This inspection took place on the 5 and 6 January 2017 and was unannounced. Whiston House provides accommodation and support for up to 15 people who may have a learning disability or autistic spectrum disorder. Some people display behaviour which may challenge others. At the time of the inspection 11 people were living at the service, the service was divided into two areas. The top part of the service was called The Willows which was more suitable for people who were more physically able; the bottom part of the service was called The Oaks which was suitable for people with mobility issues.

Within both areas of the service people had access to a communal lounge, dining room, kitchen, shared bathrooms, and laundry room. Each person’s bedroom had its own ensuite facilities. There was a large garden which people could access when they wished.

The service is run by 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. The registered manager was present throughout both days of the visit.

There were enough staff with the right skills and knowledge to support people. Staffing was sufficient and flexible to meet people’s needs; staff had time to respond to people’s needs in an unrushed way. People were given the time to communicate at a pace that suited them. Staff had good support and supervision to fulfil their role effectively and felt confident in approaching the registered manager if they needed extra guidance. People were protected by the service using safe and robust recruitment processes.

Staff understood that although they had a duty of care to help keep people safe, people were also free to make their own choices even if this could increase the level of risk to that person. The risk of harm to people was reduced as robust risk assessments had been implemented. Staff were trained in safeguarding and understood the processes for reporting abuse or suspected abuse.

Incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people. Staff had clear guidelines to follow to support people with behaviour which could challenge others, interventions focused on being preventative rather than reactive.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment.

There were safe processes for storing, administering and returning medicines. Medicines were administered by trained staff who were regularly competency checked by the registered manager and deputy manager.

The registered manager had a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). People were offered advocacy services and the provider had taken the appropriate steps to meet the requirements of the legislation. Staff understood the importance of asking people for their consent when supporting them with their needs.

Staff had appropriate training and experience to support people with their individual needs and demonstrated a clear understanding of the people who lived there. Staff were supported to undertake further health and social care qualifications to improve their knowledge and skills.

The service was good at responding to people who needed help to manage their health needs. People were supported to access outside health professionals.

People were offered a variety of food and drink and were encouraged to make their own choices around this. Staff monitored people’s food and drink intake so further professional health input could be sought if necessary.

Staff demonstrated caring attitudes towards people. People felt confident and comfortable in their home and staff were easily approacha

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not always able to tell us about their experiences. One person we spoke with told us that they were going out to buy a paper and drink that day. A relative told us that “[The manager] is wonderful. All the staff I have spoken to are brilliant.” And “[Their relative] does drawings and puzzles”. A mental health professional who visited the service to provide support to one person living there told us “The staff were keen to help and support” and “I felt that [the person] was well looked after.”

We saw that the provider had systems in place to obtain consent from people in relation to people's care and support.

People received care that met their needs and promoted their rights. Advice and guidance was sought from health and social care professionals to be able to meet people's needs effectively and promote their welfare and safety.

There were systems in place to manage people’s medication effectively and safely.

Staff were supported to undertake their roles safely and effectively. They received relevant training, regular supervision and were encouraged to undertake further professional development. Staff told us that “It is a good team” and the manager was approachable.

There was a system in place to manage compliments and complaints and we saw that complaints had been responded to promptly. One person told us that they could talk to any of the staff if they had any problems and they would resolve the matter for them.

Because of their complex needs, only limited communication was possible with the residents at the home. Those we could communicate with expressed contentment with the care provided for them. We observed residents and they appeared to be happy at the home. We talked to families of residents who said that the staff were caring. Staff kept them informed about any issues that affected their relative. We spoke to local social services who raised no issues of concern.

It was not possible to talk directly with people who lived in the home about most of the outcomes because it was difficult for them to engage with the process. We spent time with people during our visit, they showed us they were content living in the home and got on well with staff and the manager.