The inspection took place on 20 June 2017 and was unannounced.

Vicarage Road provides accommodation and personal care, for up to six adults. They specialise in care for adults who may have learning disabilities or autistic spectrum disorder, dementia, physical disabilities or sensory impairments. Six people were living at the home at the time of our inspection. At the last inspection, the service was rated Good overall. At this inspection we found the quality of service had improved even further and was now Outstanding in the well-led key question.

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.

The providers’ values were person-centred and made sure people were at the heart of the service. Staff shared this view and had a common vision to provide an environment where people were enabled to live their lives as they chose, pursue their interests and maintain their independence. Staff demonstrated they cared through their attitude and engagement with people. People were valued and staff understood the need to respect their individual wishes and values. Staff knew people well and they respected people’s privacy and dignity and encouraged people to maintain their independence.

People were encouraged to plan ahead, set personal goals and maintain their interests. They were supported to take part in social activities which were meaningful to them, in a group or on a one-to-one basis and these improved the quality of people’s lives.

The provider was innovative and demonstrated sustained improvement to the quality of care they delivered. They worked in partnership with other organisations to make sure they followed current best practice and provided a high quality service. They had developed systems which ensured excellent standards of care were maintained for people.

The registered manager and deputy manager were dedicated to providing quality care to people. They valued staff and promoted their development. There was an open culture at the home where staff felt well supported, able to raise any concerns and put forward suggestions for improvements. The provider encouraged people to provide feedback on how things were managed and to share their experiences of the service in creative ways which suited their needs.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks, while promoting people’s independence. People and their families were included in planning how they were cared for and supported. The registered manager regularly checked that the premises and equipment were safe for people to use.

Staff understood their responsibilities to protect people from the risk of abuse. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were administered and managed safely.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain a healthy diet that met their preferences and were referred to healthcare services when their health needs changed.

When we visited Vicarage Road we spoke with the registered manager, the home leader and one support worker. The six people who lived at the home had complex needs. This meant they were not able to tell us in detail about their experiences. Therefore we observed care practice and staff’s interaction with people when they delivered their care. We read the care records for two people who lived at the home.

We saw that people who lived at the home were relaxed. Staff demonstrated they understood people’s personal needs and the individual ways they communicated their needs.

On the day of our visit, people who lived at the home engaged in different activities throughout the day. Five people spent the day at the provider’s resource centre. People told us they were going to do music and sewing. One person spent the day at a local farm. They told us they were going to, “Help out.” We observed staff speaking with people when they arrived home, about what they had done during the day. We saw that people were happy to share their experiences with the staff.

During our visit we observed that the staff were polite and asked people’s permission before they helped them. We found that people had agreed to the care and treatment they received.

We saw that the home was clean and well maintained. Staff we spoke with explained how they minimised the risk of infection.

We found that the provider had an effective recruitment process and appropriate checks were made on staff before they began work.

We found that the provider dealt with complaints and comments in accordance with their policy.

One person we spoke with who lived at the home told us, "I like my home. I love it.”

We spoke with two people who lived at Vicarage Road on the day of our inspection about their experiences of the service. We observed the care that was given to people during our inspection. We also spoke with a member of staff and the manager who supported people.

People we spoke with told us that the care that was discussed with them matched the care that was being provided to them. We saw their family members were regularly kept up to date about the changes to their relative's care. We saw staff listened to the people's input about their care needs and their wishes.

We saw that the care plans were person centred and reflected the people’s individual needs. We saw the member of staff supported the person as detailed within their care plan. We saw care plans were easy to read and had pictures to help people understand their care plan.

People we spoke with told us that staff were friendly and supported their needs well. We saw staff knew what people's care needs were and how they needed to be supported.

We spoke with the staff member about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

On the day of the visit on 24 August 2011, we spoke with people living in the home and staff. We saw that the home provided a small, homely and comfortable living environment for the six people that lived there. Five of the people living in the home were at home and there were no visitors in the home on the day of the visit.

Due to the needs of some people living at the home who were unable to verbally share

their experiences, we spent time observing the support given to people and how they

spent their day.

People living in the home, who were able to do so, told us that they were happy with the care they received. They told us “I like it here’ and “I like everything.”

We observed how staff offered people care and support and how staff spoke with them. We looked at how staff interacted, to ensure that people were treated with dignity, were able to stay as independent as possible and if they were offered privacy.

We found that staff treated people kindly and respectfully and demonstrated that they knew them as individuals and understood their personal needs. We saw that staff tried not to speak for people, encouraging them with their own methods of communication.

We looked at the kinds of activities and events that happened in the service and asked people about how they spent their day. They showed us pictures of the daily schedules and what each one did on a day to day basis. We saw that people assisted staff with cleaning, and tidying, laundry, cooking, shopping and washing up.

People told us they enjoyed going to day centres and to college and also told us about their trips out of the home and holidays spent both in England and abroad.

People told us they liked the food provided and how they chose the menu on a daily basis.

We were shown their individual and private rooms and the bathrooms. They told us that they were happy with their rooms and how they chose the decoration. “I like my bedroom, I like the colour pink.”

We carried out this inspection on 2 and 17 March 2015. The inspection was unannounced.

Vicarage Road provides accommodation and support for up to six people with learning disabilities and there were six people living at the home at the time of our inspection.

A registered manager was in post but at the time of our inspection the service was being managed by the deputy manager, as the registered manager had been away from the service for some time. 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 we spoke with told us they felt safe living at Vicarage Road. Staff demonstrated they understood the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Risks to people’s health and welfare were assessed and care plans gave staff instructions on how to minimise identified risks, so staff knew how to support people safely.

There were enough staff on duty to meet people’s needs. Checks were made on staff’s suitability to deliver personal care during the recruitment process.

There were processes in place to ensure people received the medicines prescribed for them in a safe manner.

Staff received training and support that ensured people’s needs were met effectively.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). No one was under a DoLS at the time of our inspection. People’s records showed that their families and other health professionals were involved and decisions were made in their best interests.

People were supported to maintain a balanced diet. Staff referred people to other health professionals for advice and support when their health needs changed.

We saw staff supported people with kindness and compassion. Staff treated people in a way that respected their dignity and promoted their independence.

People and their relatives were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed.

People were encouraged to share their opinions about the quality of the service and we saw improvements were made in response to people’s suggestions.

Staff were supported by the provider in the absence of the registered manager. The deputy manager maintained an open culture at the home and there was good communication between staff members.

There were processes in place to ensure the necessary standards of care were maintained for people.