United Response - 14 Lingwell Approach is a 'care home'. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service is registered to provide accommodation and personal care for up to four people who have learning disabilities and or physical disabilities.

The care service has been developed and designed in line with 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.

This inspection took place on 24 and 25 September 2018. The inspection was unannounced on the first day. This meant the staff and provider did not know we would be visiting. The second day was announced.

There was a registered manager. A registered manager is a person who has registered with the 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.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We observed people living in the home were safe and relatives told us staff kept people safe. Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Risk assessments were carried out, reviewed and updated when people’s needs changed. We found the provider monitored risk effectively and in the least restrictive way. Accidents and incidents were recorded and appropriate action taken to reduce the risk of reoccurrence.

Medicines were managed safely. They were checked regularly and audits carried out to ensure people received their medicines as prescribed. ‘As required’ medicines were managed appropriately with guidance in place for staff to follow.

Safe recruitment processes were in place and had been followed. Pre-employment checks on employees were completed that helped to minimise the risk of unsuitable staff from working with adults at risk. Records confirmed staff received induction training when they were new in post.

Staff received training which helped them to meet people’s needs and staff told us there was enough training to meet people’s needs.

We checked and found the provider was working within the principles of the MCA and all people using the service had a DOLs in place. Best interest decisions also took place and were documented in care plans.

People were supported with their nutritional needs and specific dietary requirements. If requiring support from health care professionals, this was arranged for people and they were supported to attend hospital if needed.

We observed positive interactions between staff and people living in the home. We saw people were encouraged to maintain relations with their family and friends.

Care plans recorded people’s preferences, likes and dislikes to ensure staff met their individualised needs. These were reviewed regularly with people and their relatives. Due to people’s complex needs staff ensured detailed communication plans were in place to support people to consent and make choices about their care.

Staff protected people’s rights for privacy and respected these. People were encouraged to remain as independent as possible and relatives confirmed this.

The provider had not received any complaints since

This was an unannounced inspection carried out on 25 February 2016.

We last inspected 14, Lingwell Approach in November 2013. At that inspection we found the service was meeting all the legal requirements in force at the time.

14, Lingwell Approach provides accommodation and personal care for up to four people who have learning disabilities and physical disabilities. Nursing care is not provided.

A registered manager was in place. 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.’

Due to their health conditions and complex needs people were not able to share their views about the service they received. People appeared content and relaxed.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. There were other opportunities for staff to receive training to meet people’s care needs. Staff received supervision and appraisal.

People received their medicines in a safe and timely way. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Staff knew the people they were supporting well and there were enough staff on duty to provide individual care to people. Care was provided with patience and kindness and people’s privacy and dignity were respected. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People’s nutritional needs were met and they received a choice of food. People were supported to be part of the local community. They were supported to maintain some control in their lives and they were encouraged to be involved in every day decision making.

Staff said the registered manager and management team were supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people’s care and support needs and the running of the service. There were effective systems to assess and monitor the quality of the service that people received.

The service cares for and supports people with a wide range of complex needs. They were not able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

We saw that care practices were good and people looked very well cared for. Staff were kind and supportive to people. They treated people as individuals. Staff gave good examples of how people were treated with dignity and respect. They said this was important to give people as much choice in their life as possible and be respectful of people as individuals. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and good eye contact.

People were cared for in a clean, hygienic environment. Staff said there were good systems in place to make sure the home was kept clean and fresh. They said they had enough time to carry out the tasks to be done.

Overall, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

Staff said they had enough staff to meet people's needs properly. They said they did not feel rushed and had enough time to make sure people got what they needed.

There was an effective complaints system available.

We were unable to communicate verbally with people who used the service to find out their views and experiences. We spent time sitting with people and observing how everyone interacted and observed how staff cared for people. We also spoke to one person’s family member who said ‘The whole approach is very good. Staff are very obliging and take her out regularly. They always see to her needs’. Staff were observed giving high standards of care and spoke to people in a friendly, kindly manner. They also encouraged people to do as much as they could for themselves. We observed the care being given to people and saw how staff interacted with each individual. The atmosphere in the home was very calm and homely and people were observed being cared for to a very high standard. Staff were able to say how each person liked to be cared for and what was important to them.

We were unable to communicate verbally with people who use the service to find out their views and experiences. We spent time sitting with people and observed how everyone interacted and saw staff centre the care on each individual. Care practices were of a very high standard.

Staff told us people received very good care and people’s needs were always met. They said people get good support with their healthcare needs and other professionals were consulted when appropriate.

The registered manager discussed different measures they have in place to check that people receive safe and effective care. She said they do daily, weekly, monthly and quarterly checks. Audits were carried out by staff and management at the service, and senior managers from United Response.

Staff were very complimentary about the manager. They said she was always available and spent a lot of time working directly with people who use the service and alongside staff, so understood what happened at the home. One member of staff said, “You couldn’t wish for a better manager, she has an open door policy and is brilliant with everyone.”