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Inspection carried out on 4 December 2018

During a routine inspection

What life is like for people using this service:

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People continued to receive safe care. Staff had a good understanding of safeguarding procedures that should be followed to report incidents of harm or concern.

Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

People were supported to be as independent as possible, often through activities that carried a risk of injury such as swimming and horse riding. These activities were risk assessed to mitigate risk of injury and without unduly restricting people from exercising choice.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Safe staffing levels were in place to meet people's needs.

There were procedures in place for evacuating people with limited mobility in the event of an emergency.

Infection control procedures were in place that were based on Code of Practice on the prevention and control of infections. The premises, including communal areas and people rooms were clean and fresh.

Staff training had training that provided them with knowledge they needed to perform their roles. The management team supported staff to put their training into practice. Staff were knowledgeable about people’s needs. Two staff had won national awards in recognition of their support of people who used the service.

People were supported with their nutritional needs.

Staff obtained people's consent before they provided care and support. 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 treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner, addressing them by their preferred name. We saw positive and friendly interactions between staff and people. Staff acted professionally and recognised professional boundaries without compromising the quality of care and support.

People or their relatives were involved in the planning of care and could contribute to the way in which they were supported. People and their relatives were involved in reviewing their care and making any necessary changes if they wanted.

People participated in a wide range of meaningful and stimulating activities.

Care plans were detailed and included information about the support people required. People experienced outstanding outcomes because of the care and support they received.

People knew how to raise any complaints or concerns. These were acted upon promptly and where necessary the management team reviewed care plan and made changes.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection: Good (report published 23 June 2016).

About the service: Waring Close is care home that was providing personal care to 16 people at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 20 May 2016

During a routine inspection

We inspected the service on 20 May 2016 and the visit was unannounced.

Waring Close consists of one house and two bungalows, purpose built to provide person centred support for up to 16 people with learning disabilities who may also have autism.

The service had a registered manager in place although they were currently away from work. It is a requirement that the service has 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 area manager was providing support to the staff in the absence of the registered manager.

Relatives felt that their family members were safe. Staff understood their responsibilities to keep people safe and knew how to respond to accidents, incidents and concerns they may have had about abuse. The provider had made sure that people were being protected from avoidable harm, for example, by regularly checking equipment and having plans in place to support people with their behaviour that could challenge.

People’s support needs had been considered to keep them safe during an emergency. The provider had a plan in place to make sure that the service would continue in the event of a significant event such as a fire.

People were being supported by staff who had been checked before they had started to work for the provider. This had helped the provider to make safer recruitment decisions. Relatives and staff felt there were enough staff available to support people to keep safe and we found this to be the case during our visit.

People received support to take their prescribed medicines. Staff had received training and support on how to handle medicines safely. People’s medicines were not always stored securely. We found that people's cabinets were not always locked. We also found that staff had not always signed when they had administered people’s medicines. We were given assurances after out visit that all medicines cabinets were now locked and that an audit was being carried out of people's medicines.

People received support from staff that had undertaken training. The provider had plans in place to address any gaps in the required training. For example, some staff required training to support people when they became anxious. The area manager told us that this training would be attended by all staff within the next six months.

Staff had received guidance in order to provide effective support to people. For example, they had received an induction and attended regular meetings with their supervisor to discuss and gain feedback on their work.

People were being supported in line with the Mental Capacity Act (MCA) 2005. Where people were able to express their own choices this was being encouraged. The provider had undertaken assessments where people may have lacked the capacity to make decisions for themselves. We found that staff knew about the MCA and could describe how to protect people’s rights. Advocacy support was being provided where people required this to make important decisions.

People were being supported to remain healthy and had access to healthcare professionals. For example, we saw that people had seen their GP when they had become unwell. We also saw that people were being supported to eat and drink based on their preferences. Where there were concerns about a person’s well-being, staff knew what to do and took the appropriate action.

People were receiving support by staff who showed kindness. Their privacy and dignity was being respected and their care records were being handled and stored safely. People were being supported to maintain relationships that were important to them.

Staff knew about people’s preferences and things that mattered to them. People were being supported to be

Inspection carried out on 14 November 2013

During a routine inspection

As part of the inspection we observed people living at the home, spoke with several support workers and two senior support workers. We were unable to speak with people who used the service due to their limited and specialised communication. We were accompanied by an expert by experience to help us understand people�s experiences of the home.

We looked at numerous records including people�s care records, staff records, medication records and records in relation to the management of the service. The registered manager was unavailable on the day of our visit but we spoke with them the following day. The manager sent us some further information that we requested.

Our observations showed that people were comfortable, well kempt and were being cared for in a pleasant and clean environment. People�s bedrooms had been decorated according to their personal tastes and staff had a good understanding of people�s needs. We found that people�s independence and community involvement had been promoted by the service and we saw that staff treated people with dignity and respect.

Staff we spoke with were positive about their roles and demonstrated a good rapport with people using the service.

We looked at the records of six people who used the service and found care had been planned and delivered appropriately with regard to people�s health, safety and welfare. The service had appropriate arrangements in place to ensure people�s legal rights were upheld when they did not have capacity to make decisions about their care and support.

There were appropriate arrangements in place for the obtaining and administration of medication.

Staff had been appropriately screened to ensure they were appropriate to work with vulnerable people and had received a thorough induction.

There was an appropriate complaints handling process in place and arrangements were in place to support people with making a complaint.

Inspection carried out on 15 October 2012

During a routine inspection

At the time of our visit most people who used the service were not present as they had gone on holiday or were at daycentres. We were unable to speak with people we did meet and gain their views about the service due to their limited and specialised communication. However, from brief observations we saw that people were comfortable and relaxed with staff.

We looked at the results of the services last satisfaction survey. Comments included �X was cared for in a very special way during her recent bout of ill health� and �pleased with my son�s care, excellent staff, very kind and supportive to him�.

We found people�s needs were assessed and care was planned and delivered in line with their individual plan. Records contained details of people�s health needs and contact details for involved health care professionals. We found that people�s health had been monitored by the service and when necessary appropriate referrals to health professionals had been made.

We looked at the records of three members of staff during our inspection. Records showed staff had undertaken a range of training in topics linked to the care and welfare of people which included, manual handling, autism awareness and first aid. We found that the service was compliant with the essential standards of quality and safety that we inspected.

Inspection carried out on 15 November 2011

During a routine inspection

Some people we met have limited and specialised communication, therefore we were unable to directly ascertain what people felt about their experiences in all the outcome areas.

Comments made in the 2010 Quality Assurance questionnaire included-

�My daughter is always looked after well, and is treated well, I am happy with my daughter's support, and knows who to contact if there is a problem.�

�I as a parent is very happy with my sons care and all the staff are very friendly when I go to see him.�

�By the sparkle in my friends eye's he certainly enjoys his home and ongoing activities - with excellent staff and their support.�

There were no negative comments passed.

We observed members of staff talking with people throughout the visit. This was done with privacy and dignity in mind and showed the staffs� awareness of individual support needs.

We spoke with the staff group and found they were aware of how to safeguard people and how to recognise different forms of abuse.

Reports under our old system of regulation (including those from before CQC was created)