Autonomy: Victoria & Elizabeth

Autonomy: Victoria & Elizabeth is a residential care home providing personal and nursing care to up to 9 people. The service provides support to people with learning disabilities, autistic people, and people with mental health needs. At the time of our inspection there were 7 people using the service.

Autonomy: Victoria & Elizabeth accommodates people across 2 adapted buildings, the buildings contain individual apartments.

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

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.

Right Support:

Staff were recruited safely, there were sufficient numbers of staff with the necessary training to support people safely and meet their needs.

People were supported by staff to pursue their individual hobbies and interests.

Staff supported people to maintain their health and wellbeing by accessing healthcare services and activities which positively supported their physical and mental health.

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.

Right Care:

People were supported to make decisions for themselves. Staff respected people's choices and decisions. Medicines were managed safely, and we were assured that the provider had sufficient infection, prevention and control measures in place.

Staff delivered care in line with information in people's care plans. Care plans had been updated following our previous inspection and contained person-centred information and clear guidance for staff to follow in line with people’s individual needs.

Right Culture:

The service provided a person-centred culture. People were supported to identify individual goals and plans were developed for staff to follow.

Positive relationships had been developed with people using the service and people felt staff understood them and supported them well.

The service had effective governance arrangements in place to assess the quality and safety of the service.

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 requires improvement (published 16 November 2022).

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.

Why we inspected

We carried out an unannounced focused inspection of this service on 29 September and 7 October 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance in the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autonomy: Victoria & Elizabeth on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Autonomy: Victoria & Elizabeth is a residential care home registered to support up to up to nine people across two adapted buildings, the buildings contain spacious apartments. At the time of our inspection there were seven people using the service. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs.

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

Right Support

The provider had not accurately or fully assessed risks people might face and as a result people were at increased risk of avoidable harm. People were not always kept safe and protected from abuse.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. People’s support plans were not detailed and had not reflected their range of needs and had not promoted their wellbeing and enjoyment of life.

Risk related to fire safety were not always fully assessed.

People received their medicine as prescribed, however we found some minor concerns relating to medicine records.

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.

Right Care

People were not always protected from the risk of abuse because staff did not always follow the systems and processes in place to protect them.

Staff protected and respected people’s privacy and dignity.

Staff supported people to live healthier lives and to access healthcare services and support when this was needed.

Right culture

When things went wrong, safety concerns were not always consistently identified or addressed to improve safety to people.

The provider had a clear vision for the service based on a culture of improvement to enhance people's quality of life.

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 good (published 22 July 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service was harmed. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk to people. This inspection examined those risks.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autonomy: Victoria & Elizabeth on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to assessing and managing risk, safeguarding people, person centred care and good governance at this inspection.

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

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.

Autonomy: Victoria & Elizabeth accommodates up to nine people across two adapted buildings, the buildings contain spacious apartments. At the time of our inspection there were seven people using the service. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs.

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

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 which 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.

Right Support

Staff supported people with their medicines in a way which promoted their independence and achieved the best possible health outcome. Medicines were managed safely.

People had a choice about their living environment and were able to personalise their rooms. People’s room were very personalised, and people were able to decorate their room to reflect their interests and hobbies.

Staff enabled people to access specialist health and social care support in the community and people were supported to play an active role in maintaining their own health and wellbeing.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Care

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could take part in activities and pursue interests that were tailored to them.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

Staff retention was good, which supported people to receive consistent care from staff who knew them well. This meant people received compassionate and empowering care which was tailored to their needs.

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.

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

Why we inspected

The inspection was prompted in part due to anonymous information of concern received by CQC and concerns from commissioners from a local authority. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

Rating at last inspection and update

The last report for Autonomy: Victoria & Elizabeth was published on 17 March 2021 and the service was rated good. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

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

The service accommodates up to nine people across two adapted buildings, the buildings contain spacious apartments. At the time of our inspection there were nine people using the service. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs.

We found the following examples of good practice.

¿ There were Covid-19 stations throughout the service. These contained hand sanitiser, gloves, aprons and masks. They also contained lateral flow tests and forms for those using the service, staff and visitors. There was also a small amount of first aid equipment on each station. If people using the service had tested positive they were encouraged to isolate and a Covid-19 trolley was place outside their apartment.

¿ A system had been adopted whereby staff used the back door to enter the premises and then went into a large kitchen area where they could put on their personal protective equipment and also do a lateral flow test prior to starting their shift.

¿ People using the service had also embraced wearing face masks. The registered manager told us that they enjoyed wearing some of the more fun creations which were available.

¿Staff had been trained in infection prevention and control, food hygiene and COVID-19. They were aware of steps to take if there was an outbreak and had engaged with people living at the service and it made a team effort. One person had made a notice which read ‘Please can you sanitise your hands and wear a mask when coming in because we are preventing Covid.’

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

¿ One person was anxious that their mother was in a residential home and concerned regarding the risk of becoming ill. The service purchased two devices, one for each so that they could have video calls and offer reassurance.

¿ We saw that cleaning took place throughout the day and the member of staff overseeing the cleaning told us that they continued to regularly sterilise touch points throughout the service.

¿ Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe.

About the service:

Autonomy: Victoria and Elizabeth is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to nine people across two adapted buildings, the buildings contain spacious apartments. At the time of our inspection there were nine people using the service. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs.

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 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. We saw that people had choice and control and independence to make decisions about their lives. Care was person centred and staff encouraged people to live confident, inclusive and empowered lives.

People’s experience of using this service:

People received safe care, from staff that had received training and knew how to meet people’s needs. People were kept safe from potential abuse, and any concerns were reported to the local safeguarding team to investigate. Staff were safely recruited and there were enough staff to meet people’s needs. People’s medicines were managed safely and given as prescribed. People were protected from the spread of infection during the COVID-19 pandemic.

There was a positive culture to provide good outcomes for people. Staff spoke highly of the management in place. Robust systems were in place to monitor the quality of the service and there was a focus on continuous development to improve quality outcomes for people. The Local Authority safeguarding team had identified that improved quality of incident reporting was needed, we could see clear action had been taken to improve this.

Rating at last inspection:

The last report for Autonomy: Victoria & Elizabeth was published on 21 November 2020 and the service was rated good.

Why we inspected:

The inspection was prompted following information received about the service and concerns raised by commissioners and the safeguarding team. This was focused on incident management and the quality of incident referral documentation.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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

Autonomy: Victoria and Elizabeth is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to nine people across two adapted buildings, the buildings contain spacious apartments. At the time of our inspection there were nine people using the service. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs.

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 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. We saw that people had choice and control and independence to make decisions about their lives. Care was person centred and staff encouraged people to live confident, inclusive and empowered lives.

People’s experience of using this service:

People were kept safe by staff who had received training in how to safeguard people from abuse and the actions they needed to take to protect people from the risk of harm. People were supported by staff who had undergone a robust recruitment process and had the training to enable them to meet people’s needs. Enough staffing numbers were in place to meet the individual needs of people, this enabled people to take part in activities of their choice. People’s medicines were managed safely.

People were treated with dignity and respect and staff engaged well and understood the needs of people who they were supporting. Robust systems were in place to monitor the quality of the service and there was a focus on continuous development to improve quality outcomes for people.

Management maintained good oversight of the service, supported the staff and worked towards continuous improvement. Risk was managed and monitored effectively throughout.

Rating at last inspection:

The last report for Autonomy: Victoria & Elizabeth was published on 30 April 2020 and the service was rated good.

Why we inspected:

The inspection was prompted following anonymous information received about the service and concerns raised by commissioners.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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

Autonomy: Victoria and Elizabeth is a residential care home providing accommodation and personal care to nine people with support needs related to their mental health. There were nine people using the service at the time of our inspection.

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

People were happy with their care and felt supported to live a lifestyle based on informed decisions, choices and risks. Staff knew what to do to keep people safe and were confident any concerns would be taken seriously. Risks to people's well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks as effectively as possible whilst supporting people's independence with the least restrictive approach. People received support to take their medicines safely and as prescribed. Staff took measures to protect people from the risk of infections and encouraged people to follow personal measures to protect themselves. There were systems in place to report any incidents, including safeguarding concerns, which were analysed for any themes or trends.

Staff provided good support through effective training and induction to the service. They worked with health and social care professionals to meet people's needs and maintain their health and well-being. People had access to the foods they liked, and staff encouraged them to choose healthy options. 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.

Staff demonstrated person-centred values in their interactions with people. Staff focused on people's strengths and abilities whilst encouraging independence. People were fully involved in planning their care and support and care plans captured people's wishes and feelings. People were supported in a manner which recognised their right to privacy and space. People were supported to maintain links and relationships with people who were important to them.

People were supported to develop care plans that were specific to them. These plans were regularly reviewed with people to keep them up to date. Staff enabled people to take part in a range of activities, pursue hobbies and interests and be a part of their communities. A complaints process was in place and the registered manager understood their responsibilities in relation to this.

The leadership of the service promoted a positive culture that was person-centred and inclusive. Effective systems were in place to check the quality and safety of the service. The registered manager and the staff team were motivated to improve on the service provided and in turn the quality of life experiences and outcomes for the people using the service.

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 from a focussed inspection was Good (published 14/06/2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Autonomy: Victoria and Elizabeth is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to nine people across two adapted buildings. Accommodation is provided in a range of apartments. At the time of our inspection there were eight people using the service. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs.

The care service has been developed and designed in lines 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’s experience of using this service:

People were kept safe by staff who understood how to safeguard people from abuse and the actions they needed to take to protect people from the risk of harm. Staff were aware of and implemented the guidance recorded in people’s risk assessments and care plans to promote people’s safety. People were supported by staff who had undergone a robust recruitment process and had the training to enable them to meet people’s needs. Sufficient staffing numbers were in place to meet the individual needs of people, which enabled people to take part in activities of daily living and access the community safely. People’s medicines were managed safely.

The culture of the service respected, supported and celebrated people’s differences. The open and inclusive environment enables people and staff to comment about the service to drive improvement. Systems were in place to monitor the quality of the service and there was a focus on continuous development to improve quality outcomes for people.

Rating at last inspection:

Requires improvement. The last report for Autonomy: Victoria & Elizabeth was published on 3 April 2019.

Why we inspected:

The inspection was prompted following anonymous information of concern by local commissioners of the service, who shared the information with the Care Quality Commission.

The previous inspection found a breach of regulations. The provider informed us what they would do to meet the regulation. This inspection has checked on their progress in meeting the regulations.

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

Autonomy: Victoria and Elizabeth is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to nine people across two adapted buildings.

Autonomy: Victoria and Elizabeth provides care and accommodation to up to nine younger adults. The service is based in two separate buildings, one called Victoria and the other Elizabeth. It specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs. Accommodation is provided in a range of apartments situated on a private residential estate. At the time of our inspection there were eight people using the service.

At our last focussed inspection in July 2018, we rated the service as requires improvement. The service was rated as requirements improvement in Safe and inadequate in Well-led. This was because risks to people were not always assessed and people's safety not always monitored. Safeguarding incidents had not been reported to CQC as required. There were no comprehensive systems in place to monitor the quality of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-led to at least good.

At this inspection we found the provider had made some improvements but the overall rating has remained as requires improvement.

There was a registered manager in post. 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 quality of the service was monitored through limited audits carried out by staff and the management team. These had not been effective at identifying the areas of concern we found.

Staff recruitment processes did not always protect people from being cared for by unsuitable staff. Records did not demonstrate that recruitment checks had always been completed before staff started work.

Safeguarding incidents that had occurred within the service were not always notified in a timely manner to CQC to ensure appropriate action was taken to prevent the risk of future harm for people.

Medicines were in the main managed safely. Further improvements were needed to ensure recordings were detailed and systems were in place to ensure medicines were stored safely.

Risks to people were assessed and monitored regularly. Records included detailed guidance and information on the measures staff needed to follow to keep people safe.

People felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

There were sufficient staff to meet people's needs. People received care from a consistent staff team who had the knowledge and skills to meet their needs.

People's health and well-being was monitored by staff and they were supported to access health professionals.

People were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and staff. Staff supported people to achieve as much independence as possible and were respectful of people's diversity and dignity.

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 support this practice.

People's care and support needs were monitored and reviewed to ensure care was provided in the way they needed. People had been involved in planning their care.

People knew how to raise concerns and complaints and were confident these would be listened to and acted on.

Staff and people were positive about the registered manager's leadership and support. Staff felt improvements had been made since our last inspection.

The provider had sought advice and guidance to enable them to make improvements to the governance of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This report only covers our findings in relation to ‘Safe’ and ‘Well-led’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria and Elizabeth on our website at www.cqc.org.uk.

Victoria and Elizabeth is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Victoria and Elizabeth provides care and accommodation to up to nine younger adults. The service is based in two separate buildings, one called Victoria and the other Elizabeth. It specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs. Accommodation is provided in a range of apartments situated on a private residential estate. At the time of our inspection there were eight people using the service.

The service has a registered manager. This 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.

Ineffective quality monitoring systems had failed to pick up and address shortfalls at this service. Some care plans and risk assessments were not always complete and had not been reviewed and updated as planned or following serious incidents. Serious incidents reports did not always show appropriate action being taken following each incident.

Safety issues at the premises and fire and food safety concerns had not always been addressed despite the registered persons being aware of these. The registered persons had failed to notify CQC about incidents that affected the people using the service.

It was difficult to ascertain the actual staffing levels at the service as staff told us people often declined their allocated one-to-one or two-to-one hours and there were no records of what staff were doing at these times. Staff were not always been safely recruited. Medicines were mostly well-managed.

Staff had good relationships with the people using the service and people and staff were relaxed in each other’s company. Staff reassured people and had a positive approach toward them. The service had an open and inclusive culture. People trusted the registered manager and sought him out if problems arose. People and relatives told us they were satisfied with the service provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

Victoria and Elizabeth provides care and accommodation to up to nine younger adults. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs. Accommodation is provided in a range of one- to six-bedded apartments situated on a private residential estate. At the time of our inspection there were eight people using the service.

The service has a registered manager. This 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 said they felt safe using the service. There were enough staff on duty to keep people safe, meet their needs, and enable them to take part in activities. The staff were experienced, well-trained, and knowledgeable about the needs of the people they supported. People told us the staff were caring and kind.

Staff supported people to be independent. People had progressed since coming to the service, for example some people had begun to use public transport independently. Records showed that activities were central to the support provided and people took part in educational and leisure pursuits on a daily basis.

Staff were knowledgeable about people’s emotional states and any triggers that might cause their anxiety to increase. They worked closely with mental health, learning disability, and other relevant professionals to provide people with consistent ongoing support. They understood people’s healthcare needs and enabled them to access healthcare services when they needed to.

Each person had their own individual food and drink budget and chose, shopped for, and prepared their own meals with staff assistance where necessary. We observed one staff member assisting a person to prepare their own meal. The atmosphere was calm and the setting homely and domestic. The staff member and person appeared to have a good, trusting relationship and to enjoy each other’s company.

Staff treated people with dignity and respect. The design of the environment helped to ensure people’s privacy was promoted. Each person had a spacious bedroom with a double bed, an ensuite toilet with a shower or bath, and a large television set. This meant that if people wanted to spend time away from others they could do this in comfort with the facilities they needed at hand and private to them.

People were involved in how the service was run. They had the opportunity to talk with managers and staff every day and share their views with them. The service had an open and friendly culture. Managers and staff were welcoming and enthusiastic about their work. They were keen to discuss ‘best practice’ and to listen to people’s suggestions about the service. This had led to a number of positive changes being made to the environment, activities, and access to the wider community.

Some improvements were needed to the service. Staff supported people to manage risks but appropriate risk assessments were not always in place. Care plans provided good information with regard to people’s behavioural issues but needed more detail when non-behavioural issues were being addressed. Improvements were needed to the way medicines were managed and how staff recorded incidents.