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Inspection carried out on 27 February 2018

During a routine inspection

This inspection took place on 27 February 2018 and was announced. At the last inspection on 7 February 2017, the service was rated as requires improvement. We asked the provider to take action to make improvements with regard to staff induction, medicine management and risk of people, visitors and staff consuming contaminated water. This action has been completed.

Colenso is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 and support with personal care for up to five adults with learning disabilities who may also have mental health needs. At the time of our visit, there were three people using the service.

There was no registered manager in place 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.

Relatives and people told us the service was safe and they did not have any concerns.

There were processes in place to minimise risks to people's safety. Staff understood what constituted abuse or poor practice and systems were in place to protect people from the risk of harm. They knew when they should escalate concerns to external organisations. Potential risks to people’s health and well-being were identified and managed effectively.

The recruitment procedures were thorough with appropriate checks undertaken before new staff members started working for the service. There were sufficient numbers of staff available to meet people’s individual needs.

Staff received training and support to deliver a good quality of care to people and a training programme was in place to address identified training needs. Newly appointed staff completed an induction programme.

The manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They respected decisions people made about their care and gained people's consent before they provided care and support.

People received care and support in a compassionate way from a staff team that knew them well and were familiar with their needs. Staff had built a good relationship with people and their privacy and dignity were respected. Confidentiality of people’s personal information was maintained.

People’s dietary needs were taken into account and their nutritional needs were monitored appropriately. Staff supported people to take their medicines safely.

The complaints policy and procedure was accessible to people and their relatives. The manager ensured that any issues raised were resolved to the satisfaction of the person.

The provider had effective systems in place to quality assure the services provided and to drive improvement. Feedback about the service was sought from people, relatives, staff and other professionals. If any improvements were needed, these were implemented.

Inspection carried out on 7 February 2017

During a routine inspection

This was an announced inspection carried out on 07 February 2017. The registered manager was given one hour notice as we needed to be sure that someone would be in to assist with the inspection. This is the first inspection since the service was registered with us in June 2016.

Colenso House provides accommodation and support with personal care for up to five adults with learning disabilities who may also have mental health needs. At the time of our visit, there were two people using the service.

The service had 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.

The provider had measures in place to ensure the environment was suitable and safe for people using the service, as well as staff. However, people were at risk of drinking contaminated water because the shower heads in the bathrooms could drop below the water level or could reach the bottom of the shower trays.

We also noted people did not have a Personal Emergency Evacuation Plan (PEEP) to guide staff about how to safely evacuate them in the event of a fire. We advised the registered manager of this and also made a recommendation for the provider to update risk assessments for people.

People were supported to eat and drink enough and were given choices when planning the menus. Where they had any special dietary requirements, this was catered for. However, their medicines were not managed safely as they did not always receive their medicines at the required times and in the way they had been prescribed.

There were sufficient staff available to meet people's needs. Staff received training in a variety of areas to ensure they had the skills to meet people's needs. However, staff did not receive suitable inductions when they started their employment.

The management team did not always demonstrate effective quality assurance of the service and the registered manager was being supported by an external consultant.

Staff had access to relevant safeguarding guidance and contact numbers. They were aware of their roles and responsibilities to report any potential safeguarding incidents. Risks to people had been assessed and there was guidance in place on how to manage them safely.

Staff and people told us the management team were supportive, approachable and friendly. There were systems in place to routinely monitor the safety and quality of the service provided but they were not always effective.

People had access to other healthcare professionals and staff had a good understanding of their needs. They were supported to express their views and to make decisions about their care. We found the staff interacted well with people and respected their privacy and dignity. People were encouraged to take part in household chores and their independence was promoted.

People's consent was sought as appropriate and where people lacked the capacity to consent to decisions, legal requirements were met. People’s records reflected their current health needs including any advice given by other healthcare professionals. This enabled staff to deliver safe care.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the back of the report.