We carried out an unannounced comprehensive inspection on 20 January 2018.

The Bungalow provides care and accommodation for up to three people with learning disabilities. On the days of our inspection there were three people living at the care home.

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. At the last inspection on the 8 October 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

We met and spoke to all the people during our visit and observed the interaction between them and the staff. People were not able to verbalise their views and staff used other methods of communication, for example visual choices.

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff confirmed there was sufficient numbers of staff to meet people’s needs and support them with activities and trips out. Staff said people were safe because; “There is a great staff team here. We all work well together.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training and the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity needs of people.

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. People’s end of life wishes were not currently documented, however one person had a funeral plan in place which had been provided by relatives. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care plans were person centred and held comprehensive details on how people liked their needs to be met, taking into account people’s preferences and wishes. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff, who had all worked at the service for some time, had built strong relationships with people. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received would be fully investigated and responded to.

The service continued to be well led. People lived in a service where the registered manager’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager was very approachable and made themselves

We inspected The Bungalow as part of our scheduled inspection programme. We also used this inspection to follow up on concerns we had at the last visit on the 1 November 2013. During the November inspection we found that there were some gaps in recruitment records for staff. The provider wrote to us and told us what they were going to do to address these concerns and by when.

An adult social care inspector carried out this inspection. The focus of the inspection was to look at how the provider had addressed the previous concerns and to answer five key questions; is the service safe, caring, effective, responsive, and well –led?

People who used the service required a high level of support and due to their degree of learning disability were unable to provide verbal feedback about their experiences of the service.

At the time of the inspection there were three people living in the service. We were able to meet all three people and spend time observing the care being provided to them.

As part of the inspection we spoke to the Registered Manager and four members of the care team. We also met and spoke with one relative and a representative from the Learning Disability service in Plymouth.

We reviewed a range of records relating to the service and people’s support arrangements. These records included policies and procedures, support plans and risk assessments.

Below is a summary of what we found.

Is the service safe?

We observed that people laughed and smiled when staff spoke and interacted with them and it was evident that people had developed positive and trusting relationships with the staff who supported them.

We saw that detailed risk assessments had been completed. Some of these were general to the service and the environment and others were specific to the individual and their particular care needs. We saw that one person had a risk assessment in place to ensure that they were safe when walking inside and outside the home. Another person had risks identified in relation to their dignity and how this should be protected.

Recruitment practices were safe and thorough. Records confirmed that new staff did not start working in the home until all recruitment checks had been completed.

Staff and management were clear about the need to ensure that any form of restraint or restriction was safe, lawful and protected people’s rights. The service followed the correct legal procedures when they believed a person’s rights or freedom was being restricted.

There were regular medicine audits to ensure people received the medicines they were prescribed in a safe way.

Financial audits took place regularly to ensure that people’s money was safe and all incoming and outgoing expenditure had been accounted for.

Is the service caring?

A relative we spoke to said they visited the home regularly and told us “The care is very good, there is nothing to complain about”.

We observed that people looked very happy and relaxed in their home. It was a very hot day when we visited and we saw that staff regularly checked that people had sufficient fluids, that clothing and temperature of the room was appropriate and that people were comfortable. We observed that one staff member supported a person to wash their hands and change their top after they had something to eat. The staff member spent time ensuring the person concerned was clean and comfortable, and told us “It is important that we ensure people’s basic care needs are met”.

Is the service effective?

It was clear from what we saw and from speaking to staff that they understood people’s care and support needs and knew them well. Support plans were regularly reviewed and updated to reflect any changes.

When people were not able to make choices about their care and support, the views of relatives and other agencies were taken into account and documented. Induction and training plans ensured staff had the appropriate skills and experience to meet the needs of people who used the service.

Is the service responsive?

Records confirmed that people’s preferences, interests, and diverse needs had been recorded and care and support had been provided that met their wishes.

We saw that staff were observant to people’s changing needs, moods and behaviours and responded promptly to any concerns.

The provider had liaised closely with health and social care professionals and followed advice when needed.

A representative from the specialist learning disability service said “They make appropriate referrals without any delay”.

People had access to activities they enjoyed and had been supported to maintain relationships with their friends and family. A relative we spoke to said “I visit every week and the staff pick me up and take me home”. Staff we spoke to said they supported another person to speak regularly to their family using the homes computer and this worked well for all concerned.

Is the service well-led?

Quality assurance processes were in place to ensure that standards of care and excellence were maintained. The provider had responded positively to concerns raised at the previous inspection and had improved recruitment procedures across the service.

The staff we spoke to said they were clear about their roles and responsibilities. The Registered Manager was regularly in the home and staff had access to regular training and supervision.

The service worked well with other agencies to ensure people received care that was joined up and appropriate.

The views of people who used the service, their representatives and relatives were taken into account when planning and delivering care. A formal complaints procedure was in place and a clear record was maintained about any issues raised in relation to the home and people who used the service.

Relatives we spoke to said they had no concerns about the service but felt if any issues arose they would be addressed appropriately.

We gave the service short notice that the inspection would take place. There were three people living in the home on the day of our visit. These people were unable to communicate with us and we observed them at various times throughout our visit.

'The Bungalow' had a friendly and homely atmosphere. A relative told us "they (the staff) do everything well - they (the people) are well looked after" and that they were always made welcome at the home.

People's care needs were being met by staffing ratio of one staff to one person. Each person had a complete and up to date plan of care which contained all the information required to care for each person fully.

Staff knew each person's care needs well and treated people with respect and dignity. Staff told us they worked as a team and felt supported. Comments included "the staff group is stable", "we help each other out" and "we can go and talk to the manager about anything".

We saw that people received balanced and nutritious food and specialist diets were catered for.

People lived in a home that was safe and suitable to their needs, choices and abilities.

The home had an up to date complaints policy. Records showed that people's concerns were listened to and acted upon. One relative told us "there isn't anything to complain about".

Not all of the staff who worked at the home had undergone the necessary recruitment checks before they started work.

We (the Care Quality Commission) carried out this inspection as part of our scheduled plan of inspections to check compliance with the Health and Social Care Act 2008.

We reviewed all the information we held about this service and carried out an unannounced visit on the 22 August 2012.

People using the service had very complex needs. This meant that it was difficult for people to tell us what they thought of the home and the care they received.

We used a number of different methods to gather information about people’s views and experiences of the service. We observed people in the home while they were being supported by staff. This helped us decide if people were happy with the way they were being supported and cared for.

We saw several examples of positive interactions between staff and people using the service. We observed people’s privacy and dignity being respected and staff using their skills and knowledge to encourage people to make choices and maintain their skills whenever possible.

We pathway tracked three people using the service. Pathway tracking means we looked in detail at the care three people using the service received. We spoke to the staff about the care given, looked at records related to them, met them and observed staff working with them. Where possible we also spoke to other agencies and professionals also involved in their care.

All the records we looked at were well organised and included detailed and clear information about people’s needs. The staff we spoke to said that the information was accessible to them and easy to understand. Staff were able to tell us about how they support people and said that they had training, guidelines, and support to assist them when required.

The manager and staff were aware of people’s rights and we were told about meetings that had taken place or were planned to ensure that decisions being made were in the best interest of the people concerned.

We found that people engaged in a range of activities inside and outside the home. On the day of our visit people were involved in a music session at the home and during the afternoon staff took advantage of the sunny weather to take people out for a walk.

We spoke to staff about their understanding of abuse and how to raise concerns. They demonstrated a good understanding of different types of abuse, and knew where they should go to report any suspicions they may have.

We looked at auditing systems within the service. We found that auditing systems were in place to check and monitor the quality of the service, and staff used their skills and knowledge to regularly check that people were happy with the care and support they received.

The inspection took place on 26 and 27 August 2015 and was unannounced.

The Bungalow provides care and accommodation for up to 3 people. On the day of the inspection 3 people lived within the home. The Bungalow provides care for people who have a learning disability and may also have physical disabilities. Each person received one to one support from staff and needed to be supervised whenever they went out.

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.

On the day of our inspection there was a very calm, friendly and homely atmosphere. People were relaxed and happy. People’s relatives and health and social care professionals all spoke highly about the care and support The Bungalow provided. A relative told us, “I couldn’t be happier with the service and the people who provide the care at The Bungalow”.

Staff encouraged people to be independent and promoted people’s freedom. The design of the building and adaptations had been carefully thought out and took account of people’s needs. People moved freely around the building and its grounds as they chose.

Care records were comprehensive and written to a high standard. They contained detailed personalised information about how individuals wished to be supported. People’s individual method of communication was taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep people safe. People had choice and control over their lives and were supported to take part in a varied range of activities both inside the home and outside in the community. Activities were meaningful and reflected people’s interests and hobbies.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, behavioural advisors and speech and language therapists.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff were highly motivated, creative in finding innovative ways to overcome obstacles that restricted people’s independence, and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.

The service had an open door policy, relatives and friends were always welcomed and people were supported to maintain relationships with those who matter to them. Staff were well supported through induction and on-going training. Staff were encouraged to enhance their skills and individual development was promoted. A staff member said, “You are made to feel valued and encouraged to continually improve”.

People were supported by staff who had a strong understanding of how to keep them safe. Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. The manager had sought and acted on advice where they thought people’s freedom was being restricted.

Staff described the management as very supportive and approachable. Staff talked positively about their jobs. Comments included, “I love my job, I get praise when I deserve to get praise and I’m very well supported” and “I really enjoy my job, I’m a caring person, I’m passionate about what I do and I don’t think I could be working in a better place”.

The service had a very open and transparent culture. The registered manager had set values that were respected and adhered to by all staff. Staff were encouraged to come up with innovative ways to improve the quality of care people received. Staff felt listened to and empowered to communicate ways they felt the service could raise its standards and were confident to challenge practice when they felt more appropriate methods could be used to drive quality.

People’s relatives and health and social care professional’s opinions were sought and there were effective quality assurance systems in place that monitored people’s satisfaction with the service. Timely audits were carried out and investigations following incidents and accidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service.