The inspection of this service took place on 15 December 2016 and was unannounced.

Welbeck house provides care and accommodation for up to four people with a learning disability. There were four people living at the home on the day of our inspection.

There was a registered manager in post and they were present at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, 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 were supported by staff who knew how to keep them safe and free from the risk of harm. Staff knew how to recognise and report any risks, problems or potential signs of abuse. Risks were assessed and managed safely whilst promoting people’s independence. People were protected by safe systems for administering, storing and recording medicines.

People were supported by sufficient staff to meet their needs safely and effectively. People received flexible and responsive support. Staff were recruited through safe recruitment practices which meant only people suitable to work in the role were appointed.

People who required support to take their medicines were protected by safe systems in place for administering, storing and recording medicines.

People were supported by staff who had the knowledge and skills to provide effective support. Staff received training to enable them to meet the individual needs of the people who used the service.

People’s rights were protected under the Mental Capacity Act 2005 and staff had an understanding of how it affected people’s care. People were offered choices as to how they lived their lives and staff recognised the importance of people making their own decisions

People were supported to eat and drink and were given choices about what they ate and we saw people enjoyed their meals. Staff worked with healthcare professionals when required to ensure people maintained their good health and wellbeing.

People were supported by staff who were caring and supportive. Staff knew how people liked to be supported and they enabled people to live the lives they chose. People’s privacy and dignity was respected.

People received a responsive service which met their individual needs. Care plans were detailed and people had been involved in developing them. People were supported in ways they preferred as staff were aware of people’s individual needs and preferences .People enjoyed a range of activities of their choice.

People knew who to speak to if they had a worry or concern about the service provided. They were confident that their concerns would be acted upon. The provider had a system to deal with any complaints.

The registered manager provided good leadership. People and staff told us they were involved in the running of the service. Staff felt well supported and there were systems in place to monitor the quality of the service provided.

We spoke with three people who lived at the home, the manager and the provider’s representative.

People told us they were happy with the care and support they received from staff. One person said, “All staff help me in here”. Another person said, “I’m quite happy here”. People told us they had regular contact with health professionals.

We saw that up to date information was available for passing to other providers should people use their services. This meant the home was able to support people receiving consistent care and support when they moved between different services.

The provider had systems in place that promoted infection control whilst respecting people’s wishes as to the décor of the home.

The home was staffed with suitably qualified, skilled and experienced staff because the provider carried out appropriate checks before staff began work. We saw the manager kept people’s dependency under review and any impact this may have had for the staffing numbers to ensure people needs continued to be met.

The provider had an effective system to regularly assess and monitor the quality of the service that people received.

We spoke with three people who lived at the home, two staff and the manager.

People’s decisions were well recorded in their records. We saw that a person was supported to understand medical treatment they were to have from another service. A relative had commented that “Everyone seems to have (the person’s) best interests at heart”. This meant people were supported by staff to make informed decisions.

People had regular contact with health professionals. This was documented in records and confirmed by people we spoke with. One relative stated in a survey form that “We are more than happy with how (the person) looks and how happy he seems”.

We spoke with people about foods they liked and these reflected what we saw recorded in their records and the home’s menu. People told us they discussed food choices with staff. This meant that people had involvement in their food choices.

We spoke with two staff about how they were supported to do their jobs. One told us that the managers within the company were “Really approachable” and were always available on the end of a phone if they needed support.

We saw that people were able to tell staff about things that they wanted without reservation. We saw comments from a social care professional that “Any concerns or queries are dealt with quickly and efficiently when Sarah (the manager) is on duty”. This meant that people were able to raise any issues that they were concerned about.

We spoke with people living at all three of the provider’s locations. The following reflects the views of all people using the provider’s service. Where comments related to a specific service location this is stated.

People told us about the care they receive. We found that this reflected their needs and choices as recorded in their care plans, and books that were titled ‘all about me’. One person informed us that the ‘all about me’ book was owned by them. We saw it contained lots of photographs of them and their life. Some people told us they were not bothered about their care plans but said staff had spoken to them about it. Other people told us that they had seen their care plans. Most people we spoke with told us about choices they had made and how staff had involved them in making decisions.

We spoke with a health professional at the Hilton House and they told us that staff had asked for help in ensuring a person understood the care options available to them due to refusal of a specific treatment. The home has since worked with other health professionals. This has given the individual a chance to have a better understanding about what would be involved in respect of the treatment, so they can make a better informed choice.

People told us that they are supported to live their life as they choose and participate in activities that they enjoy. People told us that they are given an opportunity to pursue their individual interests and they informed us that they “Decide what [sic] going to do every day” “come and go like manager does if feel like it” and “Like staying here, playing on games”. Some people told us about the day centres and other places in the community they go to such as the local pub, theatre, cinema and shops. People said to us that staff are flexible and take them out by ring and ride or taxi. Some people used ring and ride to go out independently (subject to risk assessments that we saw) and others are supported by staff as needed. People told us they have access to a telephone and are able to keep in touch with family and friends.

People told us that they liked the staff as they were approachable and listened to them. Interaction that we saw between staff and people living at the home was relaxed and positive. People told us that they are encouraged to be independent with staff only offering assistance when needed with tasks they could not complete. We saw that people are able to move around the houses as they wish and are able to go to their rooms for privacy whenever they want.

Risks to people are recorded and steps taken to reduce any potential dangers. The only notable exception was the lack of recording to how staff would deal with one individual’s epilepsy in the event of a seizure. This related to a person living at Hilton House. The individual in question had not had a seizure recently though, but staff would need to be aware of what was expected in the event they did. We saw in Walton and Welbeck House that people’s plans included such guidance for people who have epilepsy.

People we spoke to told us that they had contact with health services as and when needed. One person told us “If need to see anyone staff sort” in respect of health services. People told us about seeing opticians, dentists and their GP. Some people were out attending GP appointments on the day we visited Hilton House.

People told us that staff listen to what they say and deal with issues that may arise. One person told us they “Talk to staff, if not happy, do something about it” and another said “Can complain and staff listen to me”. Other people told us that they are “Safe in here”. Some people told us that they meet with managers from the day centres they use and know they could raise concerns with them as well as their families. No one we spoke to had any worries about where they lived or the staff that supported them.

We spoke to staff about what they thought abuse was, and they showed us they had a good awareness of what should be reported. This meant that abuse would be investigated and people would be protected. Staff confirmed that the provider has a no restraint policy and this reflected what people told us.

People we spoke to told us that they get their medication on time. They told us they consent to the staff managing their medication. One person at Welbeck house said that their GP had reviewed their medication recently. They also told us that their medication is stored safely, and that when staff give them their tablets they can take these themselves.

All the houses we visited are adapted semi- detached buildings that blend in with the surrounding housing. There is nothing to indicate that they are anything other than a family home. We also saw that there is sufficient communal space in all the houses to allow people privacy when needed. We saw that people have access to keys to their bedroom doors, although most told us they are not to bothered about having these.

People from all three houses told us about how they are involved in the running of the home and their choices are listened to. They told us how redecoration of their rooms was chosen by them. They also told us about how changes within the service are discussed with them. People have meetings to discuss developments at their respective homes; minutes of these were seen and signed by people living at the homes. We also heard that people can speak to the managers or staff on a one to one basis should they wish.

They told us “Its alright I love it here”, “Happy here” and “Love it here, would be no where else”.

People told us that they like and have confidence in the staff team at their respective homes. One person told us “they are pleasant helping out and all that”.

Staff told us that they have sufficient training to do their job and usually have refresher training every year.