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Inspection carried out on 28 March 2019

During a routine inspection

About the service: Action Deafness is a charity which provides a range of specialist services, including care and support, to people who are deaf or hard of hearing. Action Deafness works in partnership with another specialist agency in Cambridgeshire to provide care and support to people in their own homes in Cambridgeshire. Its office base is in Leicestershire. At the time of the inspection, Action Deafness was providing personal care to eight people using the service. All eight people and staff supporting them were deaf and communicated using British Sign Language.

People’s experience of using this service:

People received safe care. However, information in their risk assessment did not always reflect known risk to their care and support. This meant that staff did not always have sufficient information to guide them. The provider needed to make improvement in their recruitment protocols to ensure that they assure themselves that they employed staff who were suited to work with people that used the service.

There was sufficient number of staff deployed to meet people’s needs. People’s medicines were managed safely. Staff were knowledgeable on how to identify and report any concerns regarding people’s welfare and wellbeing,

Staff had the relevant skills and experience they required to meet people’s needs. They sought people’s consent before they delivered care and offered them choice and control. They demonstrated that they understood the requirement of the Mental Capacity Act (2005).

People received care that was tailored to their individual needs. They were actively involved in planning their own care and support. Care staff supported them to access opportunities and events of their choice.

The provider had suitable systems in place to deliver a good standard of care. The management team provided sufficient supervision and guidance to support staff to meet the needs of people that used the service.

Rating at last inspection: Requires Improvement; published 27 December 2017.

Why we inspected: Planned inspection based on previous rating.

At the last inspection on 21 September and 03 October 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.The service was rated overall Requires Improvement.

Following our inspection, the provider informed us what they would do to meet the regulations.

At this comprehensive inspection we checked if they had now met the regulations. Our visit was announced. This meant the staff and the provider knew we would be visiting. During this inspection we found the provider had implemented the necessary improvements. At this visit we found evidence to demonstrate and support the overall rating of Good.

Follow up: We will continue to monitor the home in line with our regulatory powers.

More information is in the detailed findings below.

Inspection carried out on 21 September 2017

During a routine inspection

This announced inspection took place on 21 September 2017 and 03 October 2017.

Action Deafness is a charity which provides a range of specialist services, including care and support, to people who are deaf or hard of hearing. Action Deafness works in partnership with another specialist agency in Cambridgeshire to provide care and support to people in their own homes in Cambridgeshire. Its office base is in Leicester. At the time of the inspection, Action Deafness was providing personal care to six people using the service. All six people and staff supporting them were deaf and communicated using British Sign Language.

This was the first inspection for this service since they registered with us.

The service had a registered manager in post, though they were on long-term absence at the time 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. A care manager was responsible for the day-to-day management of the service, supported by a care supervisor.

People were not always supported by the number of staff required to meet their needs as detailed in their care plans. This exposed people to the risk of harm. The care manager took immediate action to ensure sufficient numbers of staff were available to meet people's needs.

People did not always receive their medicines as prescribed. Staff did not demonstrate sufficient knowledge to support people to manage their medicines safely.

Potential risks had been assessed, such as risks associated with the person's care and support. Risk assessments did not always record the measures in place to inform staff in how to control the potential risks.

Staff demonstrated a basic understanding of protecting adults from abuse but were not always clear on their responsibilities to raise concerns on people's behalf. Staff were suitable to work in the service through appropriate recruitment practices.

People were supported by a regular individual or group of staff who they knew. Staff completed induction and basic training, although this was not evaluated by the provider to ensure training provided staff with the detailed knowledge and skills they required.

Staff understood the requirements of the Mental Capacity Act (2005) and how it applied to people in their care. People were supported to make choices and decisions about their care and support, although care plans did not include an assessment of their mental capacity.

People were supported to maintain good health and well-being, included access to health professionals. Staff supported people to have sufficient to eat and drink in line with their wishes and preferences. Care plans did not always contain specific guidance for staff to help them support people with more specialist health conditions.

People were cared for by staff who demonstrated kindness and understanding. Staff were able to communicate with people to ensure they were involved in determining their care and support. People were shown respect and treated with dignity in the way they wished to be. People were provided with information in their preferred format to enable them to make decisions before using the service.

People had been involved in developing care plans following an assessment of their needs. Staff demonstrated that they knew people well and were responsive to their needs. However, care plans did not contain all the information staff needed to meet their needs.

People were informed on how to raise any complaints or concerns.

There was a lack of systems to monitor the quality of the service and identify where improvements were needed. Staff did not feel they received the support they needed as leadership and governance within the service was fragmente