropriate intervals.

People were safe living at the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe but also enabled positive risk taking. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Care plans were written in a person centred approach and focussed on empowering people with personal choice and people being in control of their life. They detailed how people wished to be supported and people were encouraged to make decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People had caring relationships with the staff that supported them. Staff spoke with warmth and pride about the progress people had made since they moved to the home. There was a supportive management team which focussed on providing good quality person centred care for people.

During this inspection, we gathered evidence against the outcomes we inspected to help answer our five key questions; 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 detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw there were sufficient numbers of experienced and competent staff on duty to safely meet people's personal and healthcare needs. We found that the home had been kept appropriately maintained throughout. We saw that people were cared for in a homely environment that was kept clean and was free from hazards. We found that risk assessments identified individual risks to people's health, safety or welfare and were acted upon. This meant that people were supported and cared for in a safe environment by staff who knew their job. We saw that people's health was closely monitored and appropriate and timely action was taken in seeking the advice, guidance, and appropriate attention of health and social care professionals.

Is the service effective?

We found there were arrangements in place to monitor the quality of the service provided, both on a day-to-day basis, and longer term. This meant that people were assured of receiving a consistent standard of care.

The three staff we spoke with had good knowledge of the needs of the people they supported. We saw that people’s care plans were person centred and contained up-to-date information that enabled staff to support people to make choices about their care.

We saw that people's care plans and risk assessments were regularly reviewed and updated as and when their needs changed. This meant that because staff had access to accurate information they had a good knowledge of each person’s care needs and were able to provide effective care.

Is the service caring?

We saw that staff treated people respectfully and ensured their dignity and right to privacy was protected. We observed that staff interacted well with the people we saw in residence. We also saw there was a good rapport between the staff and the people they supported.

Is the service responsive?

The nature of people’s disabilities included autistic spectrum disorder, and most people had compromised verbal communication skills. All the people in residence benefited from a structured day of activities and we saw that staff communicated with people in a variety of ways, including using visual tools to ensure that people had choices and were able to express preferences from a range of options.

Is the service well-led?

The three staff we spoke with said they consistently received the managerial support they needed to do their jobs effectively. We found that staff were encouraged to discuss care issues and make constructive suggestions for improvements to the standard of people’s care that were acted upon.

This inspection focussed on the Warning Notices that had been issued in relation to safeguarding, staff professional development and quality assurance processes. We spoke with relatives of people who used the service however their feedback did not directly relate to this inspection.

We found that improvements had been made in the three outstanding areas of concerns however the provider still had some action to take to ensure that all staff had received their mandatory training.

We were not able to speak to people who use the service as most were out at a day centre. We observed one person sat listening to music who looked happy and we saw feedback from family members stating their relatives were happy at the home and thanking staff for their kindness.

Because of communication difficulties, we were not able to speak to the people who live in the home. All the relatives we spoke to were very satisfied with the care they received from the service, and praised staff members for their work. No one had any suggestions for improving the service. We spoke with three relatives, who highly praised the service: ‘’I cannot believe there could be a better home than this’’. ‘‘If there is anything wrong they will quickly look into it ’’. ‘‘Fantastic standard of care. I don't need to worry about anything as I know they would contact me whenever they need to’’, ''Staff are friendly and welcoming and they treat my son with respect’’.

People who used the service were either unable to talk with us or decided that they did not wish to talk with us during our inspection. We spoke with three people's relatives and two of them gave us positive feedback. The relatives also raised individual concerns and one person told us that they had raised an issue about their relative's personal care and they had not seen an improvement or given feedback about the care that was provided. One relative said “Tabs@42 was amazing and any young man that gets the chance to go there is very lucky".

We looked at how people, or their representatives, were involved in the service and given information, and found this to be appropriate. We looked at people's support plans and found that they did not always contain accurate and updated information. We looked at the procedures the provider had put in place to safeguard people from abuse and found that the procedures were not robust. We looked at the premises and found that there was some maintenance work that required completion. We also looked at equipment and found this to be satisfactory, but the provider may wish to ensure all electrical equipment has received a safety check.

We found there were not always adequate numbers of staff to support people's needs, and that staff were not given appropriate professional development. We also found that robust quality assurance measures were not in place.