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Inspection carried out on 17 July 2018

During a routine inspection

The inspection took place on 17 and 26 July 2018. Day one was unannounced and we arranged with the registered manager to return on day two. We brought the inspection forward following concerns raised by a whistle blower relating to medicines management, confidentiality, nutrition, maintaining people’s dignity, training and culture of the service. At this inspection we found that although there were some minor issues relating to medicines management there was no other evidence to support the allegations.

Lifestyles 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. The service provides accommodation for up to 19 adults who have mental health needs. Five people living at the service had a learning disability.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The house is made up of three converted properties in a residential area of York and blends well into a row of town houses.

The care service has been developed 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 who used the service could live as ordinary a life as any citizen.

There was a registered manager employed at Lifestyles.

People told us they were safe and we saw that policies and procedures were followed by staff to support this.

Risks to people’s health and safety had been identified. Medicines were managed safely.

Staff recruitment was robust. There were sufficient staff on duty to meet people’s needs. They had been trained in subjects that were relevant. Staff told us they were well supported by the registered manager and through regular supervision.

People were encouraged to eat a nutritious diet and their choice of what to eat respected. People assisted with cooking.

Care plans were personal to each individual giving clear information about their needs. These were reviewed regularly.

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.

Activities were chosen by people and their choices supported by staff. Where those activities posed a risk staff worked with people to keep them safe.

Staff were positive in their praise of the management team and enjoyed working at the service.

Further information is in the detailed findings below.

Inspection carried out on 22 June 2016

During a routine inspection

This inspection took place on 22 June 2016 and was unannounced. We previously visited the service in April 2014 when we found that the registered provider met the regulations we assessed.

The home is registered to provide accommodation and care for up to 19 people with mental health needs and / or a learning disability. On the day of the inspection there were 15 people living at the home. Two people share a flat within the premises and other people are provided with a single bedroom. The home is situated in the city of York, in North Yorkshire close to transport routes and local amenities. There are various communal areas where people can spend the day and a small garden. The first and second floors of the home are accessed by stairs so people who live at the home have to be active enough to manage the stairs.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following robust recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at Lifestyles.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Any identified risks had been considered and risk assessments recorded how to manage these risks to promote people's safety and well-being. Accidents and incidents had been recorded and appropriate action taken to address any risks, although more analysis of accidents and incidents would help to identify any trends that were emerging.

Staff told us that they were well supported by the registered manager, and felt that they were valued. They confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. This included training on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussion with the registered manager and staff showed that the principles of this legislation was understood.

We checked medication systems and saw that medicines were recorded and administered safely. We had some concerns about the recording of controlled drugs (CDs) and these have since been rectified. Staff who had responsibility for the administration of medication had received appropriate training.

People who lived at the home, visitors and social care professionals told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, visitors and staff.

People told us that they were very happy with the food provided and people's nutritional needs had been assessed. We observed that people’s individual food and drink requirements were met. People were able to use the kitchen to prepare meals if they wished to do so, within a risk management framework.

No complaints had been made to the home during the previous twelve months but people were aware of how to make a complaint and told us there was always a member of staff for them to speak to if they had any concerns. There were systems in place to seek feedback from people who lived at t

Inspection carried out on 1 April 2014

During a routine inspection

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

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

Is the service safe?

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. All staff had received training in this area and the staff we spoke with confirmed that they understood when an application should be made, and how to submit one. This meant that people were safeguarded as required.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people�s safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes.

Systems to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations were evident although the home could have developed these further. This helped to reduce the risks to people and helped the service to continually improve.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

Is the service effective?

The home had appropriate arrangements in place for gaining people�s consent. People�s health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. This meant that staff were able to deliver care in a way that supported people.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, �The staff here are the best I have ever had" and "The staff do anything. We have fun here, it's like one big family."

People�s preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people�s wishes.

Is the service responsive?

Since our last visit the service had reviewed records and systems to ensure the care being delivered was appropriate for those who lived there. They had responded to advice from other professionals including the local authority and had developed the service that people received. We saw that the home had responded to suggestions made within questionnaires and people were confident that the home would respond to any concerns if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive.

Inspection carried out on 29 October 2013

During an inspection looking at part of the service

This visit was carried out to follow up previously identified concerns at this service. We wanted to check that the actions included within the providers action plan had been undertaken to address the issues we had previously found.

People told us that they liked living at Lifestyles. Comments included "Things couldn't be better" and "I go out whenever I like, sometimes I go fishing overnight." Another person told us "I get on well with the staff, they help us when we need it. I have a care plan it is kept in the office (my choice) but I can look at it when I want to."

We spoke with the provider, manager and staff on duty during our visit. They told us that the restrictions which were previously in place for some people, (for example, times to be in by) had been lifted. However, they also told us that they were waiting for input from other health professionals to support them in writing care plans where risks had been identified to help people remain safe and to minimise risks.

We found that the manager had reviewed and updated the care records since our last visit. There were clear strategies in place for supporting people in managing difficult or potentially challenging behaviour. The home had a safeguarding procedure in place and all staff had received training in safeguarding adults. They had responded positively to the previously identified concerns and were working closely with lead agencies to implement improvements. This helped to protect people.

Inspection carried out on 26 July 2013

During a routine inspection

People told us that they liked living at the home. They also told us that there were rules to follow and we saw examples of these recorded in people's care records. This meant that care and treatment was not always planned and delivered in a way which ensured people's safety.

People were not sufficiently protected from the risk of abuse as the provider had failed to respond appropriately to allegations of abuse. Some people had restrictions in place which had not been dealt with under proper legal safeguards.

We found that people were protected from the risks of infection and people were cared for in a clean and hygienic environment.

In the main people were protected from the risks of unsafe or unsuitable premises and people told us they liked their rooms. Some improvements have been suggested by the Community Infection Prevention and Control Nurse and the home is taking action to address these.

Appropriate checks were carried out before staff began work and people were supported by suitably qualified and experienced staff. People were positive about the staff who supported them.

Poor record keeping meant that people were not always protected against the risks of inappropriate or unsafe treatment as their records were not always fit for purpose.

Inspection carried out on 31 August 2012

During a routine inspection

Some people had complex needs and chose not to share their views and experiences with us. However, two people told us they felt that they were, 'treated like a person, treated fairly and with dignity' by the staff at the service. One person said that they felt 'in control' of their life but knew that they had staff support on hand if needed it. We spoke to five people and they all said they were 'happy' at Lifestyles.

Everyone who shared their views gave us positive feedback about the staff team. Staff were described as 'all nice, they are good to us.' One person told us, �Staff make time to talk to you and go out of their way to look after us.� People we spoke with confirmed there were always at least two staff on duty through the day and night.

People we spoke with said that they knew exactly who to �turn to� if they had any complaints.

Inspection carried out on 12 September 2011

During an inspection looking at part of the service

People said that the staff had consulted them about many areas of their daily life, such as activites, outings, meals and the way they wanted their personal care to be given. One person said, 'I am getting out more now I have settled in.' Another person told us they enjoyed going out but let staff know where they were going and what time they would be back. They said this gave them the "freedom" to choose where they went but thought staff should know where they were going incase they were taken ill whilst away from the home. People said the staff understood their individual care needs and that they received the care they needed, in a way which suited them. One person said, 'I know the staff are here to help us all and they are always asking me what extra help I need.'

People said they felt safe and well cared for at Lifestyles. People said that the home was clean, tidy and that it was safe for them. One person said, 'I really like my room, I help keep it tidy and help staff in the kitchen, when I can.' People told us they were satisfied with the management of the home and that they felt confident they could talk to the manager or owner about anything which might affect them. People told us about the help they had been given to settle in and the support they received to make their lives more comfortable.

Inspection carried out on 10, 11 May 2011

During a routine inspection

People told us that they were involved in reviews about their care, had seen their care plans and risk assessments, and that their feelings and wishes were taken into account. They told us that they were happy with their care and that they were encouraged to become more independent. They also told us that they enjoyed the food provided by the service and that there was a lot of choice. People told us that they looked after their own money with support from staff. They told us that they were happy with the support that they received and thought that the home was clean. People told us that they were working towards being able to self-medicate and a person told us that they were happy for the staff to manage the medication for them. They also said that there were enough staff working in the home.

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