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Inspection carried out on 4 July 2018

During a routine inspection

This inspection took place on 4, 7, 25 and 30 July 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

The service was last inspected in March 2016 and was rated good. At this latest inspection we found the service remained good.

367 Thornaby Road 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. It accommodates up to five people in one adapted building. At the time of our inspection five people were using the service.

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.

There was a registered manager in place. 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 registered manager was registered in July 2018 during the course of our inspection.

Risks to people were assessed and plans developed to minimise the chances of them occurring. Systems were in place to monitor and learn from accidents and incidents. Plans were in place to support people in emergency situations. People were safeguarded from abuse. The premises were clean and tidy. People’s medicines were managed safely. The provider ensured enough staff were in place to support people safely. Robust recruitment processes were in place to minimise the risk of unsuitable staff being employed.

People’s support needs and preferences were assessed before they started using the service. Staff were supported with regular training, supervisions and appraisals. People are were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were supported to maintain a healthy diet. The service worked closely with external professionals to monitor and promote people’s heath. The premises were custom-built and had been designed for the benefit and convenience of people living there.

Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were treated with dignity and respect. People were supported to be as independent and live as full a life as possible. People were supported to access advocacy services where needed.

People received personalised care based on their assessed support needs and preferences. People were supported to access activities they enjoyed. The provider had systems in place to investigate and respond to complaints.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Staff spoke positively about the culture and values of the service and said they felt supported in their roles. The registered manager carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from relatives and staff and acted on.

Inspection carried out on 29 January 2016

During a routine inspection

We carried out this inspection on the 29 January 2016 and 22 February 2016. The first day of inspection was unannounced which meant the staff and registered provider did not know we would be visiting. Due to people who used the service being out throughout the day we returned early evening on the second day to observe.

367 Thornaby Road is a small home providing personal and nursing care for five people with learning disabilities and additional support needs. The bungalow is purpose built, and each room has an en-suite bathroom. Two of the bedrooms are adapted to meet the needs of people with a physical disability.

The home had a registered manager in place who has been registered with the Care Quality Commission since November 2014. 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 our last inspection January 2015 we asked the registered provider to take action to make improvements in the management of medicines, good governance, assessing and monitoring the risks relating to the health and safety and welfare of service users, seeking and acting on feedback from relevant persons, acting on complaints and supporting staff through supervision and appraisals. The registered provider sent us an action plan stating they would be compliant by 31July 2015.

During this inspection we found that the registered provider had put systems in place to manage medicines safely. The registered provider was now assessing, monitoring and improving the quality of the service. Risk assessments were now in place to protect the health, safety and welfare of people who used the service and others. The registered provider was now seeking and acting on feedback from relevant persons. Complaints were now acted on and recorded effectively and staff were receiving regular supervision and an appraisal.

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

The registered manager had knowledge of the Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS]. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The registered manager understood when an application should be made, and how to submit one. At the time of our visit all five people living at the service were subject to a DoLS authorisation.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents were too few to identify any trends.

Staff received relevant training and competency assessments took place in subjects such as safe handling of medicines..

Staff were observed to know people well and to be caring and respected people’s privacy and dignity.

People were supported to access healthcare professionals and services.

Activities took place more on a one to one level with the occasional group outing to the beach. People who used the service had a busy social life.

People’s care records were person centred. Person centred planning (PCP) p

Inspection carried out on 27th January 2015

During a routine inspection

The inspection visit took place on the 27th January 2015 and this was unannounced.

We last inspected the service on 18th December 2013 and found the service was not in breach of any regulations at that time.

367 Thornaby Road is a small home providing personal and nursing care for five people with learning disabilities and additional support needs. The bungalow is purpose built, and each room has ensuite bathroom facilities. Two of the bedrooms are adapted to meet the needs of people with a physical disability.

The service had a registered manager in place and they have been in post as manager since 2012 and registered with the Care Quality Commission since 4th November 2014. 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 living at the service received good, kind, attentive care and support that was tailored to meet their individual needs. Staff ensured they were kept safe from abuse. People we spoke with were positive about the care they received and said that they felt safe.

Staff were trained and understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would feel confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

Accidents and incidents were monitored each month to identify trends. At the time of our inspection there were no significant accidents and incidents to trigger alerts or to highlight any trends.

We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

We saw medicines were not being managed or stored appropriately.

The service was very clean and tidy. We saw there was plenty of personal protection equipment (PPE) such as disposable gloves and aprons. Staff we spoke to confirmed they always had enough PPE available.

Staff received training to enable them to perform their roles effectively and the service looked at ways to increase knowledge to ensure people’s individual needs were met. Staff did not receive supervisions. We saw an annual appraisal for one staff member had taken place in May 2014. This identified developmental needs that still had not been addressed such as monthly key worker summary meetings. We saw no appraisals prior to May 2014 as these had been destroyed.

The registered manager had knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They understood when an application should be made, and how to submit one.

The registered manager said they were in the process of sourcing an Independent Mental Capacity Advocate (IMCA) in case it was needed in the future. IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions.

People were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. Some of the staff had worked with the people who used the service for about 18 years and knew their likes and dislikes.

367 Thornaby Road was built to accommodate the people who lived there; all their needs and preferences had been incorporated into the build such as low windows to enable people to see outside easier.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans did not include sufficiently detailed risk assessments to demonstrate consideration of risk and how risk should be managed to ensure the safety of each individual.

Each person who used the service attended a day service where they enjoyed activities such as swimming, pottery and hydrotherapy. The service encouraged people to maintain their preferred activities and people were supported to be involved in the local community as much as possible such as going to the local coffee shop and attending the theatre.

The service had no system in place for the management of complaints.

There were no effective systems in place to monitor and improve the quality of the service provided.

We saw safety checks and certificates that were all dated within the last 12 months for items that had been serviced such as fire equipment and water temperature checks. Some documentation of checks were confusing as the estates maintenance person had added information onto the incorrect page or had wrote ‘all done’ but did not state what ‘all’ was. Fire drills had never taken place. Therefore people were at risk due to no one being aware of evacuation procedures.

We found the provider was breaching a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to care and welfare of people who used the service, use of managerial oversight, record keeping, assessing and monitoring the performance of the home; safety and the management of medication. You can see what action we took at the back of the full version of this report.

Inspection carried out on 9, 18 December 2013

During a routine inspection

We spoke to the relatives of three people, who told us they thought the service was excellent. Comments included, "I feel so lucky to have my relative so well looked after as they are.", "The service is absolutely fantastic." and "It's 100% a family of carers. You see examples on the TV of where things are not good. This home should be put on the TV as an example of good quality care. They are excellent."

We found people who used the service had safe and appropriate care, treatment and support. This was because their individual needs were established from when they were referred to or began to use the service. Care and treatment was planned and delivered in a way that was intended to ensure people�s safety and welfare.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.