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Inspection carried out on 23 February 2017

During a routine inspection

This comprehensive inspection took place on 23 February 2017 and was unannounced. Fiorano is an eight bedded service for people with a learning disability and supports people to live within their community. On the day of our inspection there were five people using the service. There was a second similar service located on the same site managed by the same provider.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 03 February 2016. At the inspection in February 2016, we had found two breaches of legal requirements in relation to Regulation 12 and 18. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. The overall rating from the inspection in February 2016 was Requires Improvement.

At this inspection we found improvements had been made to meet the relevant requirements.

There was a newly appointed manager in post at the time of the inspection and an application for registration was in progress. A fit person’s interview had been scheduled for the following week and we received confirmation that the application had been approved on the 06 March 2017. 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 kept safe by staff who understood how to identify and report potential harm and abuse. Staff were aware of the risks to people and what they needed to do to help reduce those risks, such as helping people to move safely around the service. Risks to people’s health and wellbeing were identified, recorded and managed. Staff understood how to keep people safe and they helped people to understand risks. Medicines were managed safely by staff who were skilled to administer medicines.

Care and support plans provided a holistic view of people’s care and support needs. Staff demonstrated they had a good knowledge and understanding of people’s individual needs

People were supported by sufficient numbers of staff who had the skills and knowledge to meet their needs. There were sufficient numbers of staff to meet people’s care and support needs. Staff received regular training and supervision that provided them with the knowledge and skills to meet people’s needs. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed. Staff had received appropriate training and supervision relevant to their roles and felt supported by the manager.

Staff respected and supported people's right to make their own decisions and choices about their care and treatment. People's permission was sought by staff from appropriate people and before they helped them with care tasks. Staff supported people to make decisions about their care by helping people to understand the information they needed to make informed decisions. People who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People were supported to eat and drink enough to maintain good health. People told us they enjoyed the food, had plenty to eat and drink and had lots of choice. Where people needed support with eating, staff provided the level of support that each individual person required. Following assessment and as part of their enablement plan some people prepared their own meals.

People had access to other healthcare professionals as required to make sure their health needs were met. People were treated with kindness, consideration and respect and staff promoted people’s independence and right to privacy. P

Inspection carried out on 3 February 2016

During a routine inspection

The inspection took place on 3 February 2016 and was unannounced.

Fiorano is an 8 bed service for people with a learning disability and supports people to live within their community. On the day of our inspection there were four people using the service. There was a second similar service located on the same site managed by the same provider.

There was no registered manager in post at the time of the inspection but the newly appointed manager was present at this 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.

People told us that they liked living at the service. The building was purpose built with a flat for one person created on the first floor. Some of the internal original doors had been replaced with metal doors with spy holes that were locked and unlocked by staff. This did not meet the needs of the majority of people who used the service. There were systems in place to reduce the risks to people and there were clear plans in place for emergencies. However, recent events within the local community had occurred due to the deployment of inexperienced staff who had not been following the care plans in order to reduce risks relating to people. Members of the public had been concerned for their safety. Staffing levels were said to be now more flexible and were adjusted to take account of the needs of the individuals who used the service and their access to day time activities and the wider community.

Medicines were safely managed. Staff understood people’s health needs well people were supported to access health professionals. Relatives were involved when appropriate. Staff were trained in a range of areas including medication, safeguarding and first aid. New staff had not been trained in Studio III [techniques to support people who may be anxious and challenge] before they were placed on shift.

Individuality was respected by staff. Choices were promoted and people were involved with planning their aspirations and future. People’s privacy was not promoted as actively as it was needed to be and people’s dignity was compromised on occasion. People were encouraged to be independent and to exercise choice in how they were supported. People had good access to transport and community facilities. Complaints were investigated and responded to.

The manager was accessible for staff and they were motivated and most felt well supported. Staff understood the aims and objectives of the service and worked towards and in line with these. They were clear about what was expected of them and there were systems in place to review the care provided. These could further be enhanced by developing a range of ways to consult people who have an interest in the service and people who live here.