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Inspection carried out on 22 February 2018

During a routine inspection

The inspection took place on 22 February 2018 and was announced.

Echo Square is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support for up to three adults with a learning disability. There were three people with autism living at the service at the time of our 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.

The service continued to be run by a registered manager who was present on the day of our visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection on 4 December 2015 the service was rated Good, but the domain of ‘safe’ was rated Requires improvement as there was a breach of regulation with regards to staff recruitment. At a focused inspection on 3 February 2017 we found there were no breaches of regulation and the domain of ‘safe’ was rated as 'Good'. At this inspection we found the service remained 'Good'.

Staff had received training about protecting people from abuse and knew how to follow the provider’s safeguarding procedures to raise concerns.

Staffing levels had been maintained to ensure there were enough staff available to meet people’s physical, social and emotional needs.

People’s care was planned to maintain their safety, health and wellbeing. Positive risk assessment took place to maintain people’s safety and enable them to be as independent as possible. Systems were in place to monitor incidents and accidents.

Medicines continue to be managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

Staff received the training they needed for their roles and were supported through regular supervision and an annual appraisal.

Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity.

People’s health, social and physical needs were assessed and clear guidance was in place to ensure they were effectively monitored. Care plans included information about people’s personal history, what was important to them and how diagnoses of autism affected them, so staff could meet their needs and individual preferences.

People continued to experience care that was caring and compassionate. They were supported by a staff team who had known them for many years and positive relationships had developed where people were valued and respected. Staff knew how to communicate with people in a way they understood and to provide an environment and atmosphere where people felt safe and reassured.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service. Information on a range of topics had been provided for people in an easy read format.

The registered manager was approachable and the atmosphere in the service was relaxed and informal. They were supported by a staff team who understood the aims of the service and were proud and motivated to support people according to their choices and preferences.

Inspection carried out on 21 February 2017

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 4 December 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Echo Square House on our website at www.cqc.org.uk

The Inspection was carried out on 21 February 2016 and was announced. We announced the inspection to ensure that the manager and person living at the service were available. The home is registered to provide accommodation and personal care for up to three people with learning disabilities and autism. The service is located in a town and supported three people at the time of inspection.

There was a registered manager employed at the home. 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 safe. Staff understood the importance of people's safety and knew how to report any concerns they may have. Risks to people's health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

There were sufficient staff employed to meet people’s needs and staff knew people well and had built up good relationships with people. The registered provider had effective recruitment and selection procedures in place.

Inspection carried out on 04 December 2015

During an inspection looking at part of the service

The inspection was announced and took place on 04 December 2015. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received.

Echo Square House is a service that accommodates three people with autism. The service is located in a town and supported three people at the time of inspection.

The service had a registered manager, who was present during the 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 is run.

At our previous inspection on 12 and 13 November 2014, we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We asked the provider to take action in relation to quality assurance and keeping confidential records. We also recommended that the provider should follow The Royal Pharmaceutical Societies’ guidance on the handling of medicines in social care.

The provider gave us an action plan on 31 March 2015 which detailed they had met the regulations.

At this inspection, we found that improvements had been made to records, confidentiality and quality assurance.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

One person gave us positive feedback about the service. Some people were unable to verbally tell us about their experiences. People were relaxed around the staff and in their own home. We received positive feedback from relatives about all aspects of the service.

Staff knew and understood how to safeguard people from abuse, they had attended training, and there were effective procedures in place to keep people safe from abuse and mistreatment.

Risks to people had been identified. Systems had been put in place to enable people to carry out activities safely with support.

The premises and gardens were well maintained and suitable for people’s needs. The home was clean, tidy and free from offensive odours.

Medicines were appropriately managed to ensure that people received their medicines as prescribed. Records were clear and the administration and management of medicines was properly documented.

There were suitable numbers of staff on shift to meet people’s needs.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had not needed to submit any DoLS applications.

People had access to drinks and nutritious food that met their needs and they were given choice.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner and took appropriate action.

Relatives told us that staff were kind, caring and communicated well with them. Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect. People’s information was treated confidentially and personal records were stored securely.

Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere within the home.

People’s view and experiences were sought during meetings. Relatives were also encouraged to feedback during meetings and by completing questionnaires.

People were encouraged to take part in activities that they enjoyed, this included activities in the home and in the local community. People were supported to be as independent as possible.

The complaints procedure was available, each person had a copy in their room. No complaints had been received.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour.

Audit systems were in place to ensure that care and support met people’s needs and that the home was suitable for people. Actions arising from audits had been dealt with quickly.

You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 12 November 2014 and 13 November 2014

During a routine inspection

The inspection was unannounced and took place on 12 and 13 November 2014.

Echo Square House is a service that accommodates three people with autism. The service is located in a town and supported three people at the time of inspection. During our inspection the registered manager was present. 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.

Our observations and discussions with people, their relatives and staff showed us that there was an open and positive culture which focused on people and promoting people’s independence. One staff member was on duty during each shift and this was sufficient to meet people’s needs because people were largely independent and did not require a high level of support from staff. Three permanent staff worked at the service and one bank staff member, all of whom had worked there for several years.

People we spoke with, their relatives and staff told us that people were safe at the service. Staff understood how to recognise signs of potential abuse and to report their concerns. Written risk assessments had been completed for the majority of circumstances and were centred on the needs of the person to be as independent as possible. However, there was no written assessment of risk in relation to three long standing arrangements, including contact with family and friends that involved some overnight stays at the service.

The premises were safe for people, staff and visitors to use. The environment was free from trip hazards to support people to move about safely.

There were arrangements in place to ensure that the one person who required regular medicine to promote their health received it. However, not all areas of the provider’s medicines management policy had been followed. For example, daily temperature checks of the cupboard where the medicines were kept had not been completed. This was brought to the attention of the manager who took action to address these matters.

We recommend that the service considers the Royal Pharmaceutical Societies’ guidance on the handling of medicines in social care.

Staff knew how to meet people’s needs and had received training relevant to their role. One family member told us that “It seems like the perfect world for my relative”. Staff we spoke with demonstrated their knowledge of people’s needs. Staff received regular supervision and appraisal.

People told us that staff sought their consent before providing support to them. Staff knew what action to take if someone refused care that might place them at risk of harm. A healthcare professional told us that the staff were aware of people’s rights and issues around capacity and consent.

People had access to healthy food at the service and staff knew about people’s dietary preferences. People’s health needs were monitored and met. A healthcare professional told us that staff always responded positively to any advice they were given.

Overall, people were treated with respect and their dignity was promoted. However, one staff member did not obtain one person’s permission before checking the record they used to record any negative experiences out in the community. People told us that the staff were caring towards them. One person told us that staff reassured them when they were upset. A health care professional told us that the staff were very caring, “They provide comfort and reassurance to people. They anticipate their needs and responses”.

We saw that people were involved in the planning of their care and the service was responsive to people’s changing needs. One person told us they had been involved in choosing the decoration of their bedroom and planning Christmas. A relative told us that the environment had been adapted in response to their relative’s changing needs and we saw this promoted their safety.

People were given the opportunity to participate in a range of activities including attending a local day centre.

People, their relatives and staff were given the opportunity to provide feedback about the service. We saw the results of a recent survey that had been completed which were positive. There was a process in place for complaints to be raised. People and their relatives told us they knew how to make a complaint. The manager told us that no complaints had been made.

We saw that steps had been taken to provide an environment that was homely with minimal reminders that the service was a care home. A visit by the provider at the start of this year noted “It is an extremely warm, relaxed and inviting house”.

People, their relatives, staff and healthcare professionals were positive about the culture of the service. People told us that the manager was friendly and they could talk to the manager freely. One relative told us that the service was “Managed very well”. Another relative told us that “The manager sets the rules, adheres to them and makes sure staff adhere to them”. Comments from staff included “It’s all about the client. We work to achieve the best for them” and that the culture stemmed from the provider. Healthcare professionals told us, “There was a good atmosphere and a culture of staff communicating and working together” and there was a good rapport between staff and people receiving support.

Staff were positive about the management of the service. A recent survey showed that the manager helped staff as much as staff would like them to and staff trusted the manager to be honest. The manager told us that the service had an excellent record of staff attendance last year with no sick leave taken.

Inspection carried out on 9 December 2013

During a routine inspection

We spoke with two people who lived at the home. They were satisfied with the care and support they received and were happy living at Echo Square House. One person told us, "I like it here". A visitor told us, "The care is first class. My relative is safe and well cared for". We noted that the home provided a wide variety of social and educational opportunities in both group and individual settings in addition to work placements. The people we spoke with were happy with the number and types of activities on offer.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We noted that there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care. We also found that systems were in place for people and relatives to make a complaint about the service if necessary.

Inspection carried out on 28 August 2012

During a routine inspection

People told us, or indicated that they liked the home and the staff. Comments included �I like living here, it is my home� and �Staff are friendly, they help me with worries�.

People we spoke with said there was plenty to do both inside and outside the home. People told us that they went swimming, attended day services and visited their friends. One person told us that they had recently enjoyed a holiday to Yarmouth and another to Spain. People said that they were able to choose what they wanted to do.

We also gathered evidence of people�s experiences of the service by reviewing feedback questionnaires completed by people using the service and their representatives. We found that all people said that they were either very happy or happy with the service. Comments included �It is a lovely home� and �We are extremely happy with the service�.

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