United Response – 9 Beverley Road North provides care and support to up to five people who have learning disabilities. The home is a dormer bungalow providing good access to local services and amenities. Each person has their own bedroom and shares communal facilities. There is a safe and secure garden.

The inspection visit took place on 30 January 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the service was a small care home for younger adults who are often out during the day, we needed to be sure someone would be in.

At our last inspection we rated the service overall Good. It was outstanding in caring and good in the other four domains. At this inspection we found the evidence continued to support the rating of overall good and remained outstanding in the caring domain. There was no evidence or information from our inspection and on-going 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.

At the time of our inspection visit five people lived at United Response – 9 Beverley Road North.

There was a registered manager 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.

People supported in Beverley Rd had complex care needs and not all were able to speak with us or communicate in a way we understood. However we observed interactions between staff and people who lived at Beverley Rd, spoke with people able to communicate verbally and with families. They told us they felt they or their family member were safe and cared for, happy and well supported by staff.

Procedures were in place to minimise the risk of unsafe care or abuse and staff understood their responsibilities to report unsafe care or abusive practices. They had received training on safeguarding vulnerable people and knew how to do this.

Care plans were focused on each person’s individual needs and preferences. Staff involved people and where appropriate, their relatives and records were informative about the care people received. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with complex care needs. There were sufficient staffing levels in place to provide the support people required and staff responded promptly when people needed assistance.

Medicines were managed safely. They had been ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly. People received their medicines when needed and appropriate records had been completed.

People indicated they liked the choice and variety of meals. We saw people received adequate nutrition and hydration. One person said, “I enjoy cooking with the staff. We choose healthy food.”

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. The design of the building and facilities provided were appropriate for the care and support provided. We found equipment had been serviced and maintained as required. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

People had been supported to have maximum choice and control of their lives and staff supported them in the least rest

The inspection took place on 21 May 2015 and was unannounced.

This service is registered to provide care and accommodation for up to five people who have a learning and/or physical disability. The home is a detached dormer bungalow providing good access to local services and amenities. Each person has their own bedroom and shares communal facilities. The registered provider is a national, non profit making organisation, United Response.

The last inspection of the service took place on 3 September 2013. During this inspection the service was found to be meeting all the regulations assessed.

We were assisted throughout this inspection by the registered manager of 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.

At the time of the inspection there were four people who used the service. None of the people who used the service were able to verbally tell us about their experiences but we were able to meet them, observe them in their surroundings and their interactions with support staff. These observations were very positive. We also had the opportunity to speak with parents of all the people who used the service to gain their views and opinions.

During these discussions we were given exceptionally positive feedback about all aspects of the service. Every person we spoke with described the service as ‘excellent’ or ‘outstanding’ and spoke very highly about the registered manager and staff team. Their comments included, “They are a model for others to aspire too!”; “If I had a million pounds to spend I could not find a better place!” And; “Please give them an excellent report. If they don’t deserve it I don’t know who does!”

We found people were provided with a safe service. Risks to their health, safety and wellbeing were thoroughly assessed and managed well. Care workers understood their duty to protect people from harm and were fully aware of the procedures to follow if concerns about a person’s safety were identified.

People received effective health care support and care workers were able to quickly identify any health related issues and took prompt action. People’s medicines were managed in a safe manner.

Staff were carefully recruited to help ensure they had the suitable skills, knowledge and character to provide safe, effective care. There was a comprehensive training programme in place, which all staff were supported to complete.

Staffing levels were sufficient to meet people’s care needs and facilitate their valued social activities and pastimes.

People spoke highly of staff, describing them as caring, compassionate and dedicated. People felt their loved ones’ privacy and dignity was promoted at all times.

People felt fully involved in their loved ones’ care and felt staff at the service communicated well with them to keep them fully informed and updated. Care was planned in line with people’s individual needs and wishes, the things that were important to people were understood and appreciated by staff.

People were encouraged to express their views about the service and the registered manager took action as a result of their feedback. People felt able to raise concerns and were all confident any concerns they did raise would be dealt with properly.

There was a well-established management structure in place and clear lines of accountability. The registered manager and provider had effective systems to regularly assess and monitor the quality of the service that people received.

There were five people living in the home when we visited. All had communication difficulties and were unable to have a detailed conversation about the care and support they received. However where possible we talked with people in a general way and we observed how people were supported by staff. We met all five people.

We observed the care staff provided to people during the inspection. We saw staff supporting people quietly, calmly and sensitively. Records showed that people went out and about on most days, involved in a variety of activities. Relatives felt that staff supported their family member well with social, educational and leisure activities.

We observed staff communicating with people. We saw that they were able to communicate effectively together. We observed people being treated with respect and dignity.

Person centred care records were in place providing information about people. These were informative and updated frequently. They showed that people living in the home and their relatives were involved in decisions. Senior staff monitored the home effectively and sought the views of those involved in the home.

9 Beverley Road was maintained and decorated for the comfort of the people living there. Bedrooms were personalised according to people’s wishes.

The people living at 9 Beverley Road North had no verbal communication and had only limited non verbal communication. Although people were unable to answer questions, we spent time talking with them and observing staff interactions. We also spoke with relatives to find out their experience of the home.

We saw people being treated with respect and encouraged to carry out tasks in the way they wanted to. We observed that routines in the home were flexible and people were supported to get involved in activities they enjoyed.

Relatives said that their family member was treated with respect and that they were involved in decisions about care. They told us they felt that people were safe and well looked after. They said staff were approachable and they would tell the staff if something was wrong and it would be dealt with.

Person centred care records were in place, which provided up to date information about people. This helped staff to provide the right care for people.

There were satisfactory numbers of staff and staff worked flexibly to support people in the way they needed. All staff had access to a structured training and development programme, to give them the skills they needed. Managers regularly checked that the home was running well and took action if they felt improvements were needed.

The families of people living in the home spoke to us and said that staff were very good at keeping them involved in their relatives care. One relative said, “If there is any problem, if our son is ill in any way, the staff are on the phone to let us know. We have great confidence in them”. Another relative said, “The staff let us know what is going on in our son’s life.”

The families of people living in the home said they are involved in decisions taken about their relatives care and support. They spoke to us about the care their relatives received in Beverley Road. They said the care provided was excellent. One relative said “We couldn’t be happier with the care. The staff are great.” Another relative said, “I could never praise them enough. I would never get a place as good.”

The family of one person living in the home said, “The staff are receptive to any thoughts or ideas we have about the care of our son. If we feel something would be better done a different way, this has been well received and talked about.” Another relative said, “The staff take our son on days out and holidays and bring him home on visits. They are brilliant.”

The family of one person commented on how well staff supported people living in the home on the deaths of two of their ‘housemates’. They also praised United Response because they did not immediately put another person in the home in place of the deceased person. They added, “United Response took time to find someone who was compatible with those already living at Beverley Road North. Staff encouraged visits so everyone could get to know on another, so that the new person moving into the home was successful for everyone”.

One family said staff worked very well with another provider and themselves during their relative’s move to Beverley Road North and made sure the move was successful and as stress free as possible for their relative. A health and social care profession said they were well satisfied with the care and support provided in Beverley Road.

Families spoken to said they felt their relatives were safe and well looked after and that staff would immediately inform them of any concerns.

The family of one person living in the home said they were really pleased and reassured with the way staff were managing their relative’s medication reduction.

Families spoken were very complimentary about the commitment of staff and the care they provided to people living in the home. All the families spoken to said how pleased they were that the same staff were in post for a long time and how effectively they supported their relatives. One relative said, “I couldn’t be happier with the home, the staff are excellent.” Another relative said, “The staff are brilliant, excellent” and another relative commented “The staff couldn’t be better.”

A relative said of the manager, “Since she has taken over she has transformed the home.” Adding, “The staff are absolutely brilliant, outstanding and so caring”.

Families felt they had good support from staff who were willing to listen to their views and knowledge about the care of their relative. One relative said, “We are so appreciative of all they do.”

Families said that if anything had happened to their relative such as a health problem, all staff were well aware of this and knew what changes to care were needed. A relative said, “The staff communicate so well with us and between themselves”.

Relatives were also complimentary about United Response saying the organisation had high standards and made sure staff were well trained.

Families spoken to said the home provided really high quality care. One relative said, “I regularly visit without notice. I just turn up at different times and everything is always ok. I know we can trust all the staff”. Another relative said “The staff are amazing.”

The families of people living in Beverley Road North said staff listened to any thoughts or comments about the care and support of their relative and they would act on them. All the families said they had no complaints about care and could easily discuss anything they thought might improve care with the staff. One relative said, “I am certainly happy –any concerns would be rectified really quickly but I have had no complaints.”