Tanglewood provides accommodation, care and support for up to six people with learning disabilities and complex health needs. There were five people living at the home at the time of our inspection. At the last inspection on 23 April 2015, the service was rated Good.

At this inspection we found people were unable to communicate with us about their care, so we observed the care and support being given. The service had the same registered manager as at the last inspection. We found the service remained rated Good. There were some very good elements to the care provided. Relatives and health professionals described the way staff responded to people’s individual health and support needs as personalised, exceptional and distinctive. There were clear improved outcomes for people in terms of their health, behavioural and psychological needs.

At this inspection we found people were unable to communicate with us about their care, so we observed the care and support being given. Relatives told us they though their family members were safe from abuse, neglect, bullying and discrimination at the home and our observations confirmed this. There had been no safeguarding alerts or incidents of serious injury since the last inspection. Risks to people including risks in relation to the premises and equipment were effectively assessed, monitored and reduced. Staff knew what to do in an emergency. There was a safe system to manage and administer medicines. There were enough staff to meet people’s needs and effective recruitment procedures were in place.

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 had adequate training to meet people’s needs.

There were some very good elements to the care provided. Relatives told us staff went above and beyond what they needed to and that staff knew people very well and were kind and caring. Health professionals commented on the family home atmosphere at Tanglewood and the proactive attitude of staff. We observed that staff were calm and sensitive, treated people respectfully, and had a sense of fun when they interacted with people. There were robust links with health professionals and feedback we found from health professionals evidenced that they experienced the care provided by the home as very good.

People and their relatives, where appropriate, were involved as far as possible in the planning of their care. People’s needs in relation to their disabilities, race, sexual orientation, religion and gender we recognised and supported appropriately. People had personalised activity plans to ensure their individual needs were catered for. There was an effective complaints procedure in place.

Relatives told us the service was well run and that they felt their views were listened to and acted on. Staff felt well supported and said the manager was very approachable and supportive. There were systems to monitor the quality of the service and these worked effectively.

Further information is in the detailed findings of the report.

This inspection took place on 23 April 2015 and was unannounced. At the last inspection on 18 October 2013, the service met all the regulations that we inspected.

Tanglewood provides accommodation, care and support for up to six people with learning disabilities and complex health needs. There were six people living at the home at the time of our inspection none of whom were able to communicate their views about the service to us.

The service had 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.

Relatives told us their family members were safe and well looked after. We observed that people were settled and looked happy and relaxed. Staff were aware of how to recognise signs of abuse or neglect and what to do if they had any concerns.

Care was planned and delivered to protect people’s safety and welfare. Risks to people were identified and plans in place to reduce the likelihood of risk occurring. These plans were updated and where necessary health professionals were consulted for advice. People had detailed plans of care for their health and support needs which included their likes and dislikes. Staff were kept informed of any changes to those plans. Relatives told us they were involved in reviewing the plan of care and support.

Checks were carried out on the premises and equipment. There were enough staff on duty to meet people’s needs and the home had safe recruitment procedures to help protect people from the risks of being cared for by unsuitable staff. Medicines were safely administered.

Staff understood the importance of obtaining consent where possible before they provided care. They told us how they looked for signs from people that they were happy with the support they provided. Staff knew what to do if people could not make decisions about their care needs and relatives were involved in best interest meetings with professionals when required to make specific decisions. Staff knew about the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and applications for authorisations had been made appropriately.

People received enough to eat and drink and their preferences and any cultural need s were taken into account. People’s health needs were closely monitored and the service worked closely with health professionals to ensure people got the right support. Staff received enough training to support people adequately. There was a detailed induction programme for new staff. Staff told us they felt well supported to do their job.

People were supported as far as possible to make decisions about their care and support. Staff knew people well. They understood people’s preferences, likes and dislikes regarding their care and support needs. Appropriate methods were used to help people communicate and make choices, for example, we saw staff follow gestures and body language to understand what people wanted to do. Staff respected people’s privacy and treated them with respect and dignity.

There was a visible management structure in the home and staff and relatives felt the manager and the deputy manager were approachable and helpful. Staff told us that they worked well as a team to meet people’s needs. There were systems in place to monitor the safety and quality of the service provided and to obtain feedback from professionals and relatives to consider any necessary improvements for the service.

On the day of our inspection there were five people living at the home and we observed the care provided throughout the day to three people. We were not able to speak with the majority of people living at the home due to cognitive and communication difficulties. One person used non-verbal communication techniques and told us that they were going on holiday and that they were extremely excited about the trip.

Each person had their own room with en-suite facilities and there were a variety of communal areas. The staff received appropriate training to enable them to meet people's needs. A programme of staff training, supervision and appraisal ensured that staff had the necessary skills to support the people using the service. The provider carried out the appropriate checks on all new staff prior to employing them at the home. Care plans reflected people's needs and where people were unable to make decisions regarding their care the appropriate people were involved and made best interest decisions.

On the day of the inspection there were four people using the service. We were not able to speak with the majority of people living at the home as they had cognitive and communication challenges. We however used some non verbal communication techniques and observed people who used this service throughout the inspection. The home was warm, clean and had a relaxed and friendly atmosphere.

We observed that people were treated with respect and that their privacy and independence was promoted by staff. People were supported by staff in a friendly and professional way and were offered choice with regard to menus, activities and care preferences.

People told us they had good access to health care professionals such as doctors, district nurses, dentists, advocates and speech and language therapists. People who use the service indicated to us that they felt safe at the home. This was cooberated by staff who were all aware of the various forms of abuse that might occur and knew how to escalate any safeguarding alert.

We looked at health and safety documents and examined policies and procedures that were appropriate and up to date..

We were on this occasion unable to communicate well with the people living at the home due to the nature of their support needs. We did however, observe that the staff appeared to have good relationships and communicated well with the people they supported at the home.