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Inspection carried out on 5 March 2018

During a routine inspection

This inspection took place on 5 March 2018 and was unannounced. At the last inspection on 5 October 2015 the service was rated Good. At this inspection we found the service remained Good.

Devonshire Road is a residential care home for five people with learning disabilities and mental health needs. 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. At the time of this inspection there were five people living at the service.

At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We observed people to be happy and very settled living at Devonshire Road. Some people had been living at the home in excess of 20 years.

Care plans contained clear and specific risk assessments with guidelines for staff on how to support people so as to reduce or mitigate each identified risk in order to keep people safe from harm.

People and relatives told us that they felt safe living at Devonshire Road and with the support that they received from the care staff.

The service followed robust recruitment processes to ensure that only care staff that were assessed as suitable and safe to work with vulnerable adults.

We observed appropriate staffing levels available to support people. Staff levels were flexible dependent on people’s level of need.

Medicines were administered and managed safely and people received medicines as prescribed.

People’s needs were assessed prior to admission and regularly reviewed so that people received the appropriate care and support that took account of their needs and requirements.

Care staff received appropriate training and support in order to effectively deliver appropriate care and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The provider had policies and systems in place to support this practice.

People were supported with their nutrition and hydration needs which took account of their choices, preferences and wishes. Where specialist dietary requirements had been recorded, people received the appropriate and specific support as outlined in provided guidance.

People were supported to access a variety of health care service where required to enable them to live a healthier lifestyle.

People were supported to be as independent as possible. People had established caring and meaningful relationships with other people living at the home and with the care staff that supported them.

Appropriate processes were in place to deal with any complaints that were received. People and relatives confirmed they knew who to speak if they were not happy with any aspect of their care and support.

Care plans were detailed, person centred and responsive to people’s care and support needs, choices and wishes.

The provider had processes in place to ensure that the quality of care was regularly monitored and checked so that subsequent learning could take place and improvements made to the delivery of service.

Further information is in the detailed findings below.

Inspection carried out on 5 October 2015

During a routine inspection

This comprehensive inspection was undertaken on 5 October 2015 and was unannounced.

During our last inspection on 14 September 2014 we found no breaches and the service was compliant with all regulations.

Devonshire Road provides accommodation and support with personal care for up to five people with learning disabilities.

The service has a registered manager appointed. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

We found that Devonshire Road provided personalised person centred care, which people were in control of the support they received and contributed in decision-making on the support they receive. People were encouraged to be independent and there was a family type culture that promoted independence.

Medicines were stored and administered correctly. Staff administering medicines were trained to ensure they were competent and safe.

Staff were trained in safeguarding adults and had a good understanding in keeping people safe. They knew how to recognise abuse and who to report to and understood how to whistleblow. Whistleblowing is when someone who works for an employer raises a concern which harms, or creates a risk of harm, to people who use the service.

Care plans were personalised to the people and was working well. Both the people and their relative were involved in planning of care and the care plan was then signed by people to ensure they are happy with the care and support listed on the care plan.

Risk assessments were not completed for one person that required assistance with moving and handling. Feedback was provided to the registered manager and a risk assessment was completed promptly.

People enjoyed the food and were given choices on what they would like to eat during mealtimes and we found that their needs and preferences were taken into account.

The service was not routinely monitoring people’s weight as we found that some residents experienced weight loss. A nutritional assessment was not undertaken on what to do in the event someone was losing weight such as monitoring food intakes or making immediate referrals to the GP.

People had access to healthcare services such as the General Practitioners (GP) and dentists. People were supported to make healthcare appointments and regular visits were made with the assistance of staff. A GP also visited the home to undertake annual health checks. We saw individual 'health action plans' were not updated. The registered manager told us they were in the process of being updated.

People were able to consent when receiving care and support and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty and Safeguarding (DoLS).

MCA and DoLS is a law protecting people who are unable to make decisions for themselves or whom the state has decide their liberty needs to be deprived in their own best interests

Systems were in place to ensure staff received regular supervision and appraisal. Staff received induction training and also received regular training to ensure that people are safe and the care provided is effective.

Complaints had not been made by service users or relatives about the service however people were aware on how to make complaints and staff knew what to do in the event a complaint was made.

People enjoyed a number of activities such as going to the daycentre, restaurants, swimming and bowling.

People's privacy and dignity was maintained. People were encouraged to be independent and we saw people helping around the house and people told us they enjoyed helping. Support was provided with personal care and other tasks however they were encouraged to do as much as they can themselves.

Robust systems were in place for quality assurance and continuous improvements. The registered manager conducted regular audits, which included spot checks to ensure quality and used the findings for continuous improvement. This was then communicated to staff by the internal communication book and at staff meetings.

Inspection carried out on 15 September 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, response and well-led?

Is the service safe?

People told us they felt safe and secure and this was confirmed by relatives. Staff received training and both formal and informal supervision which helped them understand how to meet the needs of people and keep them safe. Risk assessments had been carried out and plans put in place to reduce the risks to people of physical or emotional harm.

We saw records which showed all staff had attended training in safeguarding adults and the Mental Capacity Act (2005). Care workers and managers we spoke with demonstrated some knowledge of the principles of safeguarding and gave us examples of raising concerns and of the provider following these concerns up.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

People all had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Staff were aware of people's preferences, interests, aspirations and diverse needs and supported people to meet these. The service had systems in place to monitor the care provided and to ensure people were happy with it.

Staff received formal and informal supervision and appraisals. In addition, there were regular staff meetings to discuss common issues and individual concerns or suggestions.

Is the service caring?

People we spoke with said they felt staff treated them with respect and dignity and involved them and their relatives in decisions about their care. We saw staff interacting with people in a respectful and warm way. Care workers showed patience and gave encouragement when supporting people. People told us "The staff are kind" and "I love it here."

Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Information about the service was provided both verbally and in writing and focused on people having choices and on helping them maintain as much independence as possible. People told us they had been given opportunities to ask questions and had any concerns listened to and acted on. People and relatives knew how to make a complaint if they were unhappy. They told us they were confident the service would take complaints seriously and look into them quickly.

The service worked well with other agencies and services to make sure people received the right care. People told us they were involved in reviewing their plans of care when their needs changed.

Is the service well-led?

The service had quality assurance systems, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff showed us they were clear about their roles and responsibilities. They had an understanding of the ethos of the service and the quality assurance processes which were in place. This helped to ensure people received a good quality service at all times.

The provider ensured that feedback from people themselves, relatives, staff and other professionals was received and this influenced the development of the service and improved care for people.

Inspection carried out on 8 November 2013

During a routine inspection

We found evidence that people were happy with the care they were receiving. Outside activities were common and enjoyed by people receiving care. People were involved in discussions and decisions about their care and support. We found that choices were offered and people had been actively involved in the running of the home.

Wherever possible, consent was sought and obtained before any care or support was given. Staff were trained appropriately and both they and people receiving care felt there were enough of them working days and nights to cover both routine and any emergencies.

The home was suitably maintained and the environment was arranged so that people could live as they wished to in a homely way, with as much independence as possible.

Feedback from people in the home, from relatives and from staff positively influenced care and living conditions. We found that people had plenty of choice in regard to their diet and standards of nutrition were good.

Inspection carried out on 17 December 2012

During a routine inspection

People took part in a range of activities. People had up to date care and support plans and risk assessments based on their current assessed needs.

The service had systems in place to help protect people from abuse.

Staff were supported to develop their skills and received training relevant to their role. Staff

received supervision.

Inspection carried out on 16 September 2011

During a routine inspection

We asked people who use services about being treated with dignity and respect. Everybody confirmed that staff knocked on their bedroom doors and ask to come in. People said that they get enough privacy in the home and a number of people said that they choose when they go to bed.

One person said that the ��staff were really helpful and supportive��. Another person stated that staff were always there to help.

"Every told us that the care provided was good".

We asked people who use services if they felt safe in the home and everybody spoken with said they did.

We asked people who use services what they thought of the environment. People said to us �it is great�.

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