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Inspection carried out on 14 November 2019

During a routine inspection

About the service

Residential Care home is a residential care home providing personal care to six people with a learning disability at the time of the inspection. The service can support up to six people.

The service has 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 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 told us they felt safe at the service. A relative told us their family member was safe. Staff at the service knew their safeguarding responsibilities and knew how to report abuse.

People had risk assessments in place to protect them from avoidable harm yet allow them to live as freely as possible. People’s medicines were managed safely. The service was clean and free from malodour, staff followed good hygiene practices.

People were supported by staff who had been recruited in a safe way.

People received an assessment of needs before moving into the home. People told us staff were good and could support them well. Staff received regular training and supervision to ensure they had the right skills to support people.

People had enough to eat and drink. The building was accessible, and people could navigate their way around it well.

People liked the staff who supported them, and staff were observed to be kind and caring.

People’s privacy and dignity was respected. Staff were non- discriminatory and respected people as individuals.

People received person centred care and were involved in the planning and delivery of their care.

People’s communication needs were documented clearly. People were supported to do activities of their choice and to attend places of worship. Trips abroad were encouraged and supported by the service.

The service had a registered manager who was visible and involved in peoples’ care. People and staff spoke highly of the registered manager.

The registered manager regularly audited the service and sought the views of people, relatives, staff and professionals to improve the service.

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 applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 8 June 2017).

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 27 April 2017

During a routine inspection

This inspection took place on 27 April 2017 and was announced. At the previous inspection of this service in March 2016 we found one breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because the provider did not have robust risk assessments in place. During this inspection we found this issue had been addressed.

The service is registered to provide accommodation and support with personal care for up to six adults with learning disabilities. Six people were using the service at the time of our inspection. The service provider is a registered individual. This means there is no requirement to have a registered manager as the provider is considered a registered person. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place. Risk assessments provided information about how to support people in a safe manner. However, medicines were not always managed in a safe manner.

Staff received on-going training to support them in their role. People were able to make choices for themselves and the service operated within the spirit of the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. We observed staff interacting with people in a caring way. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the senior staff at the service. Systems were in place to seek the views of people on the running of the service.

Inspection carried out on 10 March 2016

During a routine inspection

The inspection took place on 10 and 14 March 2016 and was announced. The provider was given 48 hours notice as it is a small care home and people are often out during the day. We needed to be sure someone would be in during our inspection. The service was last inspected in November 2013 when it was found to be meeting the requirements inspected.

Residential Care home is a care home proving care to up to six people with learning disabilities. At the time of our inspection five people were living in the home. The service provider is a registered individual. This means there is no requirement to have a registered manager as the provider is considered a registered person. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

Staff knew people well and described in detail how to support people and manage risks. However, risk assessments were not robust and did not describe measures used to reduce the risk of harm. Care plan documentation was not person-centred. We have made a recommendation about person-centred care plans.

The service completed quality assurance questionnaires and audits. However, the audits used were not robust and did not identify areas for improvement. We have made a recommendation about quality assurance processes.

The service recorded incidents and accidents but did not complete analysis to see if lessons could be learnt. We have made a recommendation about incident recording and analysis.

People told us they felt safe, and staff were knowledgeable about safeguarding adults from harm.

There were sufficient numbers of staff to provide people with the support they needed. Staff received the support and training they required to carry out their roles and responsibilities.

People were supported to take medicines, and this was managed in a safe way. People were supported to access healthcare services and follow medical advice.

People had consented to their care. The service was working in line with legislation and guidance regarding capacity and consent. People were involved in making decisions about their care and had regular meetings to review their care and support.

Care plans contained details of people's dietary preferences and needs. People were supported to maintain a culturally appropriate diet that met their nutrition and hydration needs.

People and staff had developed positive, caring relationships with each other. People's individual identities, cultural and spiritual backgrounds were supported. People were supported to have private time when they wanted and staff maintained people's dignity during care.

The home had a robust complaints policy and complaints were resolved in line with it.

The home had a positive culture that recognised people's individuality and preferences. People and staff spoke highly of the registered provider and the manager.

Inspection carried out on 22 November 2013

During an inspection looking at part of the service

On the day of the inspection, we did not stay long as there was no one at the home as people had gone to a day centre with staff. We met one person on his way out to work and spoke briefly with the manager. We reviewed copies of staff rotas, updated care plans and risk assessments.

At our previous inspection we had identified concerns with staff working long hours due to absence, records not being updated and staff rotas being maintained in pencil. On this visit we reviewed rotas from September to November 2013 and found them to be written in ink and meeting the needs of the people. For, staff working over 48 hours a week, we saw a signed work directive opt out form. Care plans and risk assessments were up to date and reflected the needs of people using the service.

Inspection carried out on 24 July 2013

During a routine inspection

People told us that they liked to live at the home and that their wishes were respected. One person said, �I would not have stayed here for ten years if I didn't like it." Another said, "It is nice here. I like my bedroom and the staff are good to me."

We found that the home was clean and well maintained. Staff were knowledgeable about infection control procedures. Equipment was clean and serviced at least once a year. Staff were aware of how to use, clean and report faulty equipment. People told us that they were comfortable. One person said, �This has been home for almost ten years. Everything is clean and comfortable."

There were inadequate procedures in place to support staff, when shortages arose due to sickness or annual leave. We found that three staff were working six days a week in order to cover all the shifts, whilst two staff were on annual leave and one staff was off sick. Staff were qualified but had limited knowledge about the Mental Capacity Act (2005).

We found that people's records were sometimes inaccurate and needed updating. Risk assessments and care plans did not have current review dates. The staff rota was in pencil instead of ink, therefore any alterations or amendments would not be retained.

Inspection carried out on 8 February 2013

During a routine inspection

The service was run in a homely and personal way. Management was carried out relatively informally. Records could be improved and made more person centred, to corroborate what we observed during our inspection visit, i.e. that people�s support needs were being met and their wishes and preferences respected. Assessments of needs, risk and capacity seen needed updating.

People�s ethnic requirements were respected and supported. People using the service felt and were kept safe. They appeared happy and content. They took part in decision making in the service.

Medications were generally handled safely apart from a recording error.

Staff felt well managed and supported and enjoyed working in the service. Some mandatory refresher training was overdue and training in mental capacity needs to be implemented.

The provider has been responsive to feedback from a variety of sources and improved the service.

People using the service we spoke to could not think of how the service could be better when we asked them. One said �they take good care here�.