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Inspection carried out on 10 May 2018

During a routine inspection

This inspection took place on the 10 May 2018 and was unannounced. At the last inspection in December 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found the service had made the required improvement and was rated as Good.

70-72 Worting Road is a ‘care home’. The service accommodated eight people in one adapted building. 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 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 who used the service lived as ordinary a life as any citizen.

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.

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 supported this practice. Staff understood and worked to the principles of the Mental Capacity Act (2005).

Medicines were managed safely. Staff had training in medicines administration and were observed by the registered manager to assess their competence.

Recruitment was safe, as all necessary staff pre-employment checks had been completed. There were sufficient staff on duty to meet people’s individual needs. Staff were aware of the different types of abuse and the signs to look for. They were confident about how to report any concerns and told us the registered manager would take appropriate action.

People accessed their local community every day and had regular clubs, meetings and activities they engaged with and enjoyed. There was opportunity for people to go on holiday; recent destinations included North Wales and Corfu, both chosen by people living at the service.

People were involved in planning their own care and support. Where possible people had signed their own care plans and drawn pictures of their goals or drawn pictures of the support they wanted from staff. Care plans were reviewed regularly and up to date.

The environment was clean and kept in good repair. People were encouraged to take responsibility for daily living activity such as light domestic cleaning and laundry. People were involved in planning their own menus, shopping for food and preparing their meals. All the meals were prepared using fresh ingredients.

Team meetings were held regularly and minutes kept. Staff received supervision quarterly and had an annual appraisal of their performance. Staff had received training in a range of areas and told us they felt well supported.

People had the opportunity to gain local employment with support from staff, which promoted their independence. The provider had gathered feedback from people, relatives and staff. People living at the service also had the opportunity to attend house meetings where they could voice their views and concerns.

Inspection carried out on 29 December 2016

During a routine inspection

The inspection took place on the 29 and 30 December 2016. The inspection was unannounced.

70-72 Worting Road is situated in a residential area of Basingstoke close to the town centre. The provider, Advance Housing and Support Limited supported people with a mental health issue or a learning disability to live and work in the community. 70-72 Worting Road provides care and support for up to eight adults with a learning disability. At the time of the inspection the service was home to eight people. The home has a lounge, a games room, a dining room, a large kitchen and a conservatory. There is also a small laundry. There is a garden to the rear and front and parking is available. People’s rooms were all ensuite and arranged over the two upper floors which were accessed via stairs. People living at Worting Road were a range of ages and had a variety of needs. Some people were able to live relatively independently and did not need support to undertake tasks such as accessing the community or maintaining employment. Others needed full support with tasks such as personal care, support to eat and drink safely and assistance to access activities.

The service had 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. The registered manager also provided three hours management support to a supported living service next door also operated by the provider.

Improvements were needed to help ensure people’s medicines were managed safely.

Risks associated with the environment needed to be more robustly monitored. Audits and checks of the safety and quality of the service were not sufficiently robust.

Staff had not always completed and recorded mental capacity assessments, particularly where these related to complex and significant decisions.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team. People had risk assessments and risk reduction measures were in place to help keep people safe.

Staffing levels were adequate and recruitment practices were safe and relevant checks had been completed before staff worked unsupervised.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration.

Where necessary staff had worked effectively with a range of other healthcare professionals to help ensure that people’s health care needs were met.

Staff showed people kindness, patience and respect, were cheerful and motivating and the atmosphere was homely and positive.

Staff had a good knowledge and understanding of the people they were supporting. Care records were person centred and helped staff provide care which was in keeping with people’s needs and wishes. People were supported to take part in a range of work and leisure activities.

People, relatives and staff spoke positively about the registered manager. There was a positive and person centred culture within the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.

Inspection carried out on 8 May 2014

During an inspection in response to concerns

We conducted this inspection in response to concerns which had been raised regarding the care and welfare of people who use the service. During our inspection we found no evidence to support these concerns.

On the day of our inspection there were eight people living at 70-72, Worting Road. We spoke with all of the people who use the service, the registered manager, five staff and a care manager. We also spoke on the telephone with six relatives and an advocate who had supported people with important decisions.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that people were cared for safely. People's needs had been assessed and reflected in their care plans. Where necessary, assessments had been completed which identified and reduced risks, whilst supporting people to remain independent.

Where people needed support with specific health needs we saw there were individual plans which detailed the care needed and how staff should provide this. We found that staff received appropriate training in relation to diversity and equality, which had ensured that people�s diverse needs were met safely.

The service ensured that valid consent had been obtained from people before providing their care. Staff told us that they had received training about the Mental Capacity Act 2005 during their induction course, which had been updated annually

People who use the service said they felt safe with staff, who treated them with dignity and respect. One person said �They talk to me about boundaries and ways to stay safe.� Another said, �I know I can call them at any time if I am frightened and they will come and look after me.�

Staff understood the different signs of abuse and knew who to raise concerns with if necessary, including appropriate external bodies. People and their relatives told us they would report any concerns to the registered manager and had no worries that this would affect the quality of their care.

The service ensured that people were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to this service. The registered manager told us they had not needed to apply for DoLS for any of the people who use the service since the last CQC inspection, but they were aware of the process to follow. We found that staff also knew the process and had received DoLS training in 2014.

Is the service effective?

We found that the service placed people at the centre of all decisions regarding their care and support. Where the service identified a person lacked capacity to make a decision, a best interest meeting was held involving people who knew and understood them, which ensured their human rights were protected.

People we spoke with were complimentary about the care received. One person we spoke with said �They (key worker) chat to me on the way to work and are always asking me if I am okay. �It was clear from our observations and from speaking with staff that they had a good understanding of the people�s care and support needs and that they knew them well. One relative told us, �The staff are wonderful. He loves it there and his reading and writing skills have improved tremendously because they spend quality time with him.� Another relative said, �His behaviour has really improved and he is getting on with living his life.�

Staff had received induction training which was recognised by the care sector, covering core subjects including safeguarding, diversity and equality, the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS), infection control, management of medicines and food hygiene.

We found that staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills and knowledge. Staff had also received training to meet the specific needs of people including positive behaviour management.

The provider had ensured that people received appropriate care from competent staff who had been supported in their personal development by an effective system of supervision and appraisal.

Is the service caring?

People were supported by kind and compassionate staff, who spoke with people in a friendly, caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. Whilst talking about their key worker one person told us �They look after me and know if I am worried. I always tell them if something scares me.� Another person told us the manager, �Is great. He helped me to get my work. I love my work.�

We observed that staff supported people to make their own daily living choices and to be as independent as they were able to be. This promoted people�s self-esteem and gave them a sense of achievement. A relative told us, �The manager and staff really do care and continually build up their confidence to be as independent as possible.�

The care staff we spoke with enjoyed working with people they supported. One person told us, �The people here are what matters and we work as a team to support them to achieve their goals with small steps.� The registered manager said, �We listen to what they want to do and then try to make it happen.�

Is the service responsive?

The service was organised to respond to the diverse requirements of different people. People's needs had been assessed and their care was planned and delivered in accordance with their personal preferences. Staff had a clear understanding of each person�s needs and how they should be met. For example, the service had responded well to an incident where a person displayed behaviours which may challenge. The person�s behavioural support plan had been updated to ensure staff knew how to respond appropriately to such behaviour in the future. The person�s relatives were informed about the incident and told us, �The manager and staff were really good, they made sure he was safe and let us know so we could discuss things to prevent it happening again.�

We found that the service was responsive to the changing needs of people, which had been continually reviewed. Where staff required further training this had been planned in advance or where anticipated arranged immediately.

People knew how to make a complaint if they were unhappy but had no cause to do so since the last CQC inspection. We spoke with a relative who had made a complaint previously. They told us, �It was more of a misunderstanding but I was happy with the way the manager listened to my concerns and sorted it out.�

Is the service well-led?

The service was well led. The registered manager and staff we spoke with were clearly passionate about the health and wellbeing of people being supported by the service. Care workers spoke with pride about the way they promoted people�s independence.

Staff told us that the registered manager spoke with them about any changes planned and they felt part of a team where their contribution was valued. They told us that the registered manager was always helpful. One care worker told us, ''You can speak to the manager at any time and he always comes in if you need support.� This meant that staff felt confident to raise concerns.

During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.

Inspection carried out on 2 July 2013

During a routine inspection

People who used the service understood the care and treatment choices available to them. We spoke with three staff. They all told us how they encouraged people to be independent. People told us they were treated with dignity and respect.

We found that people who lived in the home were well cared for. One person told us �I like everything about living here�. Another said �I love the staff. They really look after me�.

Medicines were administered to people appropriately. We spoke with three people who lived in the home and they told us that their medication was always given on time and in private.

People who used the service benefited from receiving support from staff who understood their roles and were suitably qualified to carry out their work effectively. The provider also undertook appropriate pre-employment checks.

The provider took appropriate steps to monitor the quality of service and seek feedback from people who used the service. We found that the provider undertook an annual survey and there were regular residents meetings.

The home had an appropriate complaints procedure. We noted only one complaint had been received in the previous 12 months. This was dealt with appropriately and in accordance with the provider�s complaints policy.

Inspection carried out on 31 July 2012

During a routine inspection

We spoke with six people who lived in the home and one relative.

People who used the service told us that staff always talked to them ''nicely'' and they were always helped to choose things for themselves. People said ''it's great living here, we go out in the evenings and we love to go dancing''. People told us that staff treated them very well and helped them to learn new things. People told us that it ''felt nice and safe'' in the home. They told us that if they were worried about anything they could talk to staff or their families. People told us that they did not have any worries or concerns.

The relative of a person who lived in the home told us that their family member and the other people who lived in the home were always treated with respect and dignity.

They told us that their family member was happy and settled in the home. They said that the people who lived in the home had a ''brilliant'' relationship with the majority of the staff. The relative told us that they were unhappy about the way a formal complaint they had made had been dealt with. They told us that generally staff listened to any informal concerns they had and acted upon them.

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