The inspection took place on 3 April 2018 and was announced. On the day of the inspection 7 people lived in the home. Udal Garth is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Udal Garth accommodates up to eight people with learning disabilities and/or autism in one adapted building. The care service reflected the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were safe living at Udal Garth. They were supported by staff who received the right training to meet their needs, who had been recruited safely and who understood how to protect them from abuse. 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 were empowered to make choices about their lives including how they spent their days. Staff understood people’s communication methods and ensured people’s wishes were listened to and acted upon. Staff sought consent before providing care and ensured people’s privacy and dignity were respected. People chose what they ate and drank and were supported to maintain a healthy diet.

People were supported by staff who treated them with affection and compassion. People’s records detailed how they wanted to be supported, what their aims for the future were and how staff could help reduce any risks to them. People were supported to remain healthy and saw healthcare professionals when they needed or wanted to; they also received their medicines as prescribed.

People lived in a service that was well led. The registered manager and staff ensured they were up to date with best practice and used this knowledge, along with quality monitoring activities, to improve the service. Staff told us they felt supported and listened to and their wellbeing was considered. The provider also monitored the quality of the service and checked action was being taken where gaps had been identified

We inspected Udal Garth on 30 January 2016. The inspection was announced, this was because the inspection visit took place at the weekend and we wanted to be sure people would be available to talk with us. The service was last inspected in May 2013, we had no concerns at that time.

Udal Garth provides care and accommodation for up to eight people who have a learning disability and associated conditions such as autism. At the time of the inspection eight people were living at the service. 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.

Udal Garth is part of The Priory group, an organisation providing services to elderly people as well as people with a learning disability. The service is a modern property located in Torpoint. The premises were well maintained, pleasant and roomy. People had large bedrooms which had been decorated and furnished in line with their personal preferences. All the bedrooms were en-suite. There were plenty of shared areas where people could spend time together or alone as they chose. This included three activity huts in the gardens which were used for cooking, arts and crafts and relaxing.

The atmosphere at Udal Garth was relaxed and calm. Interactions between staff and people were friendly and supportive. Staff were aware of how people liked to be supported and what was important to and for people. One person chose to spend much of their time in their room. Staff described to us how they worked to protect them from the risk of becoming socially isolated.

People were able to access the local community and amenities easily as the town centre was within walking distance. People took part in a range of activities including using a local gym, taking part in music sessions and playing pool. Session plans were developed to guide staff on how to support people well when undertaking specific activities. These included information on how to help ensure people did not become anxious or distressed. Relatives told us their family members had full and active lives.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. New staff were required to undertake a thorough induction when they started their employment. This included familiarisation with the service, training and shadowing more experienced staff members. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager.

There were sufficient numbers of suitably qualified staff to support people according to their assessed needs. Half of the staff team had been employed at the service for over two years and understood people’s needs well. Staff told us they communicated well as a team and were well supported by a robust system of supervision, appraisal and staff meetings. All the relatives we spoke with were complimentary about the staff team describing them as; “amazing” and “lovely.”

The registered manager had a good understanding of the Mental Capacity Act and the correct procedures had been followed when people had been assessed as lacking capacity to make decisions. Staff supported people to make day to day decisions such as what to wear, when to go to bed and what to eat.

People were supported to visit external healthcare professionals when necessary. People’s health was monitored appropriately and regular health checks and medicine reviews took place.

Staff demonstrated a shared approach to supporting people which valued small successes. They were committed to encouraging people to widen their horizons and were not discouraged when planned activities or routines did not go we

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a registered manager on our register at the time.

We met with all the people who lived at Udal Garth, spoke with five members of staff including the registered manager and reviewed comments received from a recent relative's questionnaire.

We found the care and support of people living at Udal Garth was effectively co-ordinated and where necessary other professionals input was being considered and actively arranged. We saw people participating in activities and they appeared relaxed and content.

The staff we met told us, "It's lovely here." Staff spoke positively about the new change in management, they told us they felt more involved and were keen to improve the service. Staff said they felt supported, listened to and involved. We were told, "...it's amazing now, more enjoyable to work here." People told us they had more confidence now, that it was, "more open and free."

Staff had good induction programmes, programmes of essential training and specialist training such as managing epilepsy to ensure they had the skills they needed to care for people.

The registered manager had started to develop good systems for monitoring the quality of the service being provided and had high ambitions for ensuring clinical excellence.

We carried out an unannounced inspection of Udal Garth on the 18th July 2012, following concerns raised about the care of the people who lived there.

At the time of our visit there were 8 people living in the home. We were able to meet all of the people using the service, however, due to their complex care needs and limited verbal communication it was difficult for people to tell us what they thought of the service 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 spent time observing people and the support being provided by staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk to us. We saw some examples of staff interacting positively with people they were supporting. However, we also observed a number of occasions when staff did not interact with people and did not respond when people using the service were trying to communicate with staff or others around them. We spoke to the Registered Manager about our observations following our visit.

We examined the care files belonging to three people who lived in the home. We were also able to meet these people and observe them within the home and while they were being supported by staff.

We spent time talking to staff who were on duty as well as the deputy manager who was in charge of the home on the day of our visit.

Following the visit we spoke to two relatives and two professionals who had been involved in supporting people who had used the service.

Relatives we spoke to said that the staff were ‘kind and caring’ and were helpful when organising and supporting visits home to family.

We did note that a relative raised concerns about the high turnover of staff and the detrimental affects this may have on people who require a staff team who know them well and understand their needs. The relative we spoke to said that they were happy to raise their specific concerns with the manager and hoped that these would be listened to and addressed.

The manager informed us that there were changes being made to the management and running of the service. We were told that the service was in a period of transition and policies and procedures were being updated to reflect these changes. Staff and relatives we spoke to said that they were being kept well informed of the changes and that they trusted that the management would take into consideration the impact any changes may have on people currently using the service.

We saw some examples of people being involved in their care and making decisions about daily living, such as what they wanted to eat. We did raise concerns about locks on people’s bathroom doors and the communal kitchen and that without formal processes being followed these restrictions may not respect and maintain people’s rights, choices and independence.

We found that people engage in a range of activities inside and outside the home, and are supported to maintain contact with family and friends. Some of the staff we spoke to said that they felt some people may be restricted in the opportunities available to them due to the needs of others within the service. This issue was raised with the manager following the inspection.

The staff we spoke to were able to tell us about the different types of abuse and what they needed to do to keep people safe.