Aspire Living - 1-2 Markyes Close

• People enjoyed living at Aspire Living - 1-2 Markeys Close and were cared for by staff who were kind and recognised people’s areas of independence.

• Staff promoted people’s right to dignity and privacy and were respectful to the people they cared for.

• People's, their relatives' and other health and social care professional’s views were listened to when people’s needs were assessed and plans for their care were developed. The provider and staff addressed potential barriers preventing people moving to the home. This approach enabled people to move to the home, and continue with relationships which were important to them.

• People were encouraged to make their own decisions and choices; staff supported people by using people’s preferred ways of communicating. We found people had access to a range of pictorially based information to help them make their own decisions. The registered manger planned to work with other health and social care professionals to further enhance people’s individual communication plans and to enable people to continue to access information.

• Staff knew people’s safety needs well and supported people so their individual risks were reduced.

• People were supported to have their medicines regularly, by staff who were competent to do this. People’s medicines were regularly checked and reviewed.

• There were sufficient staff to care for people at the times people wanted assistance.

• The environment at the home was regularly checked. The risk of accidental harm or infections was reduced, as staff used the knowledge and equipment provided to do this.

• Staff had received specialist training and developed the skills they needed to care for people. This helped staff to provide good care to people.

• Staff supported people to have the nutrition they needed, based on their preferences, so people remained well. Where people required specialist diets, or assistance with eating and drinking safely, staff supported them.

• People had access to the healthcare they needed. Staff worked with other health and social care professionals to ensure people had the best physical health and well-being possible.

• People were supported to enjoy a range of activities which reflected their interests, and enhanced their lives. This included support to enjoy spending time in the community, doing things they liked. Staff found imaginative ways to ensure people had the opportunity to connect with hobbies and interests which were important to them, as their needs changed.

• Systems were in place to take any learning from complaints, which were used to reflect on people’s needs and to further improve their individual care.

• People, their relatives, staff and other health and social care professionals were encouraged to make any suggestions for improving the care provided and the service further. We found suggestions were listened to.

• The registered manager and staff reflected on the care provided, so improvements in people’s care would be driven through.

• We found the service met the characteristics of a “Good” rating in all areas; More information is available in the full report

Rating at last inspection: Good. The last report for Aspire Living - 1-2 Markeys Close was published on 28 July 2016.

About the service: Aspire Living - 1-2 Markeys Close is a is a residential care home, providing personal care and accommodation. There were 9 people living at the home at the time of our inspection. People living at Aspire Living - 1-2 Markeys Close live with learning disabilities or autistic spectrum disorders.

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

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

The inspection took place on 29 June 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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’s individual safety needs were known by staff and these were regularly reviewed. Consideration was given to ensuring people were safe, but also to promoting their freedom. There were sufficient staff to support people safely. People received their medicines from trained and competent staff. Staff provided explanations to people when supporting them with their medicines, and people’s preferences were taken into account in the way they took their medicines.

People were supported to eat and drink, and meals were presented in a way which would be appetising and appealing for them. People were encouraged to make choices about their meals. People received specialist input from a range of health professionals to ensure that their health and wellbeing needs were met. Where people’s liberty was restricted, this was done in accordance with the principles of the Mental Capacity Act.

People enjoyed positive relationships with staff and had their own keyworkers to support them with their communication needs and making their views known. People were involved in meetings about their care and support in ways which were inclusive for them. People had access to independent advocates to ensure they were involved in decisions about their care. People were treated with dignity and respect.

People’s needs were assessed and reviewed to ensure they received all the support they needed. People were encouraged to set personal goals and were supported to achieve these. Staff knew people well and knew when people were unhappy and how to respond to them. Relatives and health professionals knew how to complain and make suggestions, and were confident their views would be acted upon by staff and the registered manager.

The registered manager created an inclusive atmosphere for people and staff and involved them in the running of the home. The registered manager encouraged staff to involve people in their local community. Staff felt supported in their roles and that the registered manager was approachable. The registered manager and provider carried out regular audits and quality assurance measures to ensure people received a high quality level of care. The registered manager and provider had values for the service, which were known and shared by the staff team.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Risks to people had been identified, assessed and kept under review. Guidance to staff on how to provide safe care had been updated and expanded. We found that the staff were able to tell us about the support they needed to give people to keep them safe and reduce risks from hazards such as moving and handling and pressure sores. They had undertaken training important to their role.

Restrictions were used appropriately to help keep people safe. The home worked closely with the local authority to ensure any restrictions were correctly authorised under the Deprivation of Liberty Safeguards (DoLS). This meant that decisions were made by a multidisciplinary team which helped protect the vulnerable people using the service.

The registered manager knew how to make safeguarding referrals to the local authority and they reviewed any accidents and incidents.

Is the service effective?

People's ongoing needs were kept under review. Decisions were made in people's best interest after consultation with their relatives and professionals. The systems in place to inform staff about changes in people's needs were effective.

Staff meetings and supervision sessions were held regularly and staff felt supported. New staff were carefully recruited to ensure they had the right skills and attitudes to support vulnerable people.

Is the service caring?

The people that were able to give us their views told us they liked the staff. The staff team was stable and they knew people's needs and preferences very well. We observed a relaxed, yet respectful atmosphere in the service. We saw staff treated people in a kind and caring way. They encouraged people to make choices in areas such as food and activities. We saw staff praise people when they took part in a task or made a choice.

Staff discussed people's needs and ensured that there was a continuity of the care provided. Staff had worked together with professionals recently to provide one person with end of life care. This had meant that the person and their family had their wish which was for the person to remain at the home until the end of their life.

Is the service responsive?

No complaints had been received since our last inspection but staff told us that the registered manager was approachable and took concerns seriously.

Staff worked closely with health professionals to enable one person to have essential medical treatment. Guidance from external professionals was followed.

The registered manager had made changes to the staffing arrangements to increase people's opportunities for activities and outings. The providers had supplied funding to improve the garden and make it more pleasant and accessible to people living in the home.

Is the service well led?

Since our last inspection the registered manager had made the required improvements to address the areas of non-compliance. The areas found at this inspection where improvement was needed were taken seriously by the registered manager and provider. The provider committed to improving the level of monitoring they carried out. There was scope to also develop quality monitoring audits and feedback surveys.

Systems to training and support staff were effective. One member of staff told us, 'The service users always come first, but the manager is also kind and caring to the staff'.

We found that the staff were well informed about people's needs. They told us they felt suitably trained and equipped to support people whose needs were increasing as they aged. The service worked closely with health and social care professionals to ensure people's health needs were met.

People's consent to care and treatment or decision made in their best interest had not always been recorded. People had support plans that contained detailed information about their needs. These had not always been updated when people's needs had changed.

People told us they liked the food and that staff gave them enough to drink. We found that people's dietary preferences and special requirements were being met. Staff knew people and their preferences well and had time to support them during mealtimes.

The home had undergone a major refurbishment during 2013 and the two houses had been joined together. The environment was homely and suitable to meet the individual needs of the people living in the home.

The staff team had remained very stable with some staff working in the home for over fifteen years. This meant that they knew people very well, which particularly helped those who had communication difficulties or dementia. We found that the staff were suitably trained and well supported.

People's needs were assessed and planned for with the help of external professionals. We found that appropriate systems were in place and people had received their prescribed medicines. Staff were suitably trained before being allowed to administer medicines.

There was a team of suitably trained staff who worked regularly with the people who lived there. The relatives we spoke with told us they were very satisfied with the care provided and felt the home was staffed by a caring and helpful team. Comments included, 'They could not be treated better', 'The care is second to none' and, 'They always ring if there is a problem'.

Systems were in place to deal with any complaints but there had not been any. The relatives we spoke with told us they had not needed to raise any concerns. They told us they had confidence that if they did the manager and staff would take it seriously.