This comprehensive inspection took place on 20 September 2016 and was announced. We announced the inspection because people living at The Bungalow attended day services and other activities and staff accompanied them. We wanted to be sure there would be someone there.

The Bungalow is registered to provide accommodation for persons who require personal care for up to three people. At the time of our inspection, there were three people living in the home. The people who lived in The Bungalow were on the autism spectrum.

The service is located on the Raby Hall site and is a distinct and separate building from the others.

The Bungalow is a relatively modern building once used as a manager’s accommodation. It is owned and staffed by the provider, Wirral Autistic Society (WAS), which now has the ‘working name’ of Autism Together. The service is still registered as being provided by WAS. Also nearby this building were other WAS homes and a home farm centre.

The home required a registered manager. 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 Bungalow had a registered manager who had been in post for several years.

We looked at information the Care Quality Commission (CQC) had received about the service including notifications received from the registered manager. We checked that we had received these in a timely manner. We also looked at safeguarding referrals, complaints and any other information from members of the public.

The home is a domestic style and had previously some years ago, been used for the manager’s accommodation. It was furnished in a homely way which was according to people’s taste, especially in their own rooms. We observed the people in the home on the day of our inspection and spoke with two of them. They appeared happy and comfortable with their surroundings and with staff.

We saw that people received sufficient quantities of food and drink and had a choice in the meals that they received.

Medication procedures were followed and the medication stored tallied with the records.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the files looked at and there was updated information that reflected the changes of people’s health.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks. New staff had an induction programme in place that included training them to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

The staffing levels were seen to be appropriate to support people and meet their needs and the staff we spoke with considered there were adequate staff on duty.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded.

People who lived at The Bungalow and their families were involved in making decisions about daily life and how they wished to be supported. We observed that staff treated people with dignity, respect, and affection.

Care plans identified people's needs and how their needs should be met. Risk assessments were individualised and covered all aspects of a person's needs.

People were provided with a clean, comfortable, safe and homely environment to live in.

People were supported by staff who had appropriate experience and knowledge.

Limited information was obtained from the people who used the service about the way they were being looked after due to communication difficulties, however they did express they were happy living at the home, liked the staff and were treated well and with respect.

People who used the service were involved in how they were cared for. Care plans demonstrated people had been involved in discussions and review meetings regarding their care and treatment plans.

We looked at the care plans of the three people who lived at the home. We found that the plans identified people’s needs and how their needs were to be met. Risk assessments were seen to be individualised and covered all aspects of a person’s needs including physical, behavioural, mental health and social. Formal risk assessments were used and management plans were in place detailing what staff needed to do to prevent or minimise the risk. Risk assessments and care plans had been completed in full and reviewed regularly. Records were seen to be accurate and appropriate and stored safely.

We found there were sufficient staff with appropriate experience and knowledge who cared for the people who used the service. Staff demonstrated knowledge in safeguarding people from abuse and had received appropriate service specific training. People who used the service sometimes participated in the recruitment of new staff to ensure they would be suitable to work with them.

Limited information was obtained from the people using the service about the way they were being looked after due to communication difficulties, however one person said he was happy living at the home and liked the staff.

The relatives of the people using the service said they were very happy with the way their relative was being looked after. They praised the staff team for their hard work and kind and caring nature. The said the staff always keep them informed about issues relating to their relatives’ wellbeing and are quick to respond to any health care issues. Both relatives said they had never seen any signs of abuse or neglect and know how to make a complaint. One relative said ‘I am very happy with the care being provided, it’s the next best thing to home’. Another relative said ‘I am always invited to care plan reviews so I know what’s going on’ and ‘My relative is very well looked after, she is very happy living at The Bungalow’.

Health care professionals involved in the service had no concerns to raise about the standard of the service. They had never seen any signs of abuse or neglect and said the staff appeared professional and caring and well managed. The said staff contact them for advice when necessary and are knowledgeable about their patients care needs. One health care professional commented his patient seemed ‘well and settled’ and that a staff member supported him well during a visit to his surgery. He commented they appeared to have a good working relationship.

Wirral Contract Department had no issues to raise about this service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We talked with one people who used the service and observed two others. We were not able to speak to these two people because one had communication difficulties and the other refused to speak with us. However we spoke with all the people’s relatives. All the people using the service appeared realxed and content. We also talked with three members of staff. We looked at various records including three care plans and four staff files.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available or on call in case of emergencies.

Staff had been appropriately and properly recruited, ensuring that Criminal Records (CRB) or Disclosure and Barring Scheme (DBS) records had been checked.

Staff were trained in safeguarding principles and procedures and the people living in the home had been given information in easy read format to help them raise a concern if they were worried about anything. The home had a safeguarding policy which was regularly monitored.

The Bungalow had a friendly, clean and well maintained feel about it.

Appropriate risk assessments had been carried out and action plans put into place for safe practice. A person living in the home told us, “I feel safe”.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People’s family members told us that they were happy with the care received by their relatives and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. We spoke with one person using the service who told us, “I can tell staff what I want".

Staff had received training to meet the needs of the people living at the home.

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Is the service caring?

People were supported by kind and attentive staff. We saw that workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us about the staff, "They treat me well”.

People had been involved in the creation of their care plans and continued to be involved throughout their stay in the home. We noted that peoples preferences about, for example, activities, room layouts or clothing choices, were respected by the staff. The people who used the service people were supported, where necessary, to make these choices and decisions.People were invited to be part of the selection process for the staff. One person was very active and involved in this.

Is the service responsive?

People’s needs had been assessed before they moved into the home and frequently re-assessed whilst they lived there.

People had key workers who related to them specifically, but they were also happy with other team members and spoke well of them. Records confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes. Other professionals, such as speech and language therapists and the organisation’s own ‘Autism Practice’ department, were involved in peoples care when necessary.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person was happy to speak with us and another had communication difficulties. The third was not willing to speak with us. However, all appeared happy and content in the home and communicated well with staff.

Is the service well-led?

The home had a registered manager in post which indicated that the person is of good character, is physically and mentally fit and has the necessary qualifications, skills and experience.

Staff had a good understanding of the ethos of the organisation and quality assurance processes were in place. People, staff and other professionals had been asked for their feedback on the service. This also confirmed that respondents were listened to and as a result, some changes had been made. The home completed various other audits throughout the year, which contributed to an annual audit. An action plan had been produced to address any areas of concern raised through all of the audit and feedback processes.

The provider had a number of homes and for all, used the same system and IT package for much of its record keeping and policies. The provider had a centralised administration at the head office. The manager was able to demonstrate effective knowledge of this and show us that he had acted according to policy regarding such things as recruitment, safeguarding procedures and CQC notifications.