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Inspection carried out on 22 November 2018

During a routine inspection

What life is like for people using this service:

People remained safe at the service and risks around their well-being were assessed, recorded and regularly reviewed. People were supported by sufficient staff that knew them well. Recruitment procedures to appoint new staff were thorough. People were supported to take their medicines safely.

The registered manager conducted quality assurance audits to monitor the running of the service. However, we found that these were not always effective as they didn’t always identify gaps in medication records. We recommend that the provider seeks guidance around the proper and safe management of medicines.

People received their care and support from a staff team, that had a full understanding of people's care needs and the skills and knowledge to meet them. Staff were given an induction when they started and had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently.

The 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 who use the service used a range of communication methods. These included non-verbal to limited verbal communication. Individual methods were supplemented by the use of pictures and objects of reference to indicate their needs and wishes, which were clearly understood by staff.

Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

People's dignity and privacy was respected. People told us staff were reliable, friendly, and caring. Staff developed positive and caring relationships with the people they supported and used creative ways to enable people to remain independent.

The registered manager and the management team strived at creating an inclusive environment to strongly encourage staff, people and their relatives to be involved in the service.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 3 June 2016).

About the service:

Boxgrove House is a care home, which is registered to provide care (without nursing) for up to 11 people living with autistic spectrum conditions and learning disabilities. The home is a detached building which is situated on the outskirts of Reading, easily accessible to local amenities and with links to public transport. Each person using the service had their own bedrooms and access to communal areas.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will follow up on issues that we identified by asking the provider to send us evidence of how and when the issues are sorted. We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next inspection is scheduled accordingly.

Inspection carried out on 26 April 2016

During a routine inspection

This inspection took place on the 26 and 27 April 2016 and was unannounced.

Boxgrove House is a care home, which is registered to provide care (without nursing) for up to 11 people with autistic spectrum conditions and learning disabilities. The home is a detached building on the outskirts of Reading, but within West Berkshire and is close to local shops and other amenities. People had their own bedrooms and use of communal areas that includes an enclosed private garden. The people living in the home need care and support from staff at all times and have a range of care needs.

The home has a manager who works full-time and is in the process of registering with the Care Quality Commission (CQC) as the registered manager. A deputy manager who also works full time within the service supports the 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.

There were effective systems to regularly assess and monitor the quality of service that people received. Various formal methods included unannounced visits by one of the organisations regional directors and health and safety audits completed by the manager, which included night spot checks. Since becoming the manager in October 2015, the manager has made substantial improvements following audits of the service. These have included improvements to the environment, people’s records, staffing, staff support and meaningful activities that have promoted an open and positive culture within the home.

The home was clean and comfortably furnished. People had their own bedrooms, which were personalised with their own belongings. Staff had received health and safety training that included infection control, moving and handling and positive behaviour support. People’s nutritional needs were met with meals that were appetising and cooked to meet individual needs.

People who use the service used a range of communication methods. These included non-verbal to limited verbal communication. Individual methods were supplemented by the use of pictures and objects of reference to indicate their needs and wishes, which were clearly understood by staff.

People received good quality care. Staff treated people with the utmost respect and kindness at all times and were passionate about providing a quality service that was person centred. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

There were robust processes in place to monitor the safety of giving people their medicine. People were supported to eat a healthy diet and they were helped to see their GP and other health professionals to promote their health and well-being.

The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient number of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

People were provided with effective care from a staff team who had received support through supervision and training. Their care plans detailed how they wanted their needs met and these were regularly reviewed to ensure they were person centred. Risk assessments identified risks associated with personal and health related issues. They helped to promote people’s independence whilst minimising the risks.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and consent issues, which related to the people and their car

Inspection carried out on 19 February 2014

During a routine inspection

Many of the people who use the service had behaviours that were challenging and limited communication skills. Therefore we looked at personal care records and spoke with representatives of people using the service. We spoke with the staff on duty and observed how they delivered care and treatment and how they interacted with people.

We looked at the care records of all of the people who use the service and found capacity and decision making to be well documented in all of the care records we looked at. We saw positive behaviour support plans on people's records and this detailed the behaviour’s people displayed if they became unhappy and what support workers should do to minimize distress. A representative told us "I am invited and attend reviews of my relative care and am asked about the choices they are unable to make for themselves".

In the records we looked at we saw that each person had an assessment of their needs on file. Care plans were reviewed every six months and more often if the needs of the person changed. Care plans included an assessment of the person's cognitive abilities, personal care needs, living skills and dietary requirements.

The provider had an up to date adult safeguarding policy and procedure on file and it was accessible to all staff. Staff told us that they understood the policy and were able to explain how to identify and report abuse. A representative of a person who uses the service told us that they knew how to raise a safeguarding concern if they needed to.

We looked at staffing rotas and found there to be appropriate numbers of staff to meet the needs of people using the service. The staff were supported by a full time registered manger. There were activity coordinators on duty throughout the day and they arranged a number of activities to meet the individual needs of people using the service. Training to staff included adult safeguarding, the mental capacity act, de-escalation techniques and communication with people who present challenging behaviour.

The provider had a robust auditing programme in place which meant that were regularly assessing the quality of the service they provided. We found all areas of the premises to be clean and tidy. Bedrooms were personalised meaning that they were decorated with items and belongings that people liked.

Inspection carried out on 8 January 2013

During a routine inspection

People living in the home had individual communication and behavioural needs and the majority were unable to provide their views about their experiences of living in the home. One person told us that “the manager is very kind to me”.

We were told that independence and individuality were promoted within the home. People living there were supported and enabled to do things for themselves. They were encouraged to express their views using their preferred individual communication styles and to participate in making decisions relating to their care and treatment.

We looked at a range of records, spoke with senior staff and three support staff in private. We saw the communal areas of the home and spent time observing interactions between staff and people living in the home.

Inspection carried out on 14 December 2011

During a routine inspection

People living in the home had individual communication needs and were unable to provide their views about their experiences of living in the home. However we saw that people were involved with their care and the running of the home.