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Inspection carried out on 4 May 2018

During a routine inspection

This inspection visit took place on 4 May 2018 and was unannounced. The accommodation at 2-4 Watcombe Circus is situated in Nottingham. It comprises of two large houses which have been joined together. Each person has their own bedroom and there were shared toileting and bathing facilities. There are shared spaces on the ground floor which include two lounges, a dining room and a kitchen. The home is registered for twelve people and at the time of our inspection twelve people were living in the home.

2-4 Watcombe Circus is a care service and was registered before the introduction of the Registering the Right Support and other best practice guidance. However the provider aimed to develop these values which 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. At the last inspection in April 2017 the service was rated requires improvement. At this inspection we found improvements had been made in the areas effective and well led, however further improvements are still required in the ‘Well-led’ section. The inspection was completed by one inspector

2-4 Watcombe Circus is in the process of changing the registered manager. We spoke with the temporary manager during the inspection. The new manager was to commence their role over the next month and had begun their registration with us. 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 supported by sufficient staff who had received training that reflected their role. When people required additional support with an activity or appointments this was arranged and reflected in the staffing requirements.

Medicines were managed safety and there was a range of health care professionals involved in supporting people’s wellbeing and ongoing health needs. Risk assessments had been completed and guidance provided including evacuating the building in an emergency.

Lessons had been learnt following events to reduce the risk of reoccurrence. Safeguards had been raised and staff understood the importance of protecting people from harm. The care plans were person centred and included care needs and preferences. Information was offered in alternative formats and ranges of communicating methods were available. People were offered opportunities to follow their interest and social time.

Staff had established positive relationship with people. People’s independence was encouraged and this was promoted with meals and daily living skills. When people required support this was done with their dignity in mind and respect of their wishes. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There was a complaints policy available. The provider understood their requirements under the regulations and sent us notifications about events and incidents. They had displayed their rating at the home and on the website.

Inspection carried out on 22 February 2017

During a routine inspection

We carried out an unannounced inspection of the service on 22 February 2017 and returned on 1 March 2017 announced.

2-4 Watcombe Circus provides accommodation and personal care for up to 12 people living with learning disabilities and an autistic spectrum disorder. On the first day of our inspection there were 12 living at the service and 11 people on the second day.

2-4 Watcombe Circus is required to have a registered manager in post. 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 the time of the inspection the registered manager was in post. They were available for the first day of our inspection but not the second day.

Some concerns were identified with the health and safety of the environment which the provider took immediate action to address. The Mental Capacity Act 2005 was not fully adhered to.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Staff had received adult safeguarding training.

Risks associated to people’s needs had been assessed and planned for and were regularly reviewed. Accidents and incidents were recorded and monitored and action was taken to reduce further reoccurrence.

There were sufficient and experienced staff available to meet people’s individual needs and safety.

Safe recruitment practices meant as far as possible only suitable staff were employed.

Staff received an induction, training and appropriate support. People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received a choice of meals and independence was promoted.

Staff had a good understanding and awareness of meeting people’s healthcare needs. People's healthcare needs had been assessed and were regularly monitored. The provider worked with healthcare professionals to ensure they provided an effective and responsive service.

Staff were kind, caring and respectful towards the people they supported. They had a person centred approach and a clear understanding of people's individual needs, routines and what was important to them. However, people’s individual communication needs were not consistently met.

People were involved as fully as possible in their care and support. People had information to inform them of independent advocacy services.

People were supported to participate in activities, interests and hobbies of their choice. Staff promoted people’s independence. A complaints policy and procedure was available and people knew how to make a complaint if required.

The provider enabled people who used the service and their relatives to share their experience about the service provided.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits. In addition the provider had further systems in place that provided monitoring of the service. However, these were not as effective as they should have been; shortfalls identified at this inspection had not been identified.

A registered manager was in post. Statutory notifications had not been sent to the CQC when required.