No 9

Updated 19 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 30 November and 1 December 2017. Both days of the inspection were announced. The provider was given 48 hours' notice because the service is for younger adults who are sometimes out during the day, so we needed to be sure someone would be in. We visited the service on 30 November and 1 December 2017. On 7 December 2017 we sought the views of four relatives via telephone calls and emails. The inspection was undertaken by one adult social care inspector.

Before the inspection we reviewed the information we held about the service. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about. We also contacted the local authority commissioners for the service, the local authority safeguarding team, the clinical commissioning group (CCG) and the local Healthwatch to gain their views of the service provided. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the feedback we received to inform the planning of our inspection.

We also looked at the Provider Information Return (PIR), which we had asked the provider to submit to us prior to the inspection. This is a form that asks the provider to give us some key information about the service, what the service does well and improvements they plan to make.

As part of the inspection we undertook a number of different methods to understand the experiences of people who used the service. Some of the people who used the service had complex needs which limited their communication. This meant they could not always tell us their views of the service so we sought the views of four relatives.

During the visit we observed how people were supported in communal areas. We spoke with the registered manager, deputy manager, a senior support worker and four support workers. We also spoke with the provider’s head of care, who was the nominated individual, and the provider’s operations manager. A nominated individual has overall responsibility for supervising the management of the regulated activity and ensuring the quality of the services provided.

We viewed a range of care records and records relating to how the service was managed. These included the care records of two people, the medicines records of three people, recruitment records of three staff members and records relating to staff training, supervisions and the management of the service. We also checked the building to ensure it was clean, hygienic and a safe place for people to live.

Updated 19 May 2018

This inspection took place on 30 November and 1 December 2017. Both days were announced. We gave the provider short notice of our inspection due to the nature of the service. This was so the registered manager could be available to assist us with our inspection.

No 9 is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. No 9 provides personal care for up to six people with a learning disability and/or autistic spectrum disorder. At the time of our inspection there were five people living at the home. The home has five large bedrooms and a separate self-contained flat where one person lives. The home is located next door to another of the provider’s services, both of which are managed by the same registered manager and deputy manager.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected this service on 3 September 2015 when it was rated 'Good' overall. During this inspection we found the service remained good and rated the key area of responsive as 'Outstanding.'

People’s lives were enhanced through access to an excellent range of activities which made them feel socially included. Relatives told us how people’s independent living skills had greatly improved since living at the home. Relatives told us staff knew people’s needs exceptionally well. The service had an innovative approach to how technology could be used to improve people’s quality of life.

Relatives described the progress people had made since living at the home as 'Outstanding.' People had made substantial progress due to the use of the SMART (specific, measurable, achievable, realistic and timely) target system. These targets were a way of setting goals for people to work towards in areas that really mattered to them and which improved their quality of life. These targets and other positive proactive support strategies had resulted in a reduction in the number of incidents that could be challenging for people. The strong focus on person-centred care had a very positive impact on people.

All of the relatives we spoke with said staff were kind and caring. Staff were highly motivated to provide compassionate care and spoke about the people who used the service with great affection and respect.

There were appropriate systems in place to protect people from harm. Staff were trained in how to safeguard vulnerable adults and told us they felt able to approach the registered manager with any concerns about people who used the service.

Staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people.

Risk assessments were in place for people and staff. Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

Staff received induction, training and supervision that helped them to give good levels of care and support. They were trained in principles of care in relation to people living with a learning disability and/or autistic spectrum disorder.

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.

People were supported to maintain their health and wellbeing by attending regular appointments with health care professionals. Meals were planned weekly based on people's likes and dislikes. People were supported to maintain a balanced diet and to have enough to eat and drink.

Relatives and staff felt the service was well managed. Staff described the registered manager as approachable and said there was an open culture. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.