The inspection took place on 3 January 2018 and was unannounced.

151 Tunbury Avenue is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support for up to four adults with a learning disability. There were three people living at the service at the time of our inspection including people with autism, physical and sensory disabilities.

The service was run by a registered manager who was present on the day of our visit. They were registered to manage this service and another small service in the local area which is registered with the same provider. 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 Care Quality Commission (CQC) inspection in November 2015, the service was rated ‘Good’ in the areas with the exception of Well-led which was rated as ‘Requires Improvement’. Audits had not been undertaken in line with the provider’s quality assurance policy.

At this inspection, in January 2018 internal and external audits were in place and systems were effective in identifying any shortfalls in service delivery.

Staff had received training about protecting people from abuse and knew how to follow the provider’s safeguarding procedures to raise concerns.

Staffing levels had been maintained to ensure there were enough staff available to meet people’s physical, social and emotional needs. Staff continued to be recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding.

People continued to have their needs assessed and their care was planned to maintain their safety, health and wellbeing. Risks were assessed and staff guidance in place about how these risks could be minimised. There were effective systems in place to monitor incidents, accidents and near misses.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

Staff had received training in infection control and followed this guidance to help minimise the spread of any infection.

Staff continued to receive the training they needed for their roles and to be supported through regular supervision and an annual appraisal.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity.

People’s health, social and physical needs were assessed and clear guidance was in place to ensure they were effectively monitored. Care plans included information about people’s personal history and what was important to them so staff could meet their needs and individual preferences.

People continued to experience care that was caring and compassionate. People’s likes and dislikes and non-verbal signs were taken into consideration when making decisions about their care and treatment. Staff respected and valued people’s contributions and understood how to communicate with people in a way they understood.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

The registered manager was approachable and the atmosphere in the service was relaxed and informal. They were supported by a staff team who understood the aims of the service and were motivated to support people accordi

MCCH Society Limited located at 151 Tunbury Avenue had one vacant room and two people who lived in the home at the time of our inspection visit. We saw that people were supported with day-to-day activities such as personal care, medication, eating and drinking.

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used this service had limited verbal communication and complex needs which meant that the people were not able to tell us their experiences themselves. During our inspection visit we spent time with one person in their bedroom and the other person in the lounge. We saw that people were content in the home. We saw that staff interacted well with them and had established effective means of verbal and non-verbal communication with people who lived in the home.

Before people received any care or treatment, they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People were made aware of the complaints system.

People living in the service were unable to tell us how they found their home but we spoke with their relatives who visited regularly. Relatives told us that they were happy with how people were supported. One person said, "They look after them well and last week when I visited they were having a nice roast. I could have easily sat down and eaten with them, it looked so good". Relatives said, "They keep us involved in what's going on and ask our permission if they want to do something different". We found that people were cared for in a kind and sensitive manner. The environment was clean and suitable to ensure people's safety and welfare. We found that people were given medication safely and that staff were competent in performing their role in other ways such as moving people and supporting them to eat their meals.

There was limited communication from the two people living in the home but they intimated that they were happy in the home when asked.

The inspection was carried out on 2 and 3 November 2015 and was unannounced.

The service provided accommodation for people who require personal care. The accommodation was a large bungalow providing support to four people with learning disabilities; some people had additional physical disabilities. People living at the service did not use verbal communication, instead they used a mixture of sounds, gestures and signs.

There was a registered manager employed at the service. 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The registered manager understood their responsibilities under the Mental Capacity Act 2005 and DoLS. Mental capacity assessments and decisions made in people’s best interest were recorded. At the time of the inspection the registered manager had applied for DoLS authorisations for the four people living at the service, with the support of the local authority DoLS team which had been granted.

Systems were in place to monitor and improve the quality of the service; however these had not always been completed by the senior operations manager.

Observations indicated that people felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. The management team had access to, and understood the safeguarding policies of the local authority.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

Accurate records were kept about the care and support people received and about the day to day running of the service. These provided staff with the information they needed to provide safe and consistent care and support to people. Potential risks to people had been identified with steps recorded of how the risk could be reduced.

People were assessed before moving into the service. Care plans were reviewed on a regular basis, and changes were made if people’s needs changed. Staff were kept up to date with any changes in people’s needs. People’s health was monitored and when it was necessary, health care professionals were involved to make sure people remained as healthy as possible.

There were enough trained staff on duty to meet people’s assessed needs. Staff were considerate and respectful when speaking about people. Staff knew people very well, including their personal histories, hobbies and interests. There was a relaxed atmosphere in the service between people and staff.

People participated in activities of their choice within the service and local community. There were enough staff to support people to participate in the activities they chose.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required.

There were systems in place to review accident and incidents, which were able to detect and alert the registered manager to any patterns or trends that had developed.

The complaints procedure was readily available in a format that was accessible to some people who used the service. Staff knew people well and were able to recognise signs of anxiety or upset through behaviours and body language.