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Inspection carried out on 4 December 2017

During a routine inspection

The inspection took place on 4 December 2017 and was unannounced. At our last inspection in February 2016 we found a breach of the legal requirements. This was because the provider had not sent us any statutory notifications for people authorised for Deprivation of Liberty Safeguards (DoLS) prior to November 2015. At this inspection we found improvements had been made and that they now met the previous legal breaches.

The service provides residential care for up to ten adults who have learning or physical disabilities, some of whom have sensory impairment, mental ill health or dementia. At the time of our inspection there were eight people using the service. 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe and had practices in place to protect people from harm. Staff had training in safeguarding and knew what to do if they had any concerns and how to report them. People who used the service told us they felt safe and protected from harm.

Risk assessments were personalised and detailed. Staff had the information they needed to mitigate risks.

Staffing levels were meeting the needs of people who used the service.

Recruitment practices were safe and relevant checks were completed prior to staff commencing employment.

Medicines were managed and stored safely. Support workers were only permitted to administer medicines to people after they had undertaken training and were assessed as competent by the registered manager to do so. Medication audits were completed monthly.

The service was clean and free of malodour. People were protected from the spread of infection due to a robust cleaning schedule.

The service documented and learned from incidents and put procedures in place for prevention or reoccurrences.

Training for care staff was provided on a regular basis and updated regularly. Staff spoke positively about the training they received.

Care workers demonstrated a good understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis.

The service was supporting people who were subject to Deprivation of Liberty Safeguards (DoLS) in an effective way.

People were supported with maintaining a balanced diet and had a choice of food and beverages.

People were supported to have access to healthcare services and receive on-going support. The service made referrals to healthcare professionals when necessary and advice from healthcare professionals was followed.

Staff demonstrated a caring and supportive approach towards people who used the service and we observed positive interactions and rapport between them.

The service promoted the independence of the people who used the service and people felt respected and treated with dignity.

Care plans were reviewed every six months and any changes were documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. Relatives of people who used the service told us they knew how to make a complaint.

The registered manager had a good relationship with staff, people who used the service and their relatives. People spoke positively about the registered manager and their management style.

The service had robust quality assurance methods in place and carried out regular audits.

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 using the service can live as ordinary a life as any citizen.

Inspection carried out on 4 February 2016

During a routine inspection

The inspection took place on the 4th February 2016 and was unannounced. At the last inspection in November 2013, we found breaches of the legal requirements. At that time, people's complaints were not always addressed or action taken to resolve them, there was no system in place to ensure cleaning was undertaken effectively and there was no consent policy in place. At this inspection we found improvements had been made in these areas.

The service provides residential care for up to ten adults who have learning or physical disabilities, some of whom have sensory impairment, mental health or dementia. There are currently six people residing at the service. There is currently 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 service had processes in place for staff to guide them to safeguard and protect people from abuse. Staff demonstrated their awareness of the signs of abuse and the actions they would take to escalate an allegation of abuse. People’s risk assessments identified their needs and the management of them by staff. Risk management plans in place gave guidance to staff to reduce their recurrence, while encouraging safe, positive risk taking for people.

There were sufficient numbers of staff to meet people’s care needs. Medicines were managed safely for people. Effective systems for the management, administration, storage, and disposal of medicines were in place.

Staff appraisal, training, and supervision supported them in their role. Staff understood best practice guidance and training used and implemented them to meet the needs of people. The registered manager supported staff so that they were effective in their role to care for people and deliver quality care.

The registered manager had an understanding of the principles the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) however DoLS notifications prior to November 2015 had not been sent to us and therefore a recommendation for this to be done was made and the service subsequently sent all outstanding notifications.

Staff had an awareness of people’s nutritional needs for the maintenance of their health. The service provided meals in order to meet people’s preferences, however we found that this was not always in response to their individual needs by involving them in the process. People did not always have a choice of meals they wanted and a recommendation to implement new ways of ensuring choice has been made. The registered manager has responded to this recommendation with an action plan

People had access to health care services to meet their needs and professional guidance implemented to maintain their health.

Staff knew people well, were aware of their personal histories, and understood their likes and dislikes. People and their relatives were involved in making decisions about how they received care. Care and support delivered to people centred on their individual needs, preferences, and choices. Staff provided care and support to people in a way, which respected their dignity and privacy.

People and their relatives contributed to regular reviews of their care and support. People undertook activities of their choice, which helped them towards independence. People maintained relationships that mattered to them with support from staff if needed.

The service had a complaints procedure in place. People and their relatives were aware of how to raise a complaint and make a comment about the service if they wished.

The registered manager demonstrated clear leadership and established with staff, a positive culture within the staff team. Staff were motivated to provide good quality care, and applied best practice to

Inspection carried out on 12 November 2013

During a routine inspection

We found that on some occasions before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. However there was no consent policy in place and the provider did not have guidance for obtaining people's consent.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed the files for four people who used the service. Most files contained a needs assessment and a cultural needs assessment which the manager told us would be completed when people were referred to the service.

We observed that people who used the service appeared happy and used signs and gestures confirming this, which were noted in their care plans.

The deputy manager told us that a cleaning company came in on a weekly basis and carried out cleaning of the service. We saw there were only completed records for three months in 2013 and there was no system in place to ensure cleaning was undertaken effectively.

Appropriate checks were undertaken before staff began work. The manager told us that before staff were employed they were required to provide two references, a Disclosure and Barring Service (DBS) check and proof of their right to work.

The provider had a complaints policy in place, however we found evidence that people's complaints were not always addressed and action taken to resolve them.

Inspection carried out on 11 December 2012

During a routine inspection

People who use the service were given the opportunity to actively engage and contribute to the planning and delivery of their care. People had a dedicated day each week, called a 'flexi day', which was an opportunity where they identified the activity they wanted to engage in for the day with their key worker. The activities ranged from being supported to cook a meal, any other domestic chores or days out.

There was a monthly meeting where all people who use the service were encouraged to contribute. Where people had communication difficulties, alternative methods of communication were used to ensure they were being understood.

Documentation for each person reflected their ethnicity and culture and this formed part of their initial assessment, and was seen to be reflected in the social activities chosen.

People had care plan that was person centered and included a breakdown of booked relevant annual health checks, referrals and follow up appointments plus communication with key health professionals. Both folders provided a complete overview of the individual persons health and social care needs.

Inspection carried out on 8 December 2011

During a routine inspection

Due to the nature of their disabilities, we were not able to talk with people who use the service about their experience. However, through observation, we found that people seem content and well supported by the service.