Derby Lodge

Derby Lodge is a care home providing personal care for up to 23 people. At the time of our inspection there were 21 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

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 provider consistently maintained sufficient staffing levels to support people to take their time when being assisted. A staff member confirmed, "Yes, there’s enough staff on the shift, which means we can spend quality time with the residents." The registered manager trained their workforce to administer and manage people’s medicines safely.

Right Care:

People asserted they were supported to maintain their independence. A relative said, “It’s all accessible. They’ve even altered things in the lift for [my relative] to reach. They’re very good like that." Staff had a range of specialist training to ensure they could meet people’s specific needs, such as in learning disability and mental health conditions. The registered manager developed person-centred care plans with people and their relatives to maintain their independence, although this was not consistent and there were gaps in records.

We have made a recommendation about care planning and risk assessment.

Right Culture:

The provider engaged closely and transparently with the local authority as part of their lessons learnt process to improve people’s care. Staff told us they were fully consulted about different aspects of the home and worked as a team to enhance people’s lives. Staff interactions with people and their relatives were consistently kind and respectful, with appropriate use of positive language. A relative stated, “It’s a fantastic place – it’s the place.”

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 20 April 2022).

Why we inspected

The inspection was prompted in part due to concerns received about staff approach, medicines administration, risk management and staffing levels. A decision was made for us to inspect and examine those risks.

The provider has taken effective action to mitigate the risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of the report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information we may inspect sooner.

Derby Lodge is a residential care home providing personal care for up to 23 people. The service provides support to adults with a physical disability, learning disability, autism and younger adults. At the time of our inspection there were 23 people using the service.

Derby Lodge is set over two floors with an accessible lift. There is a good size garden and parking facilities for visitors.

People’s experience of using this service and what we found

People living at Derby Lodge were kept safe; staff had good knowledge and skills about people’s needs, likes and dislikes. One person said their relative had, “Excellent one to one care”, and another said, “The care is marvellous.”

There were adequate staffing levels and people were supported to go out and maintain their interests. Some people said they would like to go out more.

People benefited from improvements made to the governance of the service following the last inspection, particularly in relation to management of fire safety. People and their relatives found the managers and staff approachable and responsive.

Other improvements only recently commenced, for example, auditing, was not yet embedded. We will review this at our next inspection.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Derby Lodge is a large residential home with limited opportunities for people to be in control of their day to day lives and develop independence. There was a mixture of younger people and older people, who had different interests. Some people said they would like to be able to do more. However, staff supported people to take part in their interests and hobbies where possible; care plans were person centred and staff could meet people’s needs and preferences. There were six flats available for some people to live more independently.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 September 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that fire safety measures reflected guidance. At this inspection we found the provider had acted on this recommendation and improvements were made.

Why we inspected

We undertook this focused inspection to check whether the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Derby Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

The service was not always well-led. We could not be assured the registered provider understood their roles and responsibilities to keep people safe and provide a quality service. The provider has failed to be compliant with Regulations since 2016.

People were not always safe. Fire drills had not been completed with sufficient thoroughness to assure us staff understood the homes fire evacuation procedure. We made a referral to the Fire safety service who have made some recommendations, which the registered manager and provider were committed to following.

People living at Derby Lodge told us they were very happy living in the home. Interactions between staff and people living in the home were friendly and respectful. Relatives told us they were very happy with the care people had received and praised the improvement made in people's quality of life.

People were helped to keep safe from abuse and avoidable harm by trained staff who could recognise and report any concerns. Safeguarding procedures had been followed thoroughly.

People received care from trained staff. Staff felt confident they had received enough training to support people with personal care effectively.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The model of care is a large residential home, staffed to meet people’s needs and preferences, but which does not allow for regular individual support for people to follow their choices of activity or to develop their skills. However, the home sought to mitigate the impact of this by ensuring people’s care plans were person centred and reflected their experiences and wishes. Some people living in the home had taken a lead role in supporting people to express their views. There were six flats available for people to live more independently. There was the potential for these to be used to promote more independence.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published November 2020) there was a breach of the regulations in relation to safe care and treatment. At this inspection the service remains requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. This was commonly known as the 'national lockdown - stay at home policy'. This meant the Covid 19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

The provider and registered manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly Covid 19 testing for staff and every 28 days for people living in the home. Hand sanitiser and personal protective equipment (PPE) were available throughout the home. There were signs to remind staff and people about the use of PPE, importance of washing hands and regular use of hand sanitisers.

The infection control policy and people's risk assessments had been revised and updated in response to the pandemic. This helped ensure people were protected in the event of becoming unwell or in the event of a Covid 19 outbreak in the home. At the time of the inspection, one person was isolating in their room. They had been to hospital for treatment, had not tested positive for Covid 19, but were required to isolate on their return consistent with current guidance. We found these processes to be effective and robust. People, staff and management were complying with the rules.

Staff had comprehensive knowledge of good practice guidance and had attended Covid 19 specialist training prepared by the local authority. We noted staff were reminded of the guidance at the start of their shift. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Policies and infection control processes were regularly reviewed when guidance changed. The home was clean and hygienic. All staff had received Covid 19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

People's mental wellbeing had been promoted by innovative use of social media and electronic tablets so people could contact their relatives and friends. The provider had created a suitable visiting area where visitors did not need to fully enter the home. It was a safe and appropriate place for people to see their loved ones during the pandemic. The registered manager said they were preparing for its use at the time of inspection and had advised relatives of the facility.

Further information is in the detailed findings below.

Derby lodge is a residential care home providing personal care for up to 23 people living with a learning disability or autistic spectrum disorder, physical disability or younger adults. At the time of the inspection 23 people were living at the service.

The service is situated in a residential area of Preston; close to local amenities and public transport links. All bedrooms are of single occupancy, six have ensuite facilities. Six other bedrooms also had a lounge, kitchenette and bathroom. There are two communal lounges, a dining area, games room as well as communal bathrooms and toilets.

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.

The service was a large adapted building. It was registered for the support of up to 23 people. 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.

People’s experience of using this service and what we found

Medicines were not always being managed safely. Some records had not always been completed appropriately. Systems had been developed for the safe ordering and storage of medicines.

Care files and individual risk assessments were not always reviewed and updated in a timely manner. The registered manager confirmed the actions taken as a result of our findings.

We have made a recommendation about people’s risk assessments and care plans are reviewed and in line with current good practice.

Accident records had been completed however the actions taken had not always been recorded on these records. We have made a recommendation about the recording of accidents.

People were happy and felt safe living in the service and raised no concerns in relation to their medicines. Staff were recruited safely and training was ongoing. Infection control measures were in place; we observed and, staff told us plenty of personal protective equipment was available.

All people were complementary about the management team. The registered manager and nominated individual were visible during the site visit, it was clear people knew them well. Audits and monitoring had been developed with actions recorded, however the medicines audit failed to identify the shortfalls we found at the inspection. There was evidence of the involvement of professionals. Team meetings were being completed as well as daily handover meetings ensuring the staff team were up to date. The service sought feedback from people

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 and update

The last rating for this service was requires improvement (published 4 March 2020). As a result we issued conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe Care and Treatment and Good Governance. The service has been requires improvement for the last four inspections.

Why we inspected

We carried out the last comprehensive inspection of this service on 16 October and 15 November 2019. Breaches of legal requirements were found. As a result of that we issued conditions on the providers registration.

We undertook this focused inspection to check they had followed these conditions and carried out the action plan to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. At this inspection on 21 September 2020, we found not enough improvements had been made and the provider was still in breach of regulation.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Derby Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the safe management of medicines.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Derby Lodge is a residential care home providing accommodation and personal care for up to 23 people living with a learning disability or autistic spectrum disorder, physical disability or younger adults. At the time of the inspection 22 people were living at the service.

The service is situated in a residential area of Preston; close to local amenities and public transport links. All bedrooms are of single occupancy with six benefitting from ensuite facilities. Six other bedrooms also benefited from a lounge, kitchenette and bathroom. There are two communal lounges, a dining area, games room as well as communal bathrooms and toilets.

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.

The service was a large adapted building. It was registered for the support of up to 23 people. At the time of the inspection there were no people living there with a diagnosed learning disability. 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.

People’s experience of using this service and what we found

The management of medicines was ineffective and placed people at risk of harm. We made a recommendation in relation to managing swallowing risk, the availability of current swallowing guidance and maintaining people’s dignity and respect. Improvements were noted to the monitoring of the service however medicines audits failed to identify the shortfalls noted during the inspection. The service had been rated as requires improvement for the previous three inspections and ongoing concerns were noted during this inspection in relation to the management of medicines and good governance. On the second day of the inspection we followed up the concerns identified in relation to the safe management of medicines. We noted some actions had been taken as a result of our findings however the service failed to ensure medicines were managed safely and people using the service remained at risk.

Staff understood and guidance was available to act on allegations of abuse. Risk assessments had been developed in relation to the environment and checks and servicing had been completed. The service was clean and tidy, staff had access to personal protective equipment to reduce the risks of infection. The service had been developed to support the needs of people living there. Corridors were wide and accessible and bedrooms had been personalised with people’s own possessions

Staff had received training that was relevant to their role and improvements had been made in relation to the recording of supervisions with the staff team. Staff were recruited to their posts safely. The registered manager confirmed they would access a staffing analysis tool to ensure they had appropriate numbers of staff in post to meet the needs of people using the service.

People were provided with choices of meals and they confirmed they had been consulted about the menu choices. The registered manager took immediate action to ensure a risk assessment in relation to swallowing was completed for one person who used the service as well as ensuring staff had access to up to date swallowing guidance. We observed the meal time experience whilst people were provided with support to eat their meals; little meaningful interactions were noted between people and staff. The registered manager told us a professional had recommended that the meal time experience should be quiet times to support people's swallowing risks.

People received good care and their individual needs and rights were considered. However improvements were required in ensuring people were treated with respect and dignity. The registered manager told us they would monitor the interactions between staff and people who used 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. Appropriate consent had been sought in relation to people’s needs. Improvements were noted in the care files. Care plans and risk assessments had been completed. We discussed with the registered manager who took actions to ensure further improvements were made to their content. Systems to support people’s individual communication needs had been developed. There was evidence that activities were taking place however; some feedback was that these needed to improve. People were supported to maintain relationships with relatives

Complaints were dealt with appropriately policies and guidance was available. Evidence that team meetings were undertaken were noted.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 October 2018) and there were three breaches of regulations. Following the inspection we met with the provider to discuss the actions they planned to take to make improvements at the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made; however further improvements were required in relation to the management of medicines and the leadership and management of the service. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe management of medicines as well as good governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Derby Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. 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.

Following our last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. During this inspection, we found improvements in how the service investigated and acted on allegations of abuse and the operation of systems and processes to audit and monitor the service. Whilst we saw some improvements in the management of medicines we identified that work was still required for the service to meet the requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at training, supervisions and appraisals provided for the staff team. Whilst we saw some improvements in the auditing and monitoring of the service, we identified that work was still required for the service to meet the requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We saw that action was required to ensure staff had access to appropriate training and supervision. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing. You can see what action we told the provider to take at the back of the full version of the report.

Whilst we saw improvements in assessing and monitoring risks for people improvements were still required. We made recommendations in relation to individual and environmental risk assessments. Whilst we saw some improvements had been made in relation to the care records for people who used the used the service further work was required. We made recommendations in relation to care records.

Derby Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 using the service can live as ordinary a life as any citizen. At the time of our inspection three people with a learning disability lived at the service.

Derby Lodge accommodates up to 23 people who require support with personal care in one building. There were17 single occupancy bedrooms, of which seven were ensuite, as well as six flats, which consisted of a lounge and kitchenette area, bedroom and bathroom. At the time of the inspection 22 people were in receipt of care.

The service had a registered manager in post at the time of our inspection. 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 was run.

Medicines were not given to people safely because staff did not always check medicines against the records properly before administering them. Topical medicines such as creams and medicines prescribed ‘when required’ were not handled safely. Storage of medicines was not always safe and medicines requiring disposal were not safely handled.

We saw improvements had been made in relation to risk assessments in the home. However not all environmental, and individual risk assessments were seen in relation to the needs of people. The provider took action to address this as part of the inspection.

Improvements in the environment was noted and checks and servicing was taking place in the home. The home was clean and tidy and personal protective equipment was available to reduce the risk of infection.

People told us they were happy with the staffing levels in the home and felt these met their needs. Duty rotas were adapted when changes were required, such as for staff sickness. A safe recruitment programme was in place that ensured only staff suitable to work in the home were recruited. Staff told us they had received training to support the delivery of care to people. People told us they felt safe living in the home and staff had received training in safeguarding. However, not all of the staff team had received regular and up to date training and supervision.

The home was operating under the principle of Registering the Right Support. People were clearly involved in choice in respect of their care and were encouraged to be independent. Where required a variety of professionals were involved in mainlining people’s individual health needs.

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. The registered manager told us no one living in the home was subject to Deprivation of Liberty Safeguards (DoLS). Care files we looked at considered restrictive practice and capacity assessments had been completed where appropriate.

We received very positive feedback about the care people received in the home. We observed staff treating people with dignity and respect engaging in light hearted chatter. Care was delivered to people in the privacy of their own bedrooms or bathrooms. Staff were seen knocking on people’s doors and waiting to be invited in. Advocacy services were available to people to support them in important decisions.

The care records we checked identified some areas of improvement in their content. However, further improvements were required to ensure they reflected people’s current needs.

Policies were in place to guide people and staff on how to deal with complaints. People raised no concerns and positive feedback had been received by the home.

We saw activities were being provided by the home and people taking part during our inspection. The registered manager told us the records for activities would be developed to provide more detail. Technology was being used effectively.

Whilst we saw some improvements since or last inspection further improvements were required to meet the requirements of regulation. Audits were seen however these were basic and lacked details of the actions taken or any lessons learned as a result of the findings.

Team meetings were taking place. Notes from minutes were seen which identified the topics discussed. People told us the provider asked their views and we saw positive feedback from surveys.

All people we spoke with and staff were complimentary about the management team. We saw the registered manager and nominated individual were visible throughout all areas of the home.

Derby Lodge is registered to provide personal care and accommodation for up to 23 people living with a physical or learning disability. The home is in a residential area close to local amenities with access to public transport. Bedrooms are all single occupancy and 13 benefitted from ensuite facilities. Six of the rooms were set out with a lounge, kitchenette area, bedroom and ensuite. The home manager told us people who required less support used these rooms. There is outside space for people to use during warm weather and car parking facilities are available.

At the time of our inspection the registered manager who was also the nominated individual had left their post at the home and had submitted an application to deregister with the Commission. There was a new home manager new to post that had commenced the application process with Commission. The registration requirements for the home required a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspection on 29 February 2016, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, consent and risk. We asked the provider to send us an action plan on the changes they made to make improvements in the service. We also made recommendations in relation to recruitment, decoration of the building, supervision and the quality of the service. During this inspection we found improvements had been in the areas that we had identified concerns however we identified ongoing concerns relating to risk, staff supervision and quality monitoring as well as further concerns in relation to safeguarding, medicines and records. We made recommendations in relation to records for equality and diversity, supervision and training. You can see what action we told the provider to take at the back of the full version of the report.

Whilst some care records we looked at had some evidence of completed risk assessments, not all had been completed in full to reflect their individual needs. We could not find any evidence of personal emergency evacuation plans (PEEPs) that would assist the emergency services in the event of an emergency.

People we spoke with told us they felt safe in the home and staff were able to discuss the actions to take if they suspected abuse. However the systems to record any allegations of abuse; including details of the outcome and actions going forward were incomplete.

We saw medicines were administered safely by staff. We identified concerns in relation to the storage of medicines as well as the records in of medicine that needed to be returned to the pharmacy.

People who used the service and staff told us there was enough staff on duty to look after them safely. Records confirmed safe recruitment practices had been followed and where one concerns relating to recruitment had been identified the proprietor responded quickly to demonstrate the actions taken to ensure people were recruited safely.

Staff told us they had received supervision and appraisal from the management in the home. Records we looked at identified supervision had not taken place recently.

Staff told us they had received the training they required to ensure they were able to meet people’s needs. Records we looked at identified gaps in relation to the training staff had received.

The home manager told us all of the people living in the home had the capacity make their own decisions. Staff we spoke with understood the basic principles of the Mental Capacity Act (MCA) and confirmed they had received training in MCA. People told us they had been involved in decisions about their care needs and had agreed to their care.

We received positive feedback about the meals on offer in the home. Choices of meals were available and we observed the meal time experience was positive, relaxed and friendly.

People we spoke with and our observations confirmed they received good quality care from staff that met their needs. People were treated with dignity and respect. We saw staff knocking on people’s bedroom doors and waiting to be invited in.

The home manager told us they would ensure people’s needs in relation to equality and diversity was recorded in their care files.

There was system in place to deal with complaints. We saw evidence of complimentary feedback about the home.

We saw records had some evidence of how to support people’s needs in them. Not all had been completed in full to ensure people’s current needs were reflected to guide staff.

There was evidence that activities were accessible for people who used the service. Records confirmed a range of activities taking place and we saw people engaging with staff playing table top games.

We received positive feedback about the new home manager and the changes she was making in the service. There was some evidence of audits taking place on the environment in the home. We saw no evidence of audits taking place in relation to care files, care plans, medicines, supervision and competency checks.

Staff team meetings records were in place however record confirmed team meetings had not taken place for some time. Polices and procedure were in place and up to date to guide staff in home to care for people’s needs and the operation of the home.

The home had a registered manager in place. 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.

The registered manager and service provider had not ensured that people receiving care and treatment were not placed at risk from avoidable harm. The registered manager and service provider had not made arrangements to robustly assess the risks to people's health and safety during their care or treatment, or taken action to minimize or eliminate those risks. Information held within people’s care records showed that there were policies and procedures for managing risk in place, however, these were not always robust. Risk assessments were undertaken by the service, however, for some people, there were no clear risk management strategies documented within the their care notes, and no clear details as to what the staff should do to support this person, taking into account their disability and assessed needs.

The service provider had not ensured that, following an appropriate assessment of the needs of people, they had designed a plan of care to meet those needs, that reflected their personal preferences. We found that risks were not always assessed robustly prior to admission. Although the registered manager had discussions with the person and relevant professionals, we found that they not obtained a clear and comprehensive needs assessment from the Local Authority prior to admission.

The registered manager and service provider had not ensured that the services provided at the home met the requirements of the Mental Capacity Act 2005. The registered manager and staff were aware of the need to involve relevant people if someone was unable to make a decision for themselves. However, we noted that the care records of four people living at the home did not support this. We were unable to determine if there any potential restrictions placed on people’s choices or freedoms, as the information held at the home was not based on a clear assessment of people’s needs and the risks associated with them.

Although the service had an appropriate recruitment system in place, we recommend that the registered manager and provider ensure that all the records relating to the safe recruitment of staff are properly maintained in order to promote and protect the best interests of the people living at the home.

Staff received limited supervision, and as a result we recommend that the registered manager and provider revise the home’s supervision policy, and ensure that it clearly states its commitment to supervision and clarifies its expectations regarding the frequency of supervision, and how the process will be reviewed and evaluated. The policy should also be clear about how the organisation will identify the training needs of the staff with a view to meeting the specific and specialised assessed needs of people living at the home.

Although people were happy living at the home and were happy with their accommodation, we recommend that the registered manager and service provider undertake a review of the décor of the building, to determine which areas of the home are in need of renewal. This could be completed in conjunction with service users, their families and staff.

We recommend that the registered provider ensures that there are effective systems in place to monitor the quality of the service, and where areas for improvement are identified, appropriate measures are put into place to improve practice and service delivery.

We found three breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. This related to safe care and treatment, the need to consent and person centred care. You can see what action we told the provider to take at the back of the full version of this report.

Is the service safe? People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. The service was safe, clean and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. Recruitment practice is safe. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective? There was an advocacy service available if people needed it, this meant that when required people could access additional support. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People's needs were taken into account with signage and the layout of the service enabled people to move around freely and safely.

Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People at the home said that they felt their needs were very well met by the staff. They added that the staff were quick to respond to requests for help. We observed the staff work with people in positive ways, giving them time to think, treating them with care and respect, and responding to their requests for help and support. People living at the home said that they felt safe and secure. One person said that they knew they could always turn to a staff member for help and reassurance.

Is the service responsive? People completed various activities in and outside the service. People knew how to make a complaint if they were unhappy.

Is the service well-led? The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system, records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and wanted to ensure it was implemented.

People told us they enjoyed the food and that it was always of a good standard with choices always available. Specialist advice was sought for people when dietary concerns or eating difficulties were identified. A five star Food Standards Agency rating had been awarded in 2013.

There was enough equipment to promote the independence and comfort of people who used the service. Equipment was safe and well maintained.

The staff team were suitably qualified, skilled and experienced to provide a safe and effective service. Safe recruitment and selection processes were in place.

People who used the service were asked for their views and they were acted on. One person said, 'We asked about having more activities and they arranged for someone to come and take us out'.

The home had external accreditation with a specialist care home accreditation company. However, internal audits were not carried out. This meant that the manager was not able to ensure that safe and appropriate care was provided at all times.

Following the inspection visit we received confirmation from the provider that training has been provided for all staff in first aid, infection control, load management, food hygiene and safeguarding vulnerable adults from abuse. Further training was planned for challenging behaviour, mental capacity and deprivation of liberty safeguards. The provider informed us they had also purchased training DVD's in order to do further in-house training with staff in a range of relevant subjects.