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Inspection carried out on 20 May 2019

During a routine inspection

About the service: Station Road is a care home providing accommodation and personal care for up to 12 people with learning disabilities. The home is a large detached house. The home was set out over three floors with a self-contained flat where two people lived. On the day of the inspection, nine people were living at the service.

The service had 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 a learning disability were supported to live as ordinary a life as any citizen.

People’s experience of using this service:

People and relatives told us the staff were kind, friendly and dedicated. Staff were knowledgeable around people's needs.

People were not always protected from the risk of avoidable harm as staff were not always providing care as per people’s care plan and risk assessment.

Processes were in place to ensure that people could raise concerns. Complaints were investigated and responded to.

The service was working to a service improvement plan with support from the local placing authority. Checks and audits were carried out to determine the quality of the care. The provider had acted on some areas already identified for improvement.

Overall staff morale was poor with concerns raised about staff and management working relationships. The management team assured us these concerns were being addressed.

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.

Medicines were safely managed.

There were enough staff available to ensure people’s care needs were met. Staff were safely recruited and received regular training.

People were supported to attend and engage in activities in the local community which were of interest or benefit to them.

Rating at last inspection: Good (report published January 2018).

Why we inspected: The inspection was brought forward due to information of concern that we had received in relation to people's care. The inspection was prompted in part by information we had received from the local authority where concerns had been raised around aspects of care delivery. At the time of the inspection, the service was subject to enhanced monitoring by the local authority safeguarding and quality team. The service was working on a service improvement plan.

However, the information shared with CQC about the incident indicated potential concerns about unsafe medicines management, risk management and staffing levels. This inspection examined those risks.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Inspection carried out on 4 December 2017

During a routine inspection

This inspection took place on 4 December 2017 and was unannounced. Station Road is a ‘care home’. 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 ten people living at the home. The home was set out over three floors with a self-contained flat where two people lived.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

The service had a registered manager, which 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 our last inspection on 14 December 2015, we rated the ‘safe question’ as requires improvement as urgent remedial electrical work had not been carried out following an electrical safety check carried out by an independent electrical contractor in July 2014. Following the inspection, the provider submitted evidence that the remedial work had been completed.

People told us they were well treated at the home and risks to their safety had been identified and ways to mitigate these risks had been recorded in people's care plans.

Staff were aware that the people they supported were vulnerable and they understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

The home maintained adequate staffing levels to support people.

We saw mostly friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and reviewed regularly.

People told us they enjoyed the food choices on offer and played an integral part in menu planning and preparing their meals.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians. The service was pro-active in involving the appropriate health and social care professionals when they had concerns about people’s health.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff had regular supervisions and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

People were supported to engage in regular activities. People were supported to develop and maintain their independence.

Quality assurance processes were in place to monitor the quality of care delivered.

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

Further information is in the detailed findings below.

Inspection carried out on 14 December 2015

During a routine inspection

This inspection was carried out on 14 December 2015 and was unannounced.

During our inspection on 24 June 2014 we found that the service was compliant.

Station Road provides accommodation and support with personal care for up to 12 people with a learning disability. There were 11 people living at the home at the time of our inspection.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Urgent remedial action was not carried out, following an electrical safety check by a qualified professional on 5 June 2014 to ensure people living at the home were safe. The registered manager told us after the inspection that qualified professionals have been booked to carry out the remedial work.

Each person had a health action plan focussing on aspects of their health, which included medicines, health condition and GP details. We noted the plans were not updated regularly as people's health and medication may have changed over time.

People benefitted from staff that understood and implemented the principles of the Mental Capacity Act 2005. Deprivation of Liberty safeguarding application had been made for people that, due to their own safety, required supervision when going outside. Mental Capacity Act 2005 and Deprivation of Liberty safeguarding is a law protecting people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived in their own best interests.

People were safe and protected from the risk of abuse. Staff received regular training to make sure they understood their responsibilities to identify and report safeguarding concerns.

Risks were assessed and managed to protect people from unsafe or inappropriate care. There were systems in place to manage behaviours that may challenge the service.

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

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

People had access to healthcare services such as the GP and dentists. People were supported to make healthcare appointments and visits were made with the assistance of staff.

People enjoyed the food and were supported to maintain good health.

People's privacy and dignity was maintained. People were encouraged to be independent and we saw people helped with the cooking and set up the table for dinner.

Care plans were personalised to the individual. People were involved in planning their care and the care plan was then signed by them to ensure they were happy with the care and support listed on the care plan.

Activities in the home were tailored to suit people’s individual needs and preferences. People looked forward to going to drama classes, art classes and to the day centre.

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

Systems were in place to monitor the quality of the care provided and the information was used to improve the service.

The service had a quality monitoring system which included surveys for staff and people. We saw the overall results of the survey, which was positive.

We identified breach of regulation relating to premises. You can see what action we have asked the provider to take at the back of the full version of this report.

Inspection carried out on 24 June 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, is the service effective, is the service caring, is the service responsive, is the service well led?

At the time of this inspection there were eleven people living in the home. Six of them spoke with us and expressed their views about the service.

We observed the care provided and the interaction between staff and people who used the service. We spoke with four care staff, the registered manager, a relative and a social care professional visiting the home.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People indicated to us that they were well treated by staff. One of them said, �I am happy here. The staff treat me nicely.� Another person said, �I feel safe here. The staff take care of me well.� A relative we spoke with was confident that people were safe in the home. The service had a safeguarding policy and procedure. Staff had been provided with safeguarding training. They were aware of action to take in response to safeguarding incidents or allegations. The home had been kept clean and tidy. Risk assessments of the premises had been carried out regularly to ensure that the premises were safe.

Is the service effective?

Feedback from a relative and people who used the service indicated that the service was effective and they thought highly of the home. One person stated, �I attend different activities I like. I go bowling and I also have a job.� A relative stated, �The staff know the preferences of my relative and what drink they like. My relative is always happy and well cared for.� People�s care needs had been assessed before they arrived at the home and arrangements had been made to ensure that they were able to participate in activities they liked. The care plans were up to date and addressed various aspects of the person�s care including their likes and dislikes of people. We noted that staff went about their duties in a calm and orderly manner and people interacted well with them.

Is the service caring?

People who used the service indicated that staff were caring and attentive. One person stated, �They do take care of us. Food is lovely. The home is clean.� Another person said, �I have seen the doctor and dentist. There are activities I like. I have been shopping and bowling.� A relative stated, �The staff are very caring. Whenever I visit X was always happy and looked well cared for.� We observed that care staff were friendly and constantly chatting with people. When a person came up to a staff member and wanted reassurance, the staff member listened to them, gave them a cuddle and the person appeared happy. We saw a staff member and person sharing a joke. Staff said they were aware that all people should be treated with respect and dignity. They were knowledgeable regarding the specific care needs of people. Care plans were up to date and a relative informed us that they had been consulted regarding the individual needs of people. Staff had an understanding of people�s cultural and religious needs and where appropriate, arrangements had been made to meet these needs.

Is the service responsive?

People told us that staff listened to them and their preferences and choices had been responded to. Regular meetings had been held where people could make suggestions regarding the meals provided and activities they wanted organised for them.These meetings were chaired by people who used the service and we noted that the minutes were also taken by one of them. We were informed by the registered manager that people were involved in the recruitment of new staff. This was to ensure that people have a say in areas that affected them.

Is the service well-led?

The manager was knowledgeable regarding her role and responsibilities. There were arrangements for monitoring the quality of care provided. A satisfaction survey had been carried out recently. The results indicated that there was a high level of satisfaction among people who used the service. We saw evidence that audits and regular checks had been carried out in areas such as cleanliness of the premises, medication and the health and safety of the premises. Staff meetings had been held and the minutes of these meetings indicated that staff had been updated regarding the management of the home and the care of people. Staff we spoke with informed us that they worked well as a team and felt supported by the manager.

Inspection carried out on 28 November 2013

During a routine inspection

The provider planned care using a personalised and whole life approach. We saw evidence that care plans and risk assessments were up to date and most were reviewed regularly. We spoke with four people who used the service. All were positive about their care experience. One person told us "I am so happy here that is why I have stayed for 19 years." Another person told us "The staff here are lovely." We observed that the people who used the service had good relationships with their support workers.

We found the service to be clean and tidy with staff knowledgeable about infection control. Medicines were stored safely and stock was checked regularly. We looked at medicine administration records and found them to be fit for purpose.

Staff had received appropriate training to support them in their roles. We looked at training records and found that mandatory training was up to date for all staff members. We spoke with a senior support worker who told us that staff were also supported to take other courses specific to the learning disability field.

We found that the provider regularly assessed and monitored the quality of different aspects of the service using audit, inspection and discussion with staff and people who used the service. We saw evidence that people's opinions were actively considered and changes to practice were made when deficits in service quality were found.

Inspection carried out on 26 October 2012

During a routine inspection

People said that staff were respectful towards them and always spoke to them appropriately. Two people said "they were lovely".

There were a variety of activities designed to meet the needs of people. The care plans and risk assessments were up to date and relevant to their needs.

Systems were in place to ensure that people were protected from abuse. Staff said they had regular supervision and training. Records relating to people and their care were kept securely.

Inspection carried out on 5 September 2011

During a routine inspection

We asked people who use services about being treated with dignity and respect. Everybody confirmed that staff knock on their bedroom doors and ask to come in and this was observed on the day of the visit. People said that they get enough privacy in the home and a number of people said that they choose when they go to bed. People have a key to their bedrooms and a number of people were observed to use it to lock their bedroom doors.

We asked people who use services about the care provided. Everybody said that it was good.

We asked people if there was enough to do living at the service. People do attend day centres. One person spoke about how staff had supported them to undertake some voluntary work at the charity shop. Another person attends the church regularly and has an active role in the church.

People were asked their views with regard to the meals provided by the home. Comments were, "I think that the food is nice". People said they had been asked what they wanted to eat and were involved with the development of the menu.

We asked people who use services what they thought of the environment. They were very pleased and people said to us �We love it�.

People said staff could meet their needs. A person said �Staff are great.�

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