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Inspection carried out on 4 January 2018

During a routine inspection

This comprehensive inspection took place on 4 January 2018 and was unannounced. At our last inspection in July 2016 of the service we found a breach of Regulation12 Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.This was because records relating to the safe management and administration of medicines were not always accurate or completed in full.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe to at least good. At this inspection we found that the provider had completed those actions we found the service was meeting the fundamental standards of quality and safety.

The Garden Site 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 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 and autism using the service can live as ordinary a life as any citizen.

The Garden Site is registered to provide accommodation and care for up to eight adults with learning disabilities and or autism. The provider had recently submitted an application to vary their registration to accommodate four adults. On the day of this inspection there were three people living in individual properties on the site. The service is situated near the town of Kirkby Lonsdale.

There was 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.

Medicines were being administered and recorded appropriately and were being kept safely.

There were sufficient numbers of suitable staff to meet people’s needs. Staff training was on going and people had received sufficient training to safely support and care for people. Staff were supported by the registered and deputy manager through regular staff meetings, supervision and appraisals.

We saw that the service worked well with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

When employing fit and proper persons the recruitment procedures had included all of the required checks of suitability.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

Hazards to people’s safety had been identified and managed. People were supported to access activities that were made available to them and pastimes of their choice.

People’s dignity and privacy were actively promoted by the staff supporting them.

People were treated with respect and their relatives made very positive comments about the staff team who supported them.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the provision.

The focus of the service was on promoting people’s rights. People were supported to have maximum choice and control of their lives and staff supported them in the leas

Inspection carried out on 26 July 2016

During a routine inspection

We carried out this unannounced inspection on 25 July 2016.

Underley adult care services provide care and accommodation at The Garden Site for up to seven young adults with learning disabilities and complex needs. The Garden Site consists of three semi-detached properties, a self-contained flat and a one bedroomed cottage. These are set in a courtyard on a private country estate on the edge of the market town of Kirkby Lonsdale. Each type of property has accommodation for care staff to sleep in overnight and a small office.

At the time of our inspection there were seven people living there.

We last inspected The Garden Site in February 2014 and found it met five of the essential standards that we looked at. During this inspection we found that the records relating to the safe management and administration of medicines were not always accurate or completed in full.

This was a breach of Regulation12 (2) (g) Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a registered manager in post on the day of our 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. In this service the registered manager is also the registered provider.

We found that people who used this service were safe. The staff knew how to protect people from harm. Staff had completed training in the safety of vulnerable adults and knew the signs to look for and how to report any incidents of concern.

We saw that recruitment procedures were robust this helped to ensure only suitable people worked in the service. We saw that staffing levels were good throughout all areas of the service. Staff training was up to date and provided the care staff with the right skills and knowledge for the complex needs of the people living in the homes. We saw that staff were supported by the management team through regular staff supervision and appraisals.

We found that the service worked very well with a variety of external agencies. Such as social services, local GP’s, learning disabilities, mental health teams, and advocacy to provide appropriate care and support to meet people’s physical and emotional needs.

A survey conducted by the registered provider in September 2015 to gather peoples’ views on the quality of the service said people who lived at The Garden Site, relatives and stakeholders were 100% happy with the service provided.

Observations during our inspection evidenced people who lived at The Garden Site were given choices about how they wanted to be supported and how to live their lives. Support was given to people in a manner that promoted their independence. Activities were provided to take account of people’s interests and preferences.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguarding (DoLS). This helped to protect the rights of people who were not able to make important decisions themselves. Best interest meetings were held to assist people who were not always able to make difficult decisions for themselves and where relevant independent advocacy was arranged. However the process in which the decisions had been made had not always been recorded.

We recommended the provider ensured that the decision process used in people’s best interests were always documented and to always confirm if relevant others did have legal authorisation.

‘You can see what action we told the provider to take at the back of the full version of the report.’

Inspection carried out on 21 February 2014

During a routine inspection

When we visited there were four people living across the three cottages. Some people in the home had limited verbal communication; we therefore spent time observing people's behaviour and interactions with staff. We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere.

Relatives we spoke with were all very complimentary on the support given to their relative. One relative said, "The care and support has gone from strength to strength. The new manager has been great and we have such a good team of carers." Another said, "The range of things they do is great. My son went bike riding yesterday, a countryside walk the day before and he had an amazing holiday in Wales."

We found that care planning was person centred with people being involved in the development of their care and support. People were supported in a way that maximised their involvement and ensured that they had control over their lives, to the level of their ability.

Staff were skilled at managing challenging behaviours and employed strategies to ensure that people could access the community and take part in a range of activities that enhanced their quality of life as a result.

We saw the home involved other services to ensure people received timely healthcare to maintain their health and wellbeing. The home had made positive links with specialists in supporting people with autism and had attended training courses on improving communication skills.

We found that records in the home were well kept being up to date and reviewed on a regular basis.

Inspection carried out on 15 January 2013

During a routine inspection

When we spoke with people at the Garden Site Underley they told us that they were satisfied with the service that they received.

We found that people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care and that they experienced care, treatment and support that met their needs. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. The premises in use were fit for purpose and the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 20 October 2011

During a routine inspection

People said that they enjoyed positive relationships with staff, “Made up that he’s my key worker and I like him”.

People said that they received support when they needed and that staff supported them to develop positive coping strategies to stress.” I’m a big lad and wash and dress my self. There are things I like to do but there are some rules. If I get angry I go for a walk. I go out with staff so I’m safe. Staff help me stay safe”.

People said that they were consulted about their care and chose to do things they enjoyed. I’m so tired as I’ve had lots of fun. I’ve been to the cinema to see Johnny English. I just want to go to bed”. And

"I make my own decisions and get support from staff when I'm not sure I'm making the right one".

People said they had good relationships with staff.” We have a good laugh, they help me a lot”.