We inspected the service on 10 January 2019. The inspection was unannounced. 1 Devonshire Avenue 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 service accommodates 20 people. On the day of our inspection 19 people were using the service.

At our last inspection on 1 June 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service operated 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 home 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.

Procedures were in place to ensure people were safe from harm. People had personalised risk assessments which were up to date. Staff members had received training in safeguarding adults from abuse and understood their roles and responsibilities in ensuring that people were safe.

People's medicines were managed safely. They were stored and administered appropriately. Accurate records were made when medicines were given. Staff members were qualified or had received training in the safe administration of medicines.

People had personalised care plans in place which were reviewed regularly and updated to reflect any change in a person’s needs. People's care plans and risk assessments included guidance for staff on supporting people's communication needs.

There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the registered manager. Staff were not offered employment until satisfactory checks had been completed. Staff received an induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were also supported with supervisions and observed practice.

People could make choices about the food and drink they had, and staff gave support if and when required to enable people to access a balanced diet. People were supported to access a variety of health professionals when required, including opticians and doctors to make sure they received additional healthcare to meet their needs.

The home was meeting the requirements of the Mental Capacity Act (2005). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were offered choices about what they wanted to do. Staff members demonstrated that they understood the importance of enabling people to make their own decisions.

Staff provided care and support with kindness and compassion. There were positive interactions between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say. People's independence was promoted and encouraged. There was a welcoming and homely atmosphere at the service.

People knew how to complain. There was a complaints pro

This inspection took place on 1 June 2016 and was unannounced.

Accommodation and nursing care for up to 20 people is provided in the home over two floors. The service is designed to meet the needs of people with a learning disability and physical disability. There were 19 people using the service at the time of our inspection.

At the previous inspection on 9 and 10 June 2015, we asked the provider to take action to make improvements to the area of safe care and treatment, specifically medicines management and good governance. At this inspection we found that improvements had been made in both of these areas.

A registered manager was in post and she was available during the 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.

Staff knew how to identify and respond to potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People were treated with dignity and respect. People’s privacy was respected and staff encouraged people to be as independent as possible.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken. The registered manager was aware of their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

We spoke with a relative. They told us they felt that their family member’s dignity and privacy were respected and they were “definitely” well cared for. They said, “It’s like home from home for [their family member].” They told us they were kept informed and involved in reviewing the care.

During our visit we saw positive interactions between staff and people using the service. We spent 50 minutes observing the care at lunchtime in the dining room in the larger house and 15 minutes in the smaller house. We saw staff provided support to people who needed this and people were provided with enough to eat and drink. We saw that staff communicated warmly with people as they were supporting them and respected their dignity. We also saw staff asked people about their preferences, recognised how they communicated their views and respected these.

A relative told us they felt there were enough staff and said, “There are always plenty of staff.”

We found that staff received supervision and appraisals. However, we found some gaps in staff training.

A relative told us they had received a questionnaire to provide their feedback on the service and felt they would be listened to if they raised any concerns. We found there were systems in place to monitor the service and address risks.

We found care records were not always accurate and fit for purpose.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke with two relatives of one person using the service. They told us their relative’s privacy and dignity were respected and their relative was well cared for. One relative said, “The general care is spot on.” They told us they felt their relative was safe.

During our visit we saw that staff were kind, polite and respectful. We spent 40 minutes in the dining rooms in both buildings at lunchtime and observed the care being provided. We saw staff communicated with people in a warm and supportive way and sat down next to some people to provide one to one support.

We found that staff had considered the Mental Capacity Act 2005. We saw that care records supported people’s rights to make choices.

Relatives we spoke with told us the building where their relative lived was kept clean and they had no concerns about the building. One relative said, “Oh it’s lovely now. Beautiful.”

We found there were effective recruitment and selection processes in place. We found some gaps in staff supervision and training.

We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received and records were not always kept securely.

1 Devonshire Avenue provides accommodation and personal and nursing care for up to 20 people with learning disabilities and/or physical disabilities. The home consists of two separate houses on the same site, a larger house for 14 people and a smaller house for six people. 19 people, including two people receiving a respite care service, were living at the home at the time of our inspection. This was an unannounced inspection, carried out on 9 and 10 June 2015.

We last inspected the home on 2 and 3 April 2014. At that time it was not meeting one essential standard. We asked the provider to take action to make improvements in the area of the management of medicines. We received an action plan in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found that action had been taken to address the issues previously raised. However we found other concerns with how medicines were managed. There was not a sufficient quantity of a type of ‘as and when’ required medicine available in case it was needed. Some items for use when medicines were being administered were not clean. This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A registered manager was in post 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.

Systems were in place for the provider to make safeguarding referrals when needed so that they could be investigated. Staff supported people in a safe way. Risk assessments were completed regarding people’s care. The building and equipment were safe.

There were enough staff present during our inspection to provide safe care. Robust recruitment checks were completed. Staff felt supported and had received an induction, supervision, appraisals and training.

The provider applied the principles of the Mental Capacity Act 2005. The registered manager understood their responsibility in relation to the Deprivation of Liberty Safeguards.

People were supported at mealtimes. Staff knew about people’s eating and drinking needs. People were supported to maintain good health and referrals were made to health care professionals for additional support when needed.

Staff treated people in a kind and caring way. Staff respected people’s dignity and privacy. People were involved in day to day decisions about their care. Staff knew people well and offered them choices and respected their decisions. People were supported to take part in social activities.

A complaints procedure was in place. Staff felt comfortable to speak with the registered manager if they had concerns. The registered manager was very approachable and knew people well who lived at the home.

There was a positive and open culture in the home. Systems were in place to monitor the service. However these had not always been effective. This was in breach of Regulation 17 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 this report.