24 Windermere is registered to provide accommodation and personal care for up to two adults with learning disabilities. At the time of our inspection there was one person living in the home. The service is one of many, run by the White Horse Care Trust, within Wiltshire and Swindon.

At the last inspection in January 2015, the service was rated as ‘Good’. At this inspection we found the service remained ‘Good’.

A registered manager was employed by the service but was not present during our inspection. The deputy manager and area care manager were available throughout our inspection. 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 benefitted from a safe service where staff understood their responsibilities to safeguard people from potential harm or abuse. Staff understood the procedure they needed to follow should they suspect abuse might be taking place. Risks to people’s safety were identified and plans put in place to help reduce the risk of them occurring and to support staff to manage people’s safety.

People’s medicines were managed and administered safely. People’s health care needs were monitored. Records confirmed that where people’s health needs had changed they had access to appropriate healthcare professionals.

People were able supported to eat and drink sufficient amounts and maintain a balanced diet.

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 practice.

Staff received appropriate training to ensure they had the necessary skills and knowledge to support people to meet their needs. Staff treated people with kindness and respected people’s privacy and dignity. People were supported in a way that allowed them to be as independent as possible.

Care plans were person centred. They contained detailed information of the person’s daily routines, preferences, likes and dislikes. Records showed care plans were reviewed regularly and any changes to care updated.

The service had systems in place to monitor the quality of care provided and these were reviewed on a regular basis. The service had a clear process for the handling of complaints.

The inspection took place on the 8 and 12 January 2015. This inspection was announced. We gave the provider 24 hours’ notice. This was because there are only two people living at 24 Windermere and we wanted to ensure people were at home during our visit. During our last inspection we found the provider satisfied the legal requirements in the areas that we looked at.

The home 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.

24 Windermere provides accommodation and personal care for two people who have learning disabilities. The main focus of the service is to treat everyone as individuals and involve them in choices which promote their independence. Relatives were positive about the service their family member received.

CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require providers to submit applications to a ‘Supervisory Body’, the appropriate local authority, for authority to do so. We found that the service had complied with the requirements of the MCA and DoLS.

Because of people’s complex needs they were unable to tell us verbally about their experiences of living at 24 Windermere. However, staff members communicated with people effectively. Staff treated people in a caring, kind and respectful way. They knew the people they cared for and supported well and always used people’s preferred names.

People were involved in deciding what food and drink they had. They were supported to access healthcare services to maintain and promote their health and well-being. They were encouraged to make their rooms at the home their own personal space. People and their relatives had been involved in the development of their care plans which were reviewed on an annual basis, or more frequently if required.

They were supported in a range of interests, both as activities together or on an individual basis, which suited their needs. They were encouraged to take part in activities outside of the home to enable them to access their local community.

There were enough qualified, skilled and experienced staff to meet people’s needs. All necessary checks had been completed before new staff members had started work at the home and they had completed an induction programme when they started work. Staff members received training in areas that improved their capability in providing care and support to people who lived at the home and had regular supervision and appraisal meetings with the manager at which their performance and development were discussed

Staff members were able to demonstrate a good understanding of procedures in connection with the prevention of abuse. Risk assessments in respect of the home and the provision of care and support to people had been carried out, regularly reviewed and steps taken to reduce the on-going risk.

The provider had systems in place to ensure that medicines were administered and disposed of safely. All medicines were stored securely.

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

People who lived in the home had their care and welfare needs met by an experienced staff team. Care and support plans were in place that were detailed and regularly reviewed and updated.

People’s health needs were correctly monitored and a healthy diet was promoted. Choice around food was encouraged.

All staff received training in adult protection.

The service had an effective recruitment policy in place and the appropriate checks were completed on new starters.

The provider had systems in place to monitor the quality of the service being delivered and to identify and manage risk.

We read the review of one person which happened the day before our inspection. We saw that three generations of the person's family were present and the review had been arranged on a date to suit the family. This ensured that where people lacked capacity, best interest meetings were held with people who knew and understood them.

Relatives told us that their family member felt really safe and happy because the staff knew him so well. One relative said, “He loves it there. After visiting us his face lights up and he can’t wait to go back”. Other relatives told us that they were always kept up to date with changes to medication and daily care plans. One parent said, “They always treat him so well. I’ve never seen him so happy”.

Appropriate arrangements were in place in relation to obtaining, handling and storing medicine. Relatives said they had seen staff giving people medicine in an appropriate and friendly manner.

Families told us that the staff provided excellent care, which made them confident in the quality of their training. They said the staff were well trained and were like another family to the people they supported.

Relatives we spoke with confirmed they had not made a complaint but were aware how to do so and understood the process. In a visitors survey a community nurse said, “The staff are always so welcoming and friendly. You can see the way they support people is totally based on giving them choice and preferences”.

We spent time with the people who lived at the home but they had limited capacity to provide meaningful feedback about the service. We observed that people were well supported with their personal appearance and appropriately dressed, and they were happy and relaxed in the company of staff that they knew.

We spoke to two relatives on the telephone. They were confident that their family members’ needs were met and that they were well cared for at Windermere. One person told us: “I think X is very happy there. He is always keen to go back when we have taken him out. Both people said that they were always made welcome in the home and were kept informed of their relative’s progress. One relative told us however that multidisciplinary reviews of their relative’s care took place at inconvenient times and they were unable to participate in them. They said that as a result of this, they were not well informed about their relative’s current medicines.