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Inspection carried out on 3 October 2017

During a routine inspection

This inspection was carried out on the 03 October 2017 and was unannounced.

Julians House is registered to provide accommodation and personal care for up to seven people. People living at the service had a range of learning disabilities and autism. At the time of our inspection, there were five people using the service.

When we last inspected the service on 24 January 2017 we found that they were not meeting all the regulations. These were in relation to governance systems which were not consistently effective as issues they had identified were not resolved. At this inspection we found that the necessary improvements had been made and the service was meeting all the standards.

The service had a registered manager in post. A registered manager is a person who is 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 showed us thumbs up when we asked if they felt safe. There were sufficient staff employed through robust procedures to meet people’s needs at all times.

The service had safeguards in place to protect people from risk of harm. Full assessments were carried out before people moved into the service and staff were knowledgeable about how to keep people safe. People`s care plans and risk assessments improved since our last inspection. Care plans were up to date, gave clear information to the reader and people`s changing needs were promptly documented.

People were supported to access external healthcare services and staff had a good understanding of how to support people with a variety of conditions. People’s medication was managed, stored and administered safely.

Staff received training which was relevant to their role and received regular supervision and support. Interactions between people and staff were positive and friendly and staff were knowledgeable about the people they supported. Staff were able to tell us about ways in which they gained consent to give care, and had a good understanding of the Mental Capacity Act 2008 (MCA) principles. Staff were given regular opportunities to contribute to the running of the service and develop their skills and knowledge.

People were involved in planning and preparing their meals. A visual menu was in place to promote choice for people who were not able to communicate verbally.

The registered manager and the provider`s quality manager carried out audits to check on the quality of the services provided. We found that the issues they identified were addressed and followed through in a service improvement plan.

The registered manager carried out regular health and safety checks to the premises and equipment. Regular fire drills occurred to ensure people and staff knew what to do in an emergency.

We could only observe how staff were interacting with people for a very short time due to the anxiety our presence caused to the people. Staff treated people with respect and dignity. Some people were unable to communicate verbally but their needs and preferences were understood by staff who were able to support people in a personalised way.

People had the opportunity to raise concerns or ideas for improvement at regular `Your Voice` meetings with their keyworkers. There had not been any recent complaints about the service.

The registered manager and the deputy manager had a visible presence within the service and worked with staff regularly to maintain an oversight of the service. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the management in the home.

Inspection carried out on 24 January 2017

During a routine inspection

This inspection was carried out on the 24 January 2017 and was unannounced.

Julians House is registered to provide accommodation and personal care for up to seven people. People living at the service had a range of learning disabilities and autism. At the time of our inspection, there were five people using the service.

The service had a registered manager in post. A registered manager is a person who is 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, however there was not enough staff at times to ensure people had access to the activities they wanted outside of the service. The registered manager was recruiting for new staff to build up a permanent staff group to ensure people could go out and be supported by the right number of staff.

The service had safeguards in place to protect people from risk of harm. Full assessments were carried out before people moved into the service. However people’s care plans and risk assessments were not always as detailed to reflect people`s changing needs. Care plans did not evidence if people responded well or not to the care and support they received.

People were supported to access external healthcare services and staff had a good understanding of how to support people with a variety of conditions. People’s medication was managed, stored and administered safely.

Staff received training which was relevant to their role and received regular supervision and support. Interactions between people and staff were positive and friendly and staff were knowledgeable about the people being supported. Staff were able to tell us about ways in which they gained consent to give care, and had a good understanding of the Mental Capacity Act 2008 (MCA) principles. Staff were given regular opportunities to contribute to the running of the service and develop their skills and knowledge.

People were involved in planning and preparing their meals. A visual menu was in place to promote choice for people who were not able to communicate verbally.

The registered manager and area manager carried out audits to check on the quality of the services provided. We found that the issues we identified in this inspection had been identified by the registered manager, the provider and the local authority when they carried out their monitoring visit.

The registered manager carried out regular health and safety checks to the premises and equipment. Regular fire drills occurred to ensure people and staff knew what to do in an emergency.

Staff were kind and caring and knew people well. They treated people with respect and dignity. Some people were unable to communicate verbally but their needs and preferences were understood by staff who were able to support people in a personalised way.

People had the opportunity to raise concerns or ideas for improvement at regular meetings with their keyworkers. There had not been any recent complaints about the service.

The registered manager and the deputy manager had a visible presence within the service and worked with staff regularly to maintain an oversight of the service. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the registered manager.

Inspection carried out on 13 May 2015

During a routine inspection

This inspection took place on 13 May 2015 and was unannounced.

Julians House is registered to provide accommodation and personal care for up to 6 people who have autistic spectrum conditions with behaviour that may challenge. At the time of our inspection 4 people lived at the home.

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.

Julians House was registered in December 2013 and this was their first inspection.

People and their relatives were positive about the care and support provided. Their views were listened to and acted upon. However one person presented with times of significant behaviour which whilst staff were responsive and people were kept safe the atmosphere in the home changed and this was reflected in some feedback.

Care provided was good and staff were knowledgeable about people’s needs. Staff had received appropriate training and supervision.

People were given choices and their privacy and dignity was respected. They were supported to be as independent as possible and continually worked on goals to develop their abilities. Staff developed good relationships with people, were kind and caring and worked as a team to create the best for each person.

People had access to healthcare professionals such as GP’s and mental health specialists when needed. They were given appropriate levels of support to maintain a healthy balanced diet and were looked after by staff who had the skills necessary to provide safe and effective care.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and

where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. The managers and staff were familiar with their role in relation to MCA and DoLS.

Leadership and management of the home was good. Systems were in place to monitor the quality of the service and promote continuous improvement, which included learning from incidents by reviewing what had happened, learning from them and taking any action required. There was an open culture which encouraged all involved in the home to voice their views and concerns.