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Inspection carried out on 31 January 2019

During a routine inspection

About the service: Walton House is a care home that provides personal care for up to Four people. At the time of the inspection Four people lived at the home. The accommodation was established over two floors. On the ground floor there were bedrooms, a shared communal lounge, a dining room, storage areas and laundry areas. On the second floor there were bedrooms and bathrooms.

People's experience of using this service: The property was clean, comfortable with plenty of room for people to live.

People's safety had been considered and risks were managed to maintain people's safety. Staff had received training in relation to safeguarding and knew how to protect people from harm. Medicine was managed safely. The risk to any infection was reduced by the maintenance of high standards of hygiene.

The provider was focussed on delivering person-centred care. People needs were assessed in detail to ensure the service could be tailored to meet their individual social, care and health needs. People’s care was delivered effectively, from well-trained staff. People’s outcomes and long-term goals were considered, to ensure people met their goals. Staff were recruited on their values, and in accordance with best practice. 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. Health care had a focus to ensure people's ongoing wellbeing and concentrated on improving people’s health.

People enjoyed living at the home and told us staff were kind and respectful of their choices. People were treated kindly and compassionately by staff. People and their relatives were supported to express their views and make decisions about the care and treatment they received. Staff respected people's privacy and dignity.

People were supported to lead fulfilled lives through activities of their choice. Information was provided in a range of formats to support understanding. People could access spiritual support to meet their religious beliefs. The provider had a complaints policy and process in place; people and their relatives told us they would feel comfortable raising complaints. When people were at the end of their life, the provider had policies in place to meet their wishes and preferences.

People benefitted from a service which was well led. The provider had robust quality monitoring arrangements through which they continually reviewed evaluated and improved people's care. People, stakeholders and staff had an opportunity to shape the service. The provider invested in staff development to ensure people received care from experienced and caring leaders. The provider had strong values which shaped their service. This ultimately led to people receiving personalised care.

Rating at last inspection: Good. The last report for Walton House was published in September 2016.

About the service: Walton House is a residential care home that provides personal care for up to four people with learning disabilities. At the time of the inspection four people lived at the home.

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.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services. At this inspection we found the service continued to be Good.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements. More information is in the 'Detailed Findings' below.

Inspection carried out on 15 August 2016

During a routine inspection

The registered manager was present during 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 told us that they felt safe living at the home. Staff had good knowledge of how to keep people protected from the risk of abuse. Risks to people’s safety had been identified and appropriate measures put in place to minimise the risk. People received care and support in a timely way. Staff had been recruited appropriately and safely. People received their medicines as prescribed and medicines were managed safely.

People received care and support from staff who received regular training and support to ensure they could carry out their roles effectively. People were empowered to make independent decisions about their daily routines. Staff understood the key principles of the Mental Capacity Act (2005) and sought consent from people before providing care and support. People told us that they chose what they wanted to eat and drink. People were involved in maintaining their healthcare needs.

We observed a range of warm and affectionate interactions between people and staff. People spoke positively about their relationships with staff. People were encouraged to be independent and make their own choices about their daily routines. People were supported by staff who respected their dignity and privacy.

Staff provided personalised care that met people’s individual preferences. Care plans demonstrated that people were at the heart of the service. People’s care plans were updated and reviewed on a regular basis. People living at the home saw the family and friends that they wanted to. People told us that staff supported them to follow their interests and hobbies. People told us they would feel confident to approach staff if they had any concerns. The complaints procedure was accessible to all people.

People told us that the home was managed well and that they had positive experiences whilst living at the home. There was effective leadership from the registered manager to ensure that staff were motivated and supported to provide individualised care to people. The registered manager consulted people about their experiences and views on the care provided. There were effective processes in place for monitoring and improving the quality of the care received.

Inspection carried out on 27 November 2013

During a routine inspection

We spoke with three people who lived at the home. We also spoke with one member of staff and the manager. We also looked at people�s care records and other documentation related to the running of the home.

People told us that they were involved in making decisions and were able to consent to care and support. One person told us, �It�s my life, I can do what I want�.

People told us they were happy with the care and support they received from staff. They told us that the support they received was as they wanted it to be. One person told us, �Staff are very helpful, I�m happy here�.

Arrangements for people�s medication were managed well, meaning people were protected from the risk associated with medicines.

We saw that the home was designed so that it was of a suitable design for meeting the needs of people that lived there and promoting their safety.

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

Inspection carried out on 11 October 2012

During a routine inspection

We spoke with two people who lived at the home, three staff and the manager.

People�s decisions were well recorded, with their signatures on consent forms to show their understanding of decisions made. We saw people were able to make choices and were confident with staff. This meant that people were supported by staff to make informed decisions.

One person said that they �Love living here with all of my new friends�. They said they had a healthier life style due to better diet and exercise. They told us that they �Go to the gym now� and their health had improved. Their needs were well recorded in their care plan. We spoke with staff and they were aware of what people�s needs were. This meant that people�s health care was promoted.

We saw that the provider undertook appropriate checks on staff before they were employed at the home. People were involved in the selection of staff. This meant that all new staff were vetted by the people that they would work with and the provider before employment. The staff we spoke with said they were �well supported". This meant that they were helped to do their jobs well.

One person told us that they knew how to raise any concerns they may have. They said they �Tell my carer everything, we talk about a lot of things then we write it down� We saw comment from an health care professional that �If any problems they are promptly dealt with�. This meant that people were confident any complaints would be acted upon.

Inspection carried out on 16 November 2011

During a routine inspection

We spoke with people living at all three of the provider�s locations. The following reflects the views of all people using the provider�s service. Where comments related to a specific service location this is stated.

People told us about the care they receive. We found that this reflected their needs and choices as recorded in their care plans, and books that were titled �all about me�. One person informed us that the �all about me� book was owned by them. We saw it contained lots of photographs of them and their life. Some people told us they were not bothered about their care plans but said staff had spoken to them about it. Other people told us that they had seen their care plans. Most people we spoke with told us about choices they had made and how staff had involved them in making decisions.

We spoke with a health professional at the Hilton House and they told us that staff had asked for help in ensuring a person understood the care options available to them due to refusal of a specific treatment. The home has since worked with other health professionals. This has given the individual a chance to have a better understanding about what would be involved in respect of the treatment, so they can make a better informed choice.

People told us that they are supported to live their life as they choose and participate in activities that they enjoy. People told us that they are given an opportunity to pursue their individual interests and they informed us that they �Decide what [sic] going to do every day� �come and go like manager does if feel like it� and �Like staying here, playing on games�. Some people told us about the day centres and other places in the community they go to such as the local pub, theatre, cinema and shops. People said to us that staff are flexible and take them out by ring and ride or taxi. Some people used ring and ride to go out independently (subject to risk assessments that we saw) and others are supported by staff as needed. People told us they have access to a telephone and are able to keep in touch with family and friends.

People told us that they liked the staff as they were approachable and listened to them. Interaction that we saw between staff and people living at the home was relaxed and positive. People told us that they are encouraged to be independent with staff only offering assistance when needed with tasks they could not complete. We saw that people are able to move around the houses as they wish and are able to go to their rooms for privacy whenever they want.

Risks to people are recorded and steps taken to reduce any potential dangers. The only notable exception was the lack of recording to how staff would deal with one individual�s epilepsy in the event of a seizure. This related to a person living at Hilton House. The individual in question had not had a seizure recently though, but staff would need to be aware of what was expected in the event they did. We saw in Walton and Welbeck House that people�s plans included such guidance for people who have epilepsy.

People we spoke to told us that they had contact with health services as and when needed. One person told us �If need to see anyone staff sort� in respect of health services. People told us about seeing opticians, dentists and their GP. Some people were out attending GP appointments on the day we visited Hilton House.

People told us that staff listen to what they say and deal with issues that may arise. One person told us they �Talk to staff, if not happy, do something about it� and another said �Can complain and staff listen to me�. Other people told us that they are �Safe in here�. Some people told us that they meet with managers from the day centres they use and know they could raise concerns with them as well as their families. No one we spoke to had any worries about where they lived or the staff that supported them.

We spoke to staff about what they thought abuse was, and they showed us they had a good awareness of what should be reported. This meant that abuse would be investigated and people would be protected. Staff confirmed that the provider has a no restraint policy and this reflected what people told us.

People we spoke to told us that they get their medication on time. They told us they consent to the staff managing their medication. One person at Welbeck house said that their GP had reviewed their medication recently. They also told us that their medication is stored safely, and that when staff give them their tablets they can take these themselves.

All the houses we visited are adapted semi- detached buildings that blend in with the surrounding housing. There is nothing to indicate that they are anything other than a family home. We also saw that there is sufficient communal space in all the houses to allow people privacy when needed. We saw that people have access to keys to their bedroom doors, although most told us they are not to bothered about having these.

People from all three houses told us about how they are involved in the running of the home and their choices are listened to. They told us how redecoration of their rooms was chosen by them. They also told us about how changes within the service are discussed with them. People have meetings to discuss developments at their respective homes; minutes of these were seen and signed by people living at the homes. We also heard that people can speak to the managers or staff on a one to one basis should they wish.

They told us �Its alright I love it here�, �Happy here� and �Love it here, would be no where else�.

People told us that they like and have confidence in the staff team at their respective homes. One person told us �they are pleasant helping out and all that�.

Staff told us that they have sufficient training to do their job and usually have refresher training every year.