The inspection took place on the 09 and 10 November 2017 and was unannounced. Twynham provides accommodation and support with personal care to a maximum of seven adults with learning disabilities or who have autism spectrum disorder. At the time of our inspection there were seven people living at the home on our first day of inspection and six people on our second day, as someone had moved from the home.

The home had 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.

We found people’s safety was compromised in some areas. Infection control practices were not always adhered to. Parts of the home were in need of refurbishment and presented an infection control risk.

Fire and other safety checks were carried out. However records showed automatic fire doors guards had not been working since August 2017. This meant the service did not always respond to identified concerns in a timely way which could compromise the safety of people.

People felt safe staying at Twynham and risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies.

Relevant recruitment checks were conducted before staff started working at Twynham to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

People were supported to take their medicines safely from suitably trained staff. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

New staff completed an induction designed to ensure they understood their new role before being permitted to work unsupervised. Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role.

People were cared for with kindness and compassion. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible.

A complaints procedure was in place. There were appropriate management arrangements in place. Staff felt supported by the registered manager and staff meetings took place. Regular audits of the service were carried out to assess and monitor the quality of the service.