What life is like for people using this service:

The service met the characteristics of good in all areas.

People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

The care that people received continued to be effective. They 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 received training and support to be able to care for people well. They ensured that people were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The environment was adapted to meet people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. They could get involved in activities and pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the registered manager managed any complaints in line with the provider’s procedure.

The registered manager was approachable and there were systems which encouraged people to give their feedback. There were quality structures in place which were effective in continually developing the quality of the care that was provided to people.

More information is in the full report.

Rating at last inspection: Good: report published on 3 August 2016.

About the service: Three Gates is a residential care home registered to provide personal care for up to five people with learning disabilities or autistic spectrum disorder. There were four people living there at the time of the inspection. The accommodation is an accessible bungalow with large gardens

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection visit took place on 16 and 18 May 2016. The service was last inspected on 3 December 2013, when all standards were met and no concerns identified. We gave the service 24 hours’ notice of this inspection visit because we needed to be sure that the registered manager, staff and people would be in.

Three Gates is a small home which offers personal and social care for five adults with a learning disability (including autistic spectrum disorder). At the time of our inspection, four people were using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were protected from the risk of abuse and avoidable harm. Their needs and risks associated with care were assessed and staff had clear guidance about how to meet people’s individual needs. Care plans were regularly reviewed and updated to meet people’s changing needs and preferences.

People were happy, comfortable and relaxed with staff. They were cared for by sufficient numbers of staff who were suitably skilled, experienced and knowledgeable about people’s needs.

The provider took steps to ensure checks were undertaken to ensure that potential staff were suitable to work with people needing care. Staff received one-to-one supervision and had regular checks on their knowledge and skills. They also received regular training in a range of skills the provider felt necessary to meet the needs of people at the service.

The systems for managing medicines were safe, and staff worked in cooperation with health and social care professionals to ensure that people received appropriate care and treatment in a timely manner.

Appropriate arrangements were in place to assess whether people were able to consent to their care. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS). This ensured that legal safeguards were in place to protect people who could not consent to aspects of their care.

People were supported to be as involved as possible in their care planning and delivery. The support people received was tailored to meet their individual needs, wishes and aspirations.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people and their relatives in relation to the standard of care. Regular checks were undertaken on all aspects of care provision and actions were taken to improve people’s experience of care.

Due to people’s communication skills they were unable to communicate their experiences of care to us. We observed staff supporting people on a one to one basis and people appeared comfortable with the support they received from the staff team.

As people using the service were unable to give us their views of the service, we contacted people’s family members and friends to get feedback from them. People’s family members and friends were happy with the support their relatives received. One family member talking about their relative told us, “moving to Three Gates was the best thing that’s ever happened, she is so happy there and if there are any concerns the staff always let us know. I think the place is fantastic.”

People were supported to undertake activities of their choice and to develop their skills and independence. On the day of our visit three people using the service left for a two day trip to London with staff support and staff supported the two other people using the service to access the local community.

People’s preferences and the level of support they needed was delivered in line with their individual support plans.

People were supported to access health care services as needed to maintain their health and were supported to take their medication as prescribed.

Sufficient numbers of staff were on duty to ensure people’s needs were met effectively.

There were four people living at Three Gates when we visited. Due to people’s communication skills they were unable to communicate their experiences of care to us. We observed staff supporting people on a one to one basis throughout our visit and people appeared comfortable with the support they received from the staff team.

Discussions with staff and observations during our visit demonstrated that staff had a good understanding of people’s support needs.

People’s family members and representatives were positive about the support and services provided by the staff team. Comments included, “I have only positive things to say about the support provided by the staff, they have encouraged my relative to try different experiences, I think they do a marvellous job.”

People’s method of communication was recorded in their support plans. This ensured staff could support people according to their preference and choice. Information in records demonstrated that staff were committed to promoting independence and choice by working with and involving individuals in decisions on a day to day basis.

Staff were provided with ongoing training and support, to enable them to carry out their work effectively.

Systems were in place to monitor the care and services provided, and to identify and manage risks to ensure the service was run safely.

The manager and staff told us how the services and support provided at the home had steadily improved with better resources – financial and people – being made available. This was particularly well demonstrated in better care documentation and records that were genuinely aimed at a ’person centred approach’, continuous improvements in the quality of the premises and more individualised decorating and refurbishments, and improved staffing levels.

The latter has lead to ‘more flexible ways of working and better access to community facilities’ and ‘increased levels of individual attention that has resulted in more relaxed patterns of behaviour and less need for medication’.

We were told about the increased range of activities the people living at the home enjoy and although day centre attendance has continued for some, everybody has at least one day when they are supported to enjoy activities from home. New activities are continually being tried and staff enjoy opportunities to discuss and analyse successes as well as failures.