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Inspection carried out on 29 September 2017

During a routine inspection

This inspection visit took place on 29 September 2017 and was announced.

UBU Cragmere is a detached dormer bungalow in the village of Glusburn. It provides support for up to four people with learning disabilities. Each person has their own bedroom and shares communal facilities of a kitchen/dining area, two bathrooms and two lounges. There is a garden to the front and rear of the property. When we inspected four people lived at UBU Cragmere.

At the last comprehensive inspection on 24 August 2015 the service was rated overall as good with requires improvement in the responsive domain. At this inspection we found the service remained overall good with well led as requires improvement as there had been no registered manage for over a year.

At the last inspection we recommended an increase in social and leisure activities and improvements to the maintenance of the garden area. On this inspection we saw people were involved in regular work, social and leisure activities. Also the garden was tidy and maintained.

There was not a manager registered with CQC. The previous registered manager had left the service in June 2016. The service had attempted to recruit and register a new manager since this time. They had recruited three managers who had left before completing the registration process. This had left staff without stable leadership over this period.

We spoke with people who lived at Cragmere and observed staff interactions with people. People told us they were happy at UBU Cragmere and liked the staff team. We saw interactions were frequent and caring.

There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments were in place which provided guidance for staff. This minimised risks to people.

There were enough staff to support people with personal care and social and leisure activities. There had been a period of high staff turnover but this had settled when we inspected. Staff said they were supported to develop their skills and knowledge to assist them to carry out their role and to provide safe care and support in the way people wanted.

Medicines were managed safely. Medicines were stored securely, administered as prescribed and disposed of appropriately.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People indicated they were happy with the variety and choice of meals available to them.

Care plans were personalised and informative. They described how people wished to be supported and their needs and wishes. People who received support or where appropriate their relatives were involved in making decisions about their care. Their consent and agreement were sought before providing care.

People who lived at UBU Cragmere knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they could let staff know if they were not happy about something.

Senior staff monitored the support staff provided to people. Audits of care and surveys of the views of people and their families were carried out regularly.

Inspection carried out on 24 August 2015

During a routine inspection

This inspection took place on 24 August 2015 and was unannounced. We last inspected this service on 4 September 2014 where we found the provider met the regulations we looked at.

UBU - Cragmere is owned and managed by Northern Life Care and is registered to provide 'accommodation for persons who require nursing or personal care.' The care home can provide support and care for up to four people who have a learning disability. The care home is a detached dormer bungalow which is in the village of Glusburn. People living at UBU – Cragmere have access to a kitchen/dining area, four bedrooms, bathrooms and two lounges. There is a garden to the front and rear of the property.

The home employs a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not available at the time of the inspection. A relief manager assisted with the inspection process.

Staff understood what it meant to keep people safe and although not all staff had received an update with regard to their safeguarding adult training, they could describe to us what action they would take if they saw or suspected abuse had taken place. Staff worked within the principles of the Mental Capacity Act 2005. Staff had been recruited safely.

The provision of induction, training and supervision required improvement to ensure all staff were provided with up to date skills and knowledge. Despite this staff understood how to treat people with dignity and respect and were confident people received good care.

The risk of infection was minimised for people who used the service because staff were using appropriate measures to monitor and clean the service.

Staff administered medicines safely and arrangements around medication were well organised.

The premises were on the whole were well presented, however some minor repairs were needed to kitchen units and the garden needed maintaining, in particular the grassed area and shrubs to the front of the property and the patio area at the back of the home.

The service was caring. From our observations during the day we saw that overall staff knew people well and we saw that staff approached and spoke with people in a friendly and respectful way. We met with everyone living at the service during our visit. However, were we were not able to seek everyone’s view about their experiences, due to communication difficulties. We therefore spoke to their family members on the evening of the inspection visit, to gain their views about the service and the support their relative received.

People received person centred care and were comfortable in their home. In the main, people’s support needs were assessed and plans identified how care should be delivered. However, some records would benefit from being more detailed and some were found to be in need of updating. The service had both paper and computer records, some of which were being transferred to a new system, which could explain some of the shortfalls noted.

People were offered and enjoyed activities throughout the day. This included some leisure activities and some people carried out voluntary work locally. We recommend that the provider looks at ways to improve the level of stimulation and support people receive and how opportunities can be increased to improve people’s experience’s where appropriate.

There was a quality assurance system in place, which used audits in each area of the service so that there was a consistent approach to improvement.

Inspection carried out on 4 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, responsive and well led?

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

Is the service safe?

Risks to people�s health and wellbeing were known by the staff. However, consideration had not been given to the risks posed to people during the night. At the time of the visit the �sleeping in� member of staff was alerted to people opening their bedroom doors, by a monitor during the night, but not if people needed support whilst in their bedrooms during that time.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). At the time of our visit there was no one using the service who had a DOLS in place. The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity training. This meant people would be safeguarded as required.

Systems were in place to make sure that the manager and staff learnt from accidents and incidents, complaints and concerns. This helped to reduce the risk to people and ensured that the service continually improved.

There were sufficient care workers to respond to people's health and welfare needs. A member of staff told us, "We provide a good standard of care here, we work as a team and put the clients first in everything we do.� Staffing levels were monitored and adjusted to provide people with one to one or two to one support where this was needed. This helped to keep people safe and ensure that people were supported to live the life they chose.

People were protected from the risk of infection because staff followed good infection control practices and these practices were monitored regularly.

Is the service effective?

People�s health and care needs were assessed with them or with their chosen representative. People were encouraged to live the life they wanted and be as independent as possible, even if there were risks attached to this. All of the people living at Cragmere had contact with family members and other significant people who knew them well. Help and advice was gained from relevant health care professionals. This helped to ensure that people received the help and support they needed to maintain their health and wellbeing.

People's health and care needs were assessed with them, and they, and their families were involved in developing their support plans. One person told us they were included in making decisions about how their care and support was provided.

New staff had received relevant induction training, which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

People told us they were supported by �nice� staff who they �liked.� We met all four people living at Cragmere. Not everyone was able to tell us out their experience however we observed the interactions between them and staff and it was clear staff knew them well and how best to support them. One person told us, �I like it here, I go on holiday and do what I like.� We asked people if they felt cared for, they nodded or said, "Yes." We saw that people looked well cared for. People were supported by staff in a patient, calm and kind way. Staff appeared to understand people�s needs well. Staff offered assistance and support to people in a timely way.

We saw staff spent time with people. For example we saw one member of staff support two people making their breakfast, prompt them whilst doing their laundry or helping people choose their activity for the day. We saw that staff were happy to spend as much time as required to make sure the person carrying out a task understood and was satisfied with what they had done. This showed that staff were enabling rather than taking over and doing things which the person wished to do for themselves. Staff told us that the resident�s needs were their top priority.

People looked relaxed and comfortable in the presence of the staff and each other. Staff understood how people used sounds and body language to communicate their needs. We saw staff understood people�s individual communication methods well.

Is the service responsive?

Enough staff were on duty to be able to support people in a timely way. The manager told us that the staffing rota was completed to make sure people had the support they needed at all times. Extra staff were provided for hospital appointments, outings and to take people on holiday.

Information was provided to people and their relatives about how to make a complaint. Staff spent time observing people and asked people for their views. We saw that staff acted upon comments made. This helped people to remain happy with the service provided. People's needs were met in accordance with their wishes. We saw evidence of the service ensuring people were able to continue with interests and hobbies; for example people were actively involved in gardening, craftwork or attending work placements.

People using the service, their relatives and other professionals involved with the service completed periodic surveys. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

Quality assurance systems were in place. The quality of the service provided was constantly being monitored by the manager and senior management team. Improvements were made where necessary to make sure that people living at the home received the help and support they required.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve. Procedures were in place for dealing with emergencies and staff were able to explain these to us.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

The manager and staff worked well with other health care professionals to ensure that people received the care they required.

Staff we spoke with understood their roles and responsibilities. They told us they were happy working at the home. The ethos of the service was to make sure that people lived their life to the full. We saw that the manager provided staffing levels which promoted and encouraged people�s independence. For example people were able to go on holiday, go shopping and out on day trips.

The service had been well maintained and we found that it was comfortable and clean. This meant that people were not put at unnecessary risk.

Inspection carried out on 22 April 2013

During a routine inspection

Where people did not have the capacity to consent to treatment then the home acted in accordance with legal requirements. We saw on care records that a range of people were involved in making decisions about people�s care and welfare, which included the person�s general practitioner (GP), relative, care manager and the home manager.

We observed that people were supported in a dignified and respectful way and were encouraged to be independent where appropriate, respecting people�s privacy at all times. We saw people's health and behaviours were recorded and that relevant health care professionals were involved in people's care or contacted as people's needs changed.

We asked staff what they would do if they thought someone was being abused. They all said that if they were concerned about anything then they would escalate it further. Staff said they would try and ensure that the person was removed from any danger.

We saw that all the people had been administered their medication on the morning of our visit as required and for the periods we looked at, at all those times. We checked the stock balance of two people�s medication and found these to be correct.

Suitable arrangements were in place to monitor the quality of care and support that staff provided and people living at the home received. The manager explained to us that a range of audits took place regularly by both the manager at the home and by the community manager for the organisation.

Inspection carried out on 23 July 2012

During a routine inspection

Some people had complex needs and were not able to verbally communicate their views and experiences to us. However, one person told us they were 'happy' at Cragmere and we saw people smiled when staff approached them. People were comfortable in their surroundings. One person told us that staff were 'good' and helped them to 'do things.'

One person told us their care needs were met and that they were 'happy' with the support and care provided at Cragmere. We saw that other people were calm and relaxed with staff and that support was given in a caring and professional way.

Inspection carried out on 11 November 2011

During a routine inspection

We visited Cragmere twice, during the evening and the next day, We saw people smiled when staff approached them, they appeared to be very comfortable in their surroundings and we saw Cragmere was their 'home'. Staff were able to support people to express and understand their views.

One person told us their care needs were met and a relative also told us they were very satisfied with the support and care provided at Cragmere.

During our visit we were able to observe people moving around the home freely, without being challenged. They made choices about what they wanted to watch on TV or whether they wanted to go to their rooms or stay in the lounge. We also observed staff when assisting people they did not appear to be rushed and spent time talking to people who were living there.

A relative told us they are kept fully informed about their relatives treatment and care and are pleased with the support and care which is provided at Cragemere.

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