We inspected Tanglewood on 30 October 2017, the inspection was unannounced. The service was last inspected in November 2015; we had no concerns at that time and the service was rated ‘Good.’ At this inspection we found the service remained Good.

Tanglewood is part of the Spectrum group and provides care and accommodation for up to four people who have autistic spectrum disorders. At the time of the inspection three people were living at the service.

The service requires a registered manager. At the time of the inspection there was no 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. The manager told us they had submitted their application to become registered.

On the day of the inspection visit one person was at college. We spent time with the two other people living at Tanglewood. We spoke with them and observed staff interacting with them. We saw they were treated respectfully and with patience and kindness. Staff were aware of how to report any safeguarding concerns and were confident they would be acted on.

There was a range of risk assessments in place to ensure staff were aware of any potential identified risks and the actions they could take to minimise risks. Staff supported people in line with the information in care plans. When people tried new activities assessments were developed to support them to do this safely.

Staff were supported through a system of induction, training, supervision and staff meetings. This meant they developed the necessary skills to carry out their roles. There were opportunities for staff to raise any concerns or ideas about how the service could be developed.

People were supported to make everyday decisions such as how and where they spent their time and when they got up. Communication tools were used to assist people to make and communicate their decisions. There were some restrictive practices in place to protect people from harm. We were concerned these had not been regularly reviewed to ensure they remained necessary and the least restrictive option available, in line with the principles of the Mental Capacity Act (MCA). We have made a recommendation about this in the report.

People took part in a wide range of activities and led busy lives. They accessed the local community regularly attending social clubs, taking part in voluntary work and using local amenities. Activities were chosen to meet people’s individual interests. Staff were creative when identifying new activities. The manager worked closely with families and recognised the value of maintaining these relationships.

Care plans were detailed and contained descriptions of people’s routines. The information was regularly reviewed and up to date. Relatives told us they were involved in the care planning process.

The manager took an active role within the home. There were clear lines of accountability and responsibility within the staff team. Key workers worked closely with individuals and had a good understanding of people’s needs.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly both within the service and at organisational level.

Further information is in the detailed findings below.

We inspected Tanglewood on 24 November 2015, the inspection was unannounced. The service was last inspected in December 2015; we had no concerns at that time.

Tanglewood is part of the Spectrum group and provides care and accommodation for up to three people who have autistic spectrum disorders. At the time of the inspection two people were living at the service.

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.

On the day of the inspection visit one person was at college. We spent time with the other person who had limited verbal communication. We spoke with them and observed staff interacting with them. We saw they were treated respectfully and with patience and kindness. Staff checked with the person frequently to find what activity they wanted to do and whether they were happy. The person preferred to carry out some tasks on their own and they were given time and space to do this accordingly. They showed us their own room and a newly converted flatlet; this demonstrated they had a sense of ownership of the premises.

There were robust recruitment systems in place to help ensure staff were fit to work in the care sector. Staff received a thorough induction when starting work with Spectrum. This was backed up by regular refresher training. Training covered general areas such as health and safety, infection control and food hygiene. Additional training in areas specific to people’s needs such as autism awareness was also provided. Safeguarding training helped ensure staff were able to recognise and report potential abuse. All were confident any concerns would be taken seriously.

There were sufficient numbers of suitably qualified staff to keep people safe. The staff team was small and most had been in their role for at least a year. They knew the people they supported well and had a good understanding of their needs. Staff told us they supported each other and communicated well as a team. There were a range of systems in place to help ensure staff were always up to date with any changes in people’s needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. DoLS applications had been made to the local authority as appropriate. Staff ensured people consented to their care and respected people’s wishes. People were supported to make everyday decisions such as how and where they spent their time and when they got up. Communication tools were used to assist people to make and communicate their decisions.

People took part in a wide range of activities and led busy lives. They accessed the local community regularly attending social clubs, taking part in voluntary work and using local amenities. The registered manager worked closely with families and recognised the value of maintaining these relationships.

One person had been through a difficult period in their lives. Staff had worked to

We spoke to one person who lived in the home. They told us they were happy living at Tanglewood. We did not speak directly to the other person as they had complex communication needs. Instead we saw how the person interacted with staff. We saw people approach staff in a relaxed manner and staff responded to their approach.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We examined people’s care files and found the records were up to date and reviewed as the person's needs/wishes changed.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. We noted that staffing levels needed to be reviewed as they did at times impact on the availability of activities that people could participate in.

People were protected from the risks of inadequate nutrition and dehydration. People were cared for in a clean, hygienic environment.

There were enough qualified, skilled and experienced staff to meet people’s needs.

We spoke to one person who lived in the home. They told us they were happy living at Tanglewood. We did not speak directly to the other person as they had complex communication needs. Instead we saw how the person interacted with staff. We saw people approach staff in a relaxed manner and staff responded to their approach.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people’s care files and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. We noted that staffing levels needed to be reviewed as they did at times impact on the availability of activities that people could participate in.

Staff said they had received sufficient training and support to enable them to carry out their roles competently.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights.