About the service: This service supported people with learning disabilities and/or autism. Care and accommodation is offered to younger adults.

The home was bigger than most domestic style properties. It was registered for the support of up to 13 people. Ten people were using the service at the time of the inspection. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything which suggested they were care staff when coming and going with people.

What life is like for people using this service:

• People enjoyed living at Weir End House and were cared for by staff who spoke warmly about them. People enjoyed friendships with other people living at the home, so they were not isolated.

• Staff were respectful to people they cared for and promoted people’s right to independence, dignity and privacy. Staff supported people to make their own decisions about their care and understood how people liked to communicate.

• Staff understood people’s safety needs well and supported them so their individual risks were reduced.

• The registered manager planned to review the systems they used to notify CQC about some important events which happened at the home, so they could be sure they were consistently meeting their legal obligations.

• People were confident to ask for assistance from staff when they wanted this, and there were sufficient staff to care for people.

• People were supported to have their medicines safely, by staff who were competent to do this. People’s medicines were regularly checked and reviewed.

• People were supported to enjoy the best health outcomes possible, and staff were supported to do this by the systems the registered manager had put in place to promote good working with organisations.

• People's, their relatives' and other health and social care professional’s views were listened to when people’s needs were assessed and plans for their care were agreed and reviewed. Staff understood people’s histories, what was important to them, and how people liked their care to be provided.

• Staff saw when people’s needs changed and adjusted people’s planned care, so people’s needs continued to be met.

• People were supported to keep in touch with relatives and friends who were important to them.

• The environment at the home was regularly checked. The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• Staff had been supported to receive the training they needed and to develop the skills they required to care for people.

• 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.

• Staff supported people to have enough to eat and drink so they would remain well.

• People enjoyed a range of activities which reflected their interests. This included spending time in the community doing things they liked and to go on holidays.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways [promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

• Systems were in place to take any learning from complaints and to reflect on people’s needs and to further improve people’s care.

• The registered manager sought suggestions for improving people’s care further and suggestions were listened to and acted on.

• The registered manager and staff reflected on the care provided, so improvements in people’s care would be driven through. The registered manger planned to continue to develop the

Weir End House is located in Ross-on-Wye, Herefordshire. The service provides accommodation and care for up to 13 people with learning disabilities. On the day of our inspection, there were 12 people living at the home.

The inspection took place on 25 July 2016 and was unannounced.

The registered manager had left the home in February 2016 and consequently, there was an acting manager and an acting deputy manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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’s individual needs were known by staff, and how to keep them safe. People were involved in decisions made about keeping them safe. People were supported to maintain their freedom. People received their medicines from trained and competent staff.

People’s health and wellbeing were maintained and they received specialist input from a range of health professionals.

People were supported by staff who understood the importance of offering choices in the care people received. People were supported to eat and drink and enjoyed their meals.

People enjoyed positive and respectful relationships with staff. People’s privacy was maintained. People were involved in decisions about their care.

People’s changing health and wellbeing needs were responded to. People enjoyed group social events, leisure opportunities and outings, but could not always pursue their individual hobbies and interests. People knew how to complain as this information was provided to them in a way which was clear to them.

People took part in monthly meetings in which they were given the opportunity to make comments and suggestions about the running of the home and the service they received. People, staff and relatives benefited from an open culture in which the acting manager was approachable and inclusive.

People told us they liked living at the home and felt they were well supported. We found that people were encouraged to be independent, be involved in activities of their choice and access local community facilities.

The staff team knew people and their preferences well. People’s wellbeing and any concerns were taken seriously. People had care plans that were reviewed. One person’s change in circumstances had not been reflected in their care plan but the care was being delivered correctly.

There was a consistent staff team that were suitably trained and felt well supported. The team sought input from external professionals when needed and worked closely with them taking on their advice.

The senior management of the home had remained stable. The manager and provider formally monitored the quality of the service. There were effective leadership arrangements in place to manage the care service and monitor health and safety risks.

When we visited we met eight of the people who lived there. We found that people were well presented and the staff engaged pleasantly with them involving them in daily living tasks and planned activities. People told us that the staff listened to them and respected their views.

People were provided with a nutritious and interesting diet. They were also encouraged to take part in some food and drink preparation. Suitable systems were in place to support people with their daily medicines.

The home was homely, clean and effective systems were in place for infection prevention and control.

The staffing levels were adequate to support people while both at home and when out in the community. People felt able to tell the manager and staff if they were unhappy or had a concern.

When we visited Weir End House we spoke to the registered manager and three of the staff. The majority of people who lived at the home were attending activities at a local community hall so we went there to meet them. We saw that people were enjoying games at the end of the day.

While visiting the hall we spoke in private with two people who lived at the service. They told us they were happy living at the home, they trusted the staff and were able to tell the manager if they had any concerns. One person told us “I like the staff, they have helped me a lot since I moved in”. Both people told us they enjoyed the activities they took part in, such as swimming. One person told us “The staff help me stay in touch with my family and I speak to them in private on the telephone”.

The registered manager told us that people took part in daily living tasks and had responsibility for things that interest them. This meant that one person looked after the donkey. The registered manager told us that some people who lived at the home had got voluntary jobs and some were supported to carry these out.

Five people who lived at the services gave us permission to look at their bedrooms. These had been decorated and furnished to reflect their personal preferences.

We met the staff who worked at Weir End House. The staff we spoke with told us about the care and support needs of the people who lived at the home. We saw how staff at the community hall interacted with people who use the service in a friendly, courteous and respectful manner.

The registered manager told us the home was fully staffed. The people we spoke to who lived at the service liked the staff and were pleased that staff did not leave very often.

People who lived at the service had given their views and ideas for improvements at the, “Your Voice” group meeting which had been held each month. People had been provided with information at these meetings in their preferred method of communication. This had helped people take part in discussions about their right to vote at local elections and how people were going to keep a new vehicle clean and tidy.