HF Trust - Phillippines Close

HF Trust - Philippines Close is a residential care home providing personal care to people with a learning disability and/or autism. Some people were also living with physical disabilities. The service can support up to 16 people in two separate houses, each of which has separate facilities and is set on a site which is shared with a day service, offices and supported living accommodation owned by the same provider. On the day of our inspection, there were 14 people living at the service, eight people in one house and six in the other.

People’s experience of using this service and what we found

People told us they felt safe at the service, relatives were happy their loved ones were being cared for in a safe way. Staff knew how to recognise signs of abuse and knew where to report them if they had concerns. The registered manager knew their responsibilities and had reported concerns to the local authority safeguarding team.

Risk assessments were in place for people and their specific health needs. Staff were able to tell us about individual risks and how to manage them. Environmental risks were well managed in order to keep people safe. Infection control was well managed, the home was clean and free from odour. Policies in place protected people and visitors.

Staff were recruited safely and there were enough staff to meet peoples needs. Staff had completed a variety of training and relatives felt staff were well trained. Staff had regular support through supervisions and completed an induction when starting at the service.

Staff worked with other agencies and healthcare professionals to provide effective and timely care. They shared with us good examples of how working with the learning disabilities team improved people’s lives. Calls were made to the GP and 111 where necessary and advice was listened too.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The model of care was not in keeping with the principle of right support. The service was laid out across multiple buildings, in a campus-based set up. However, the registered manager had used this to their advantage and ensured people had control and independence. People were encouraged to walk into the local town and one person done this alone daily. Where people enjoyed public transport, they were taken regularly on buses and trains to various locations. Daily support was giving to people to attend the day centre and local groups with their house vehicle.

Individual choices were considered when outings occurred dependent on what people wanted to do. Where a person required wheelchair support and blended food. They were supported to still attend the group bowling, by arranging special transport and taking a blender along so the person did not miss out. The registered manager recognised the model of care was not right but used it to their advantage by having joint events, making the bungalows more unified. People often visited each other, and it was a community.

Right Care:

Care was person-centred and promotes people’s dignity, privacy and human rights.

People and their relatives were positive about the food they were provided. People were encouraged to choose their own menu each month and assisted the staff in cooking their meals. We observed people enjoying their meals with staff and where modified diets were in place, they were being followed.

Right Culture:

The newly appointed registered manager had worked hard to create a positive culture within the service. Staff felt confident in the new manager and felt positive about the changes that were occurring. The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the service used relevant guidance and tools to support people’s pressure care. We also recommended they seek guidance from a reputable source regarding the right support, right care, right culture guidance. At this inspection we found improvements had been made. The service was now using appropriate tools to assist with managing pressure care and where possible ensured guidance was followed for right support, right care, right culture.

Why we inspected

We carried out an unannounced focused inspection of this service on 6 July 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HF Trust - Phillippines Close on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

HF Trust - Philippines Close is a residential care home providing personal care to people with a learning disability and/or autism. Some people were also living with physical disabilities. The service can support up to 16 people in two separate houses, each of which has separate facilities and is set on a site which is shared with a day service, offices and supported living accommodation owned by the same provider. On the day of our inspection, there were 14 people living at the service, eight people in one house and six in the other.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Although the service was able to demonstrate people received the right care. Shortfalls in the delivery of values, attitudes and behaviours of leaders meant they were not delivering principles underpinning right support and right culture.

Right support:

The model of care was not in keeping with the principle of right support. The service was laid out across multiple buildings, in a campus-based set up. Easing of the national lockdown restrictions has meant that some access to the community has been re-introduced. However, people told us they were keen to have access to the day services again, which had not been started. People were very secluded in an industrial style facility and relied heavily on staff support to have access to the community.

Right care:

Care that was provided was person-centred and promoted people's dignity, privacy and human rights

Right culture:

An improvement had been made since the last inspection and people were living in a happier environment. However, there was still a clear lack of leadership within the service and the staff had no direction. This meant the service could not demonstrate the principles underpinning right culture. The ethos, values and attitudes from strong leadership within the service was missing so we could not be assured people using services led confident, inclusive and empowered lives.

Staff were missing a clear lack of management and leadership within the service. No registered manager had been in post since 09 September 2020 and the new manager employed had recently left the service. Staff shared with us their concerns about managers not staying and although felt happy within their roles. They told us they were feeling ‘fed up with the broken promises’ and that it led to a high turnover of staff. Quality assurance processes were not effective in identifying shortfalls found on inspection.

Although infection prevention and control procedures were in place in line with government guidelines, some shortfalls were found. For example, people who use services should have access to regular testing to test for COVID-19. Measures have been put in place since our inspection and we were provided with evidence to confirm this was completed. Staff were trained in the administration of medicines and were following procedures when delivering medicines to people.

People were protected from abuse or harm. Staff were trained and were able to tell us what they would do if they had concerns. Relatives told us they felt their loved ones were safe and the provider raised concerns with the local authority. Risks to people were well managed, risk assessments were in place for people and were individual to them.

People were cared for by fully trained, competent staff. Staffing levels had been increased to accommodate people’s needs and allocated one to one time. Appropriate employment checks had been carried out on staff before they started working at the service. Lessons had been learnt where multiple altercations between people had occurred within the service.

We have made a recommendation to the provider to use best practice guidance as part of their care planning processes. Although no issues were identified, this guidance is in place to help support people effectively.

People had their needs assessed prior to moving into the service. Regular care reviews had taken place to ensure care staff were kept up to date on people’s needs. Staff had received a variety of training and feedback from relatives identified staff know people well. The service is currently undergoing renovations and people have been involved in how they want their home to look.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff, people and their relatives were asked to feedback about the service. We reviewed a variety of feedback forms which will enable the service to make improvements. The service worked in partnership with other health care professionals. This ensured joined up care for people and people received additional support when they required it.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 December 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We also covered the Effective question to ensure people’s care, treatment and support achieves good outcomes and promotes a good quality of life.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for this service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HF Trust Philippines Close on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to Regulation 17, the provider had failed to assess the risk of, assess, monitor and improve the quality and safety of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We have written to the provider to request an action plan that addresses the areas they need to improve. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

HF Trust - Philippines Close is a residential care home providing personal care to people living with a range of learning disabilities. Some people were also living with physical disabilities and/or autism. The service can support up to 16 people in two separate houses, each of which have separate facilities and is set on a site which is shared with a day service, offices and supported living accommodation owned by the same provider. On the day of our inspection, there were 14 people living at the service, seven people lived in each house.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Although the service was able to demonstrate people received the right care. Shortfalls in the delivery of values, attitudes and behaviours of leaders meant they were not delivering principles underpinning right support and right culture.

Right support:

The model of care was not in keeping with the principle of right support. The service was laid out across multiple buildings, in a campus-based set up. Before the national lockdown people were being supported to access the community, the local town and café to ensure local links to the community were encouraged, but people would benefit from a review of the service against the guidance

Right care:

• Care that was provided was person-centred and promoted people’s dignity, privacy and human rights

Right culture:

The lack of leadership within the service lead to a poor culture and staff did not feel confident to raise concerns to the management team. This meant the service could not demonstrate the principles underpinning right culture. The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services led confident, inclusive and empowered lives.

Although staff were able to tell us how they would recognise signs of abuse and where to report it, they did not feel confident in the management team that their concerns would be listened to. Some staff had received training in safeguarding, but new staff employed that were working alone, had not received any. The provider had reported to the local authority safeguarding team and investigated when there were safeguarding concerns raised.

Dependency tools used did not identify how much time was needed to support people. This meant that the registered provider was unable to say confidently that there were enough staff to support people. Staff we spoke with gave mixed feedback about the staffing levels and felt people missed out on meaningful activities during the pandemic due to limited staff availability. Relatives we spoke with felt there was a high staff turnover and there were not enough staff to meet people’s needs. Safe recruitment practices were followed.

Although personal protective equipment had been put in place throughout the service including the entrances, staff had come through one of the houses and into the office without putting a mask on. Although no staff were observed providing care to people without masks on, government guidelines state suitable facemasks must be worn at all times. We addressed this with the management team during the inspection. Staff were reminded of the guidance and interim management was put in the service to monitor staff practice.

Lessons were not learnt when things go wrong. Although staff filled out accident and incident reports when they occurred, management had failed to analyse them in order to take appropriate action and learn when things went wrong.

There were shortfalls in the quality monitoring of the service to ensure people were safe and their needs were met. Staff lacked clear guidance and leadership from managers. Safety checks of hot water outlets were not carried out for a period of two months and lack of oversight meant this was not picked up quickly. Staff had missed out on regular supervision and lacked confidence in the management team.

Risk assessments were in place for people and gave guidance for staff to follow to reduce risks. This included risks relating to Covid- 19 for both individuals and staff.

Medicines were managed safely and procedures were being followed by staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 January 2020).

Why we inspected

We received information of concern about peoples’ care and safety and in relation to the leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well- led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Since the inspection the provider has sent us their interim plans to manage the service until a new manager is in post.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HF Trust - Philippines Close on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to regulation 18, the provider had failed to have an effective system in place to order to deploy staff. Regulation 13, the provider had failed to respond appropriately to allegations of abuse. Regulation 12 and Regulation 17, the provider had failed to assess monitor and mitigate risks to people and to assess monitor and improve the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

HF Trust - Phillippines Close is a residential care home providing personal care to people living with a range of learning disabilities. Some people were also living with physical disabilities and/or autism. The service can support up to 16 people in two separate buildings, each of which have separate facilities and is set on a site which is shared with a day service, offices and supported living accommodation owned by the same provider. On the day of our inspection, there were six people living in one house and eight people in the other.

The service had been built and registered before Registering the Right Support (RRS) had been published. However, the provider had been developing the service in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The building design fitted into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People received care and support in a safe, caring and homely environment by caring competent and experienced staff. People were relaxed and told us they were happy with the food and the activities provided. People had all their healthcare needs met and their independence was promoted. All feedback was positive from people and staff.

There were enough safely recruited and suitable staff to meet people’s needs. People felt safe and all environmental and individual risks to people were managed. People were protected from abuse and avoidable harm. Medicines were managed safely and in line with good practice. Accidents and incidents were managed appropriately, lessons were learnt and used to make improvements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with dignity and respect. Care was person centred, met people’s needs and achieved good outcomes. No-one was receiving end of life care, but people’s wishes were known or being explored. People and relatives could make a complaint if they needed to and were involved in their care.

The quality and safety of the service was ensured by the provider. There was a positive and caring culture of continuous learning. The manager had made improvements to the service since being in post and had been supported by the operations manager and provider to do so. Care workers told us it was a good place to work and they were supported. The provider supported people to get involved with campaigns to improve the lives of people living with a learning disability.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection, the service was rated ‘Requires Improvement’ overall and in three of the key areas. There were two breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. The provider had failed to ensure that people’s needs were assessed and people’s care designed to meet their needs and preferences. The provider had also failed to establish and operate systems to assess, monitor and improve the quality and safety of the service; and failed to maintain accurate and complete records.

At this inspection, we found some improvements to people’s needs assessments and a continued breach in the failure to monitor and improve the quality and safety of the service; and maintain accurate records. We identified four further breaches of the Regulations. Therefore, this is the second consecutive time the service has been rated as Requires Improvement.

HF Trust – Phillippines Close is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 16 people in two separate buildings, each of which have separate facilities and is set on a site which is shared with a day service, offices and supported living accommodation owned by the same provider. On the day of our inspection, there were seven people living in one house and eight people in the other. People had a range of learning disabilities and some people also had physical disabilities, autism or dementia.

Although the service had been built and registered before Registering the Right Support (RRS) had been published, the provider had been developing the service in line with the values that underpin this 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.

There was a manager on site who is in the process of registering with CQC. A registered manager is a person who has registered with CQC 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.

Safeguarding policies were in line with Local Authority safeguarding procedures, staff had received training and were able to tell us what they would do in the event of a safeguarding concern. However, concerns had not always been reported to the Local Authority and CQC; and acted on by the provider.

People were protected from the risk of infection and were cared for in a clean environment. Risks to people were assessed although some were overdue for review and there was no risk assessment for one person who can present with behaviour that challenges.

The provider did not consistently ensure the safe use of people’s prescribed medicines. Not all bottles had been dated on opening and people did not have protocols in place for all their PRN medicines to ensure people received medicines when they needed them. Medicines were not always stored safely at the correct temperatures in line with the providers policy.

The provider did not always learn from incidents as not all incidents had been reported. Where incidents of behaviour that challenges had been reported, they were not always acted on and therefore lessons were not always learnt when things went wrong.

Safe recruitment practices were carried out by the provider. However, staff had not received regular supervision. The provider struggled to recruit to cover the identified staffing hours required.

The provider had trained and supported staff to understand the requirements of the Mental Capacity Act in general, and the specific requirements of the DoLS. However, the provider was not working within the principles of the Mental Capacity Act (MCA) 2005. They could not be assured that decisions were made in people’s best interest.

Staff worked together and with other agencies to deliver care and people were supported to access the health care they needed. The home had been adapted to meet people’s needs, for example around their mobility. People were supported to cook their own meals and told us they were happy with the food provided. People were supported to menu plan and to go shopping. People who had specialist needs around their diets had an eating and drinking assessment completed.

People’s views on whether staff were caring were mixed. Staff knew the people they cared for well and we saw positive personal interactions between staff and people throughout the day. People’s individual protected characteristics under the Equality Act 2010 were considered. There was a person centred culture and people’s rooms reflected their interests. Staff respected and promoted people’s needs for independence, privacy and dignity. People were supported to maintain contact with their families and relatives could visit when they wished. Advocacy services were promoted. However, people and their relatives were not always involved in their care.

One person used makaton, but staff were not trained to use it. Makaton is a language programme using signs and symbols to help people to communicate. Information had been provided to people in a way which met their individual needs, however the manager was unaware of the Accessible Information Standards and we have made a recommendation about this in our report.

People’s care was not always responsive to their needs as some people didn’t have care plans around their behaviour that challenges and staff were not provided with guidance for how to support people with their behaviour that challenges. People’s care met their needs around their dementia, epilepsy and mobility and their care reviews were person centred. People knew how to make a complaint and the complaints procedure was on display. People had end of life person centred plans which detailed their wishes.

Assistive technology was used to support people’s care where appropriate and people were supported to manage their finances. In line with ‘registering the right support’ people with learning disabilities were supported to access and be part of their communities and people were supported to take part in activities they liked.

There were auditing systems in place, however these had either failed to identify the concerns we found or the provider had not acted on them. The provider has not shown continuous learning and improvement. Not all care, service and staff records were updated or completed adequately. The duty of candour was not well evidenced as incidents were not always reported and where relevant relatives were not always informed. The provider had not always notified CQC of certain changes and important events that happened in the service.

Staffs views on leadership being available were mixed. Staff and managers were encouraged to complete further training and there was a development pathway for staff. The staff team did not have the opportunity to communicate and meet with each other regularly. Staff were invited to offer feedback and surveys were completed with people and relatives. However, we could not see any evidence of where this had led to any analysis and lessons learnt from the feedback. The provider had built up a partnership with a local school to promote a positive image of working within the care industry and to support the schools fundraising.

During this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations and one breach of The Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

The inspection was carried out on 26 June 2017 and was unannounced.

Philippines Close is registered to provide accommodation and personal care for up to 16 people. There were 16 people living at the service when we visited. People had a range of learning disabilities.

The service is split across two houses on a site which is shared with a day service, offices and supported living accommodation owned by the provider. There were seven people living in one house and nine people in the other. Each house had its own dedicated staff team, though staff occasionally supported in the other house to cover staff shortages.

There is a registered manager in post who was supported on site by an operations manager. They were also part of the provider’s partnership forum. 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.

Risks to people and the environment had been assessed and there were risk assessments in place. However, assessments related to people’s health did not always contain all the information needed for staff to minimise identified risks. When risks in the environment were identified for example, fire doors not closing when the fire alarm is tested, there was no evidence that action had been taken and the outcome. The registered manager took action after the inspection to address these issues. People’s medicines were managed safely; however one person did not have protocols in place for ‘as and when’ required (PRN) medicines and some creams had not been dated when they were opened. Some medicines, including the creams we observed need to be used within a limited time once opened or they may not work properly, so creams should be dated when opened. We made a recommendation about this.

People’s care plans were not updated on a regular basis and some not been updated since 2013 and contained information which was now inaccurate. People’s did not always have their needs assessed before moving into the service and care plans were not completed until sometime after they moved into the service. Some people could present behaviours which can challenge; care plans related to this did not give staff all the information they needed to help the person to manage their distress and feel calm. People did not have plans to support them to reach their goals or develop new skills. People’s care plans were in the process of being updated and moved to an online system.

Audits were completed by allocated staff members, the registered manager and operations manager to monitor the quality of the service. However, these audits had not identified the issues we found during this inspection and did not always record actions taken to address shortfalls. People and relatives were asked for their feedback via surveys and house meetings. There was an easy read complaints policy and complaints were dealt with appropriately.

People were supported by staff who knew them well and treated them with dignity and respect. Staff were recruited safely and had the training and skills required to meet people’s needs. Staff told us they felt supported and had access to regular supervisions with their line manager. People were encouraged to be independent and had access to a wide range of activities both at the on-site day centre and in the local community.

Staff understood their responsibilities in relation to safeguarding people from abuse and worked with people to manage their relationships with the people they lived with. The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations in line with the legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way.

People could access their kitchens at all times and chose the menu each week together. Menus were placed on the kitchen notice board with photographs of the meals on offer. There was also a picture chart showing people’s chores for each day. People had health action plans in place detailing their health needs and the support they needed. There was information in place for people to take with them if they were admitted to hospital. This laid out important information which healthcare staff should know, such as how to communicate with the person and what medicines they were taking. Advice people received from healthcare professionals was followed.

The registered manager met with the providers other managers to discuss good practice and share learning. They also were part of a partnership forum which enabled them to meet the board of the provider and discuss the organisations plans moving forward. They then shared this information with staff through regular team meetings.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.