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Inspection carried out on 2 July 2019

During a routine inspection

About the service

Carisbrooke is a care home providing personal care and accommodation for up to 12 people, who may be living with a learning disability. At the time of the inspection nine people were using the service.

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.

Carisbrooke is a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service

Maintenance issues were not always reported to ensure these were addressed promptly. This was rectified after inspection. We made a recommendation to improve this in the report.

The provider had systems in place to safeguard people from abuse. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to reduce the risk of recoccurrence. Systems were in place to recruit staff safely.

People were supported with good nutrition and could access appropriate healthcare services. Staff were equipped with relevant skills.

There was a very homely and welcoming atmosphere where people were supported by staff who were kind, caring and treated them with dignity and respect. People were relaxed and happy in the company of staff and the registered manager.

People received person-centred care from staff who developed positive, meaningful relationships with them. People had opportunities to socialise and participate in activities and entertainment of their choosing. Care plans were detailed and up to date about people's individual needs and preferences.

The environment was clean and free from malodours. People had personalised rooms.

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.

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.

There was strong leadership at the service and people, relatives and staff spoke highly of the registered manager. There was a positive culture at the service where staff felt listened to and supported. There was a drive to continuously improve the service for people and the registered manager and staff team were very responsive to any areas for improvement identified. People using the service and staff had the opportunity to feedback about the service. There was a system in place to respond to any concerns.

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

Rating at the last inspection

At the last inspection the service was rated good (published 31 Decem

Inspection carried out on 25 November 2016

During a routine inspection

Carisbrooke provides accommodation and personal care for up to 12 people with a learning disability. The service is a detached period property in a central location in the town, close to all local amenities. Accommodation is provided over three floors with access to the first and second floor via stairs; there is a stair lift to provide assisted access to the first floor. At the time of the inspection there were 10 people living in the home.

The service had a registered manager in post. They had managed the service for 10 years. 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.

At the first rated comprehensive inspection in February 2015, we found there were shortfalls with the care records and there was a breach in regulation. We rated the service as ‘good’ in the safe, effective and caring domains and ‘requires improvement’ in the responsive and well-led domains. We rated the service as ‘requires improvement’ overall. We then completed a focused inspection in August 2015 to review the responsive domain and found the necessary improvements to the care records had been made. This inspection took place on 25 November 2016 and we found sustained improvements had been made in all areas and have rated each domain as ‘good’ and the service has been rated overall as ‘good.’

The safety of people who used the service was taken seriously and the registered manager and staff were aware of their responsibility to protect people’s health and wellbeing. Staff understood the procedures they needed to follow to ensure people were protected from the risk of abuse. People we spoke with told us they felt safe living in the home.

Our observations during the inspection showed us people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs. We saw there was a recruitment system in place that helped the registered provider make safer recruitment decisions when employing new staff.

Assessments of people’s needs were completed and care was planned and delivered in a person-centred way. Care plans were regularly evaluated, reviewed and updated. Aspects of the care plan format were easy for people to understand by the use of pictures and symbols. We saw evidence to demonstrate people and their relatives were involved in their care planning.

Risk assessments had been developed to provide staff with guidance in how to minimise risk without restricting people’s independence. This included the management of their behaviours using the least restrictive options. People received their medicines as prescribed and had access to a range of professionals for advice, treatment and support.

People who used the service were encouraged to make their own decisions. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

We observed kind and caring approaches from the staff team. People’s privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. Staff were overheard speaking with people in a kind, attentive and caring way. There were very positive comments from relatives about the staff team.

Staff received training that enabled them to support people safely and meet their assessed needs. The registered manager had been working with staff to develop their knowledge and autonomy in the day-to-day management of people’s care needs. We found staff were making progress and received regular guidance, support, supervision and appraisal.

People’s nutritional needs were met and in recent months staff had been supported to provide a more balanced and healthy

Inspection carried out on 10 August 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 25 February 2015. At which a breach of legal requirements was found. This was because not every person who used the service had an assessment and plan of care to guide staff in how to meet their needs, wishes and preferences.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 10 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Carisbrooke’ on our website at www.cqc.org.uk’

Carisbrooke provides accommodation and personal care for up to 12 people with a learning disability. It is situated in a residential setting and close to local facilities. At the time of the inspection there were 11 people living in the home.

The home has a registered manager. 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 and associated Regulations about how the service is run.

At our focused inspection on the 10 August 2015, we found the registered provider had followed their plan which they had told us would be completed by the 20 March 2015 and legal requirements had been met.

We saw people had assessments of their needs and care was planned and delivered in a person-centred way. Risk assessments had been completed to provide staff with guidance in how to minimise risk without this impacting on people’s independence.

We found people’s health needs were met and they had access to a range of professionals in the community for advice, treatment and support. Records showed staff monitored people’s health and responded quickly to any concerns.

Improvements had been made to the variety of activities within the service. An activity programme had been developed and staff were monitoring people’s engagement with the range of activities provided.

Inspection carried out on 25 February 2015

During a routine inspection

We undertook this unannounced inspection on the 25 February 2015. At the last inspection on 29 November and 9 December 2013 the registered provider was compliant in the areas we assessed.

Carisbrooke provides accommodation and personal care for up to 12 people with a learning disability. It is situated in a residential setting and close to local facilities. At the time of the inspection there were 11 people living in the home.

The service has a registered manager. 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.

Although the majority of people had detailed care records in place, we found one person who used the service did not have an assessment and plan of care. This meant that staff may not have guidance in how to meet the person’s needs and there was a risk important care could be missed.

This issue meant the registered provider was not meeting the requirements of the law regarding assessing and planning care for people. You can see what action we told the registered provider to take at the back of the full version of the report.

There was a programme in place to monitor the quality of the service provided to people. We found the programme was limited in its scope and some areas of this could be improved, to make sure all aspects of the management and administration systems were thoroughly reviewed.

There were sufficient numbers of staff to look after people and provide them with the individual support and care that they needed. Extra staff were provided for people’s one to one time to support their community visits. Pre-employment checks were completed on staff before they were judged to be suitable to work at the care home.

There were policies and procedures in place to guide staff and training for them in how to keep people safe from the risk of harm and abuse. In discussions, staff were clear about how they protected people from the risk of abuse.

People who used the service were encouraged to make their own decisions. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

There was a process in place to ensure people’s health care needs were assessed and action was carried out to meet people’s individual needs. This included the management of their behaviours using the least restrictive options. People received their medicines as prescribed and had access to a range of professionals for advice, treatment and support.

People accessed a range of community facilities and also completed activities within the service. They were encouraged to follow hobbies, social interests and to take holidays. People were also supported to maintain relationships with their relatives and make friends with each other. They told us, “We are all friends here" and “I liked the singers, I played the tambourine.”

People’s nutritional needs were met. Staff monitored people’s food and fluid intake and took action when there were any concerns. People were encouraged to have a healthy diet and to eat well.

We observed people being treated with dignity and respect and enjoying interaction with staff. Staff knew how to communicate with people and involve them in how they were supported and cared for. People were encouraged to be independent where they were able to be. People who used the service told us, “They look after us well” and “I’ve been here a long time and some staff have been here nearly as long as me. They know me and look after me.”

Staff were supported and the standard and quality of their work was kept under review. New staff received induction training to ensure they understood their roles and responsibilities. Staff training and development needs were identified and met.

A complaints process was in place which was accessible to people, relatives and others who used or visited the service. Staff were enabled to make suggestions to improve the quality of people’s care.

Inspection carried out on 29 November and 9 December 2013

During a routine inspection

We were unable to gain the views of all the people who used the service when we visited due to their complex needs. Therefore we also observed how support was provided, reviewed records and spoke with staff to help us understand their experiences. We contacted three relatives following the inspection to discuss their satisfaction with the service.

We found people received the care and support they needed. People were involved in a variety of social activities and one person told us, �We are having a party and Santa is coming.�

People who used the service were provided with a balanced and varied diet. People we spoke with told us they liked the meals. Comments included, �They make nice meals here, I like them� and �The chilli is good, we are having that tonight.�

We found areas of the home were in need of redecoration, maintenance and refurbishment. There had been delays with the start of the works programme, but the manager confirmed this was due to start the following day. Relatives we spoke with told us, �I�m happy with the home, it�s always nice and clean� and �The decor is not deluxe, but more than adequate.�

We found sufficient staff were available to meet the needs of the people who used the service. People told us they liked the staff. One person said, �Staff are always here to help me.�

We saw there were systems in place to gain people�s views and check if staff were following company policies. One person said, �I like living here with my friends.�

Inspection carried out on 11 February 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. A carer we spoke with said �People express themselves in different ways, facial expressions or hand signals, we understand what they mean.�

We saw that a range of risk assessments had been completed in topics such as; falls, mobility, vulnerability and using appliances in the home. Care plans and risk assessments were reassessed on a yearly basis. Having accurate information about the people that used the service gave assurance that the staff were aware of their level of care and support required.

Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication. The home had a range of medication policies in place that outlined how to manage medicines effectively.

There were effective systems in place in relation to the recruitment and selection process. We looked at the employee files and saw that appropriate checks had been undertaken before employment had commenced. We noted that the border and immigration agency had been contacted and registration checks from the home office were in place for foreign employees.

We found that the service had received very few formal complaints. We looked at the complaints record and saw that the one documented complaint had been fully investigated. This ensured that when a complaint was received it was taken seriously by the provider.

Inspection carried out on 24 November 2011

During a routine inspection

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the staff and care provided. They told us: "staff are kind", "Staff help and sort it out" and "I like it here."

We observed staff supporting people to be as independent as possible. One person told us: �I make coffee in the morning and afternoon.� Another person said they were �Going Christmas shopping with their dad�.

Reports under our old system of regulation (including those from before CQC was created)