Archived: Milestone House

Milestone House is a residential care home for people living with learning disabilities and/or autism and physical disabilities. The care home accommodates 13 people in one adapted building and 10 people lived in the home at the time of the inspection.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service supported 10 people and was unable to demonstrate they all received good, individualised care to meet their needs.

People’s experience of using this service and what we found

Right Support: The service did not support people to have the maximum possible choice, control and independence over their own lives. Some people were supported by staff to pursue their interests. People had a choice about their living environment and were able to personalise their rooms.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Some people benefitted from the opportunity to take part in activities and pursue interests that were tailored to them.

Right Culture: People and those important to them, including advocates, were not always involved in planning their care. Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate. The registered manager was not actively involved in overseeing the delivery of care to people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 8 April 2021). There were no breaches of the regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milestone House on our website at www.cqc.org.uk

Enforcement and Recommendations

At the provider’s last inspection recommendations were made to seek guidance on reflective learning and personal behavioural support for staff. The registered manager and staff were unable to provide examples of reflective practice such as learning from complaints or accidents. Staff had completed appropriate training in personal behavioural support and clear guidance documents were available to assist them to identify when a person was in distress and how best to support them to de-escalate their behaviour.

We have identified breaches in relation to ensuring risks to people were safely managed. The registered manager failed to prevent, detect and control the spread of infections, staff had failed to ensure care and treatment needs of people were met. The registered manager did not have an established, effective and accessible system for managing complaints. They had failed to assess, monitor and improve the service, failed to maintain/keep accurate complete and contemporaneous records of care for each service user and failed to seek and act on feedback from relevant persons at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Milestone House is a residential care home for people living with learning disabilities and/or autism and physical disabilities. The care home accommodates 11 people in one adapted building and 11 people lived in the home at the time of the inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Although the size and structure of the home was not in line with the principles of Right support, right care, right culture, staff delivered care in a person-centred way that offered people choice, control and independence.

Right care:

• Care was person-centred and promoted people's dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services could lead inclusive and empowered lives.

People’s experience of using this service and what we found

The provider had made improvements; however further improvements were needed to ensure people were consistently kept safe. Staff were recruited safely but some improvements were needed to ensure all recruitment checks were fully completed. Appropriate action was taken in response to accidents and incidents, but improvements were needed to ensure lessons were always learnt from these. We have made a recommendation about seeking guidance on reflective learning.

Staffing levels had increased and met people’s needs. Individual and environmental risks to people were assessed and managed. People were protected from abuse and avoidable harm. Medicines were managed safely and in line with good practice. There was good practice around infection prevention and control, and the provider had managed to keep the home free from Covid-19.

People’s needs were assessed, and care plans offered guidance to staff how to support people in line with their needs. The provider was developing the support of people who had behaviour that challenged to be in line with best practice. We have made a recommendation the provider seeks guidance on positive behaviour support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The manager was working on reviewing all mental capacity assessments.

There was a new training programme in place for staff and there was a lot of progress with ensuring all staff had completed all the required training. There was a new chef employed and the food was good. People were supported to have enough to eat and drink and were given choice. Staff worked proactively in partnership with other health and social care professionals to ensure all people’s healthcare needs were met.

People were treated well and there was a caring atmosphere in the home. People’s dignity and privacy was respected. Care was person centred, met people’s needs and promoted their independence.

No-one was receiving end of life care. The manager was working on ensuring all people’s wishes were known in the event of an unexpected death. People were supported to engage in activities and keep in contact with their loved ones. People and relatives could make a complaint if they needed to and were involved in their care.

The management and leadership of the home had improved. The provider had employed a consultant to support them to implement new systems to ensure they were compliant with regulations. There were effective auditing systems and action plans in place to identify and act on concerns. A new manager had been in post since November 2020 and had driven improvements forward; and had been supported by the provider to do so. The manager was working on developing their practice around the root cause analysis of incidents. The culture in the home had improved and there was an openness to learn and improve. People were more engaged, and staff told us it was a good place to work.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this home was Inadequate (published 17 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 17 January 2020. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

Follow up

The provider has agreed to submit monthly audit outcomes to demonstrate their intention to improve standards and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Milestone House is a residential care home for people living with learning disabilities and/or autism and physical disabilities. The care home accommodates 11 people in one adapted building.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People continued to be at risk of harm as there was a lack of effective risk management of their care and the safety of the environment. Staff did not know how to evacuate safely in the event of a fire. Medicines continued to not be managed safely. People were at risk of serious harm from a lack of infection prevention and control in relation to Covid-19. Staff were not wearing masks, gloves and aprons in line with government guidelines.

People did not receive person centred care and care was not given in line with best practice guidance or regulation. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff had not had the induction, training and support required to ensure they were competent to keep people safe and meet their needs.

The provider had failed to make the improvements we identified in our September and November 2019 inspections and therefore people remained at risk of harm. The provider had failed to ensure there was effective management of the service. There was a lack of effective systems to ensure risk management and oversight of the quality of care people received. Incidents were not effectively reviewed and there was a lack of engagement with people, their loved ones and staff to ensure improvements were identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 21 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider continued to be in breach of regulations.

This service has been in Special Measures since 20 January 2020.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 9 (person centred care), 12 (safe care and treatment), 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We found that all of the areas we inspected relating to previous breaches which had resulted in warning notices being served, continued to be in breach of regulation. This included breaches in relation to risk and medicines management, staffing, person centred care and monitoring and management of the quality of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘special measures’. We will continue to take action in line with our enforcement procedures. This means we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Milestone House is a residential care home for people living with learning disabilities and/or autism and physical disabilities. The care home accommodates 11 people in one adapted building.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Milestone house was a large service, bigger than most domestic style properties and was clearly identified as a care service. It was registered for the support of up to 13 people and 11 people were using the service. This is larger than current best practice guidance.

People’s experience of using this service and what we found

People continued to be at risk of harm. The provider continued to fail to report allegations of abuse in line with the law. The provider had failed to take appropriate action following a whistle blowing. People's risk assessments were not reflective of the care provided and new staff could not tell us how they kept people safe. Accidents were not managed effectively and to ensure lessons were learnt.

People were at risk of serious harm if there was a fire. The fire risk assessment was not robust, checks were not always completed, and staff did know the evacuation procedures. We have alerted the fire and rescue service of our concerns. They have visited the home and asked the provider to take some urgent actions.

People were at risk of being cared for by unsuitable staff as not all the required safe employment checks were completed. There were not always enough staff available to meet people's needs. We have made a recommendation about this. Medicines were not managed safely as people did not always receive them as prescribed. The provider had employed a cleaner since the last inspection. The service was clean, and people were protected from the risk of infection.

The provider had not ensured care was always delivered in line with good practice and the law. People's care plans did not include the guidance staff needed to support people in line with their needs. Staff were not given the training, supervision and support needed to ensure they were competent to support people effectively. New staff had not received an adequate induction to their role and did not have all knowledge required about people's needs.

People were not always supported to eat and drink enough and monitoring records for this continued to not be fully completed. People were enabled to eat independently where possible.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not followed to support this practice. We have made a recommendation about this.

The service did not apply the full range of the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control and limited inclusion, for example people could not choose to go out when they wanted to.

The provider had not always ensured people were well treated. The provider had not sought people's views and involved them in their care. We have made a recommendation about this. People's confidential information was not always kept private. People's dignity was promoted. Staff were caring and there were positive interactions with people.

People did not receive person centred care. People's care had not been regularly reviewed and updated in their care plans to reflect their changing needs. People did not have a good quality of life as there were not enough staff to support people to go out when they wanted to. People were not given as much choice as possible and enabled to have meaningful activities to do. Some staff knew how to communicate with people, but people’s communication needs were not always met. There had not been any complaints, but people were not enabled to raise concerns.

The provider had not ensured they had good oversight of the safety and quality of the care. Systems were not used to identify improvements needed. Incidents were not analysed for further learning and feedback was not sought as a means of learning and improvement. The provider has not addressed the improvements needed since they received their last inspection report. There was a track record of staff leaving following raising concerns about the service. The provider had not promoted a person-centred service and the culture of the service was not open and positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 20 November 2019).

Why we inspected

The inspection was prompted due to concerns received about the service and the registered manager who was also the provider. A decision was made for us to inspect and examine those risks.

The concerns about the service included unsafe moving and handling transfers of people, unsafe medicines management; and a punitive approach to supporting people with behaviour that challenged. The concerns about the provider was about a failure to respond to and report incidents raised by whistle blowers; a failure to work within their own policies and a failure to promote person centred care.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

There is current enforcement action being taken from the previous inspection in September 2019. Therefore, where the breaches of regulations remained at this inspection we have not taken any further enforcement action. The timescale for the completion of actions to improve had not been reached and we will review at our next inspection.

We have identified two new breaches of regulation at this inspection. There was a failure to ensure people were protected from the risks associated with the employment of unsuitable staff. The provider did not ensure people were supported to have enough to eat.

Please see the action we have told the provider to take at the end of this report.

Follow up

We have met with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Milestone House is a residential care home for people living with learning disabilities and/or autism and physical disabilities. The care home accommodates 11 people in one adapted building.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The provider told us this was because the service was originally occupied by people with more physical disabilities such as Huntington’s disease and over time has come to care for more people living with a learning disability and/or autism.

Milestone house was a large service, bigger than most domestic style properties and was clearly identified as a care service. It was registered for the support of up to 13 people and 11 people were using the service. This is larger than current best practice guidance. Whilst the provider had supported a growing number of people living with a learning disability, one person living with a learning disability and characteristics of autistic spectrum disorder had lived in the service since 1989

People’s experience of using this service and what we found

People were at risk of harm. Allegations of abuse had not been reported in line with local procedures and CQC regulations and staff were not up to date in their training for safeguarding people. However, staff could tell us how they kept people safe. People’s risk assessments were not reflective of the care provided and whilst we have no evidence that harm had occurred, this placed people at risk of harm.

People were at risk of being cared for by unsuitable staff as not all the required safe employment checks were completed. There were not always enough staff available to meet people’s needs. The provider had recruited new staff and tried to ensure staff consistency. We have made a recommendation about management of staff recruitment. Medicines were not managed safely as there was not effective systems in place to ensure this. The service was not kept clean and food was stored at unsafe temperatures. The provider has since employed a cleaner.

The provider had not implemented best practice in caring for people with behaviour that challenged. People’s care plans did not include the guidance staff needed to support people in line with their needs. Staff were not given the training, supervision and support needed to ensure they were competent to support people effectively. Staff had received an induction to their role and were knowledgeable about people’s needs and told us they felt supported. People were supported to eat and drink enough and associated risks with eating were managed. However, monitoring records for this were not fully completed. We have made a recommendation about this. People were enabled to eat independently where possible.

People were supported to stay well, and staff worked with other health care professionals to ensure this. The provider worked within the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service did not apply the full range of the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control and limited inclusion, for example people could not choose to go out when they wanted to.

Staff were caring and there were positive interactions with people. However, the provider had not sought people’s views on their care. We have made a recommendation about this. People’s relatives were involved where possible. People’s confidential information was not always kept private. People’s dignity and independence with their daily living skills within the service was promoted.

People did not receive person centred care and a good quality of life as there were not enough staff to support people to go out when they wanted to. People were not given as much choice as possible and enabled to have meaningful activities to do. Staff knew how to communicate with people. There had not been any complaints.

The provider had not ensured they had good oversight of the safety and quality of the care. Systems were not used to identify improvements needed. Incidents were not analysed for further learning and feedback was not sought as a means of learning and improvement. The provider listened to our feedback following their inspection and has told us they will implement an improvement plan.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 16 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection in relation to the following - care was not person centred; people were at risk of harm, medicines were not managed safely; the management of the service had not ensured the safety and quality of the service; and there were not enough qualified staff.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify CQC of allegations of abuse; and had not displayed their inspection ratings on their website and in clear view at the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Milestone House is a service for up to 13 people who have learning and physical disabilities. The service is also provided to people who have Huntington’s disease. The home is set in a residential area in Deal. There is a drive and parking area at the front of the house.

There was a good sized secure garden with trees, plants and a large lawned area at the back of the home that people could spend time in and was wheelchair accessible. Accommodation was set across two floors and was wheelchair accessible. CCTV cameras were in operation in communal areas.

There was a spacious communal lounge, a small seating area and a dining room that people could spend time in. The home had specialised equipment including a spa bath, overhead hoists and a sensory room. One bedroom was on the first floor and could be accessed by a stair lift. All other bedrooms were on the ground floor.

The provider was also the registered manager. 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. The registered manager was not present at this inspection. A new manager had been employed to help run the home and develop the service.

At our last inspection in July 2015, the service was in breach of some of the regulations and was rated ‘Requires Improvement’. The provider sent us an action plan outlining how they would rectify those breaches. The manager and team had worked hard to update policies, the risk assessment processes and care planning to provide person centred care. At this inspection all the regulations were met and the manager had a clear plan to continue and maintain improvements.

The service had signed up to The Social Care Commitment. The Social Care Commitment is the adult social care sector's promise to provide people who need care and support with high quality services. There was a visible difference in the home since the last inspection. People were clearly benefiting from a more structured and well led service and staff carried themselves confidently. The improvements, staff training and staff support meetings were based on the principles of the Social Care Commitment and research of current best practice for people.

Staff, relatives and visiting professionals told us they thought the service was well led. The manager was experienced in supporting people with learning disabilities and health conditions like Huntingtons disease and working with other health and social care professionals to provide person centred care.

People were occupied with meaningful activities in the company of staff. There was a warm, friendly atmosphere and everyone looked calm and focused on what they were doing. A visiting professional told us, “I enjoy coming here, I look forward to it.”

Each person had a plan of care and support that had been written with them and their representative and gave a clear outline of what was important to them and what their preferences were. These were reviewed regularly and advice from other professionals was included.

People were supported to keep as well and healthy as possible. If people became unwell the staff responded promptly and made sure that people accessed the appropriate services as quickly as possible. Visiting health professionals including doctors, the community nutrition team and specialist nurses were involved in supporting people’s health and wellbeing. People received their medicines safely and when they needed them, by staff who were trained and competent.

People were supported to eat and drink healthily. There was a good variety of home cooked food and people were complimentary of the meals provided. Relatives told us that people were well fed and the food always smelled good.

Staff knew how to recognise and respond to abuse. The provider and manager were aware of their responsibilities regarding safeguarding and staff were confident the manager would act if any concerns were reported to them.

Staff completed incident forms when any accident or incident occurred. The manager analysed these for any trends to see if any adjustment was needed to people’s support. Risks relating to people’s health and mobility had been assessed and action was taken to prevent accidents as far as possible. People were encouraged and supported to maintain their independence and positive risk assessments were completed for this to make sure people were supported without being limited unnecessarily.

There were enough staff to keep people safe and additional staff were being recruited for people to have a more active lifestyle. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively. People were treated with dignity and respect and staff attended to people at a relaxed pace.

Staff had the induction and training needed to carry out their roles. They had received training in people’s healthcare needs and had achieved or were working towards adult social care vocational qualifications. Staff met regularly with the manager to discuss their training and development needs based on the topics outlined in the Social Care Commitment. Staff were motivated and enthusiastic in their roles.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been carried out to determine people’s level of capacity to make decisions in their day to day lives and for more complex decisions when needed. DoLS authorisations were in place, and applications had been made for renewal, for people who needed constant supervision because of their disabilities. There were no unnecessary restrictions to people’s lifestyles.

The manager and team were working towards a ‘total communication’ home. Total communication means everyone in the service using every available method of communication consistently to enable people to express themselves and understand the world around them as much as possible. People were able to use a variety of communication aids and staff took their time to pay attention and listen to people to allow them to express themselves and be understood.

Training had been organised for the staff to have a better understanding of different communication methods and enhance their skills. This was discussed in team meetings and one to one supervision meetings.

People took part in a variety of activities within the service. People were doing different things. Staff were interacting with people. Some people went out shopping and others attended a local day service. A variety of events had been organised over the Christmas period and further activities were planned.

People were encouraged to maintain contact with their families and the manager had plans to support people to establish friendships and links with the local community. A newsletter had been designed and produced that was sent to people’s friends, families and people involved. People were supported to get out and about as much as possible in the local area and get to know local people.

People’s representatives and visitors told us that if they had a concern they would speak to the manager or any of the staff. There was a clear complaints procedure and opportunities for people to share their views and experiences of the service in a way they could understand.

The manager had reviewed the policies in the service and carried out regular audits to make sure that the service was running safely and people were receiving consistent personalised care. People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. All results were taken into consideration and the manager had an ongoing development plan improvement.

Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills so people knew how to leave the building safely. Safety checks were carried out regularly throughout the building and the equipment to make sure they were safe to use.

The CQC had been informed of any important events that occurred at the service, in line with current legislation.

We observed that people were supported to do the things they liked to do each day like access the community and hobbies. People chose when to get up and when to go to bed, what they would like to eat and staff respected their choices.

People could choose how to spend their time at home and were provided with activities. They were helped to make choices with the use of pictures and staff support. We saw that each person was supported individually by a carer.

The home was clean and tidy and we saw that cleaning routines were in line with current guidelines. Infection control systems were followed and this protected people from the risk of acquiring an infection.

People were supported to be able to eat and drink sufficent amounts to meet their needs. The food provided was enjoyed by the people who used the service, staff and visitors. The menu was varied and nutritionally balanced.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These checks included asking relatives for their views.