At the last comprehensive inspection on 4 February 2016 the service was rated Good.

At this announced inspection on 9 May 2018 we found the service remained Good in Safe, Effective and Responsive. The service had progressed to Outstanding in Caring and Well-led giving it an overall rating of Outstanding.

Walnuts Care provides a range of support services for families and young people living with Autism. Services include respite care, support with social activities and daily living skills. At the time of our visit there were 70 people using the service. Walnuts Care Ltd. (WCL) was set-up in association with The Walnuts School, a community, residential Special School in Milton Keynes for young people on the Autistic Spectrum, to provide care and support for younger adults once they leave school, in addition to respite for children.

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.

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.

People and relatives told us that they were supported by very kind, caring and compassionate staff that often went the extra mile to provide them with exceptional care. People were at the heart of the service, which was organised to suit their individual needs and aspirations. There were exceptional relationships between people, their families and members of staff. Relatives told us about the positive impact the service had on their lives and how things had changed for the better. Each person was treated as an individual and as a result, their care was tailored to meet their exact needs. People were supported to use a range of personalised communication methods and staff ensured communication was not a barrier to people achieving their goals and aspirations. Staff and relatives told us that people were supported to use their individual communication methods and tools to help reduce anxiety and have greater control about their care and lifestyle.

There was an extremely positive culture within the service and the management team provided strong leadership and led by example. The registered manager and the operational manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they spoke about people. Individualised care was central to the service's philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people's care and support needs.

People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. Staffing numbers were appropriate to keep people safe and the registered provider followed thorough recruitment procedures to ensure staff employed were suitable for their role. There were systems in place to ensure people were protected from the spread of infections. People’s medicines were managed safely and in line with best practice guidelines. If any accidents or incidents occurred lessons were learnt and action taken to reduce risk in future.

People’s needs and choices were assessed and their care provided in line with best practice that met their diverse needs. There were sufficient numbers

This inspection took place on 04 February 2016 and was announced.

Walnuts Care provides a range of support services for families and young people living with Autism. Services include overnight respite care, support with social activities and daily living skills. At the time of our visit there were 70 people using the service.

The service 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.

Relatives told us their family members were safe and they had no concerns about the arrangements that were in place to keep people safe. Staff described to us their understanding of how to protect people from harm and abuse and knew what action they should take if they had any concerns. They had built good relationships with people and that enabled them to recognise any concerns about their safety. Relatives and staff were involved in compiling risk assessments and the service supported people to maintain their independence and take managed risks.

Staffing levels ensured that people received the support they required at the times they needed it. The service responded flexibly and robustly to ensure suitable staffing arrangements were available to meet people’s needs. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service.

There were systems in place so that people could be supported to take their medicines safely and as prescribed.

Staff received regular training which provided them with the knowledge and skills to meet people’s needs in a person centred manner. They were well supported by the registered manager and senior management team in respect of supervision and informal support. Specialist training was provided to staff that was specific to the people they were providing care for. This provided staff with the knowledge and skills to meet people’s needs in an effective and individualised way.

People’s consent to care and treatment was sought in line with current legislation. All staff and management were trained in the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and were knowledgeable about the requirements of the legislation.

People could access suitable amounts of nutritious food that they enjoyed and which met their individual preferences and dietary needs. Referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being.

People were at the heart of the service, which was organised to suit their individual needs and aspirations. There were exceptional relationships between people, their families and members of staff. Relatives told us about the positive impact the service had on their lives and how things had changed for the better. People were empowered to make their own decisions and to take responsibility for them. Throughout the inspection relatives and staff were keen to tell us about people’s achievements. We were provided with numerous examples of how staff had considered ways of helping people achieve their goals and aspirations. This contributed to the high levels of satisfaction expressed about the service. Relatives told us that the privacy and dignity of people was promoted by staff and they treated people and families with respect.

There was an extremely positive culture within the service and the management team provided strong leadership and led by example. The registered manager and the operational manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm