The inspection took place on 12 April 2018 and was unannounced. The service was last inspected in March 2017. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of is the service effective, is it responsive? and is it well led?

At the last inspection there was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safeguarding service users from abuse and improper treatment. There was a breach of Regulation 17 of the Care Quality Commission (Registration) Regulations 2009. There was also a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around Person centred care. Specifically improvements were needed in relation to the Mental Capacity Act 2005 that Deprivation of Liberty Safeguards applications were promptly resubmitted for people when their authorisation had expired. Improvements were also needed, as the registered manager at the time had not submitted notifications of all incidents that affected the health, safety and welfare of people who use the service. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

121 Watleys End Road is a care home providing personal and nursing care to up to 14 people. There were 13 people living at the home at the time of our inspection. 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 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 for the service. 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 had worked for the provider for a number of years in other services. They had worked at the home for one year.

Medicines were stored securely and administered by staff who had been trained and assessed as competent to do so. Medicines were reviewed regularly to ensure people with complex needs received them appropriately.

The service was responsive to people's needs and they were able to make choices about their day-to-day routines. People had access to a range of activities, which provided them with mental and social stimulation. People were able to go into the community safely.

People were supported to feel safe at the home and with the staff who supported them. There were systems and processes in place to reduce risks to people. These included a thorough recruitment process and ensuring staff knew how to recognise and report abuse. There were enough staff available to meet people's needs in a timely way.

Staff we spoke with understood the requirements of the Mental Capacity Act 2005 Staff completed training in a range of areas including safeguarding, moving and handling, basic life support, dementia awareness and health and safety

Staff were caring and kind towards the people they supported. The staff knew people well and understood their needs. However, at certain times during our visit, some staff communication was not fully person centred. Some staff spoke to each other and did not communicate with people when they assisted them. For example, when helping people who were in wheelch

This was an unannounced inspection, which meant the staff and the provider did not know we would be visiting. The inspection was carried out by one inspector on the 7 and 8 March 2017

121 Watleys End Road provides accommodation, nursing and personal care for 14 people. People who live at the home have learning and physical disabilities. There were 14 people with complex and high support needs living at 121 Watleys End Road at the time of the visit.

There was 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 registered manager had submitted applications to the appropriate authorities to ensure people were not deprived of their liberty without authorisation. However, these had not been renewed promptly when they had expired.

People had a care plan that described how they wanted to be supported in an individualised way. However, some of the information within the care plan was about their previous care setting and no longer relevant. Care files would benefit from some information being archived as it could be misleading.

There were systems to monitor the quality of the service. However, areas we identified during the inspection had not been identified during the home’s own audit systems. Where the provider had asked the registered manager to make improvements these had not always been actioned.

Sufficient numbers of staff supported the people living at the service. Staff had received sufficient training to enable them to support people effectively. Regular meetings were taken place however; other systems to support staff such as one to one meetings were not happening at regular intervals.

People’s medicines were managed safely. People were protected from abuse because staff had received training on safeguarding adults and they knew what to do if an allegation of abuse was raised.

Recruitment processes were robust ensuring people were protected against unsuitable staff supporting them. Ongoing recruitment was taking place to fill the staff vacancies. Regular and familiar bank and agency staff were used to cover the shortfalls.

Staff knew people well and recognised when they were unwell and reported this to the nurses. People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was positive in respect of the care being provided.

People were treated in a dignified, caring manner which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. Staff used different forms of communication to enable them to build effective relationships with people. This was important as many of the people used non-verbal communication to express how they were feeling.

People were supported to maintain contact with friends and family. Relatives confirmed they were always made to feel welcome. People were supported to take part in regular activities both in the home and the community.

We found there were 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 this report.

We used a number of different methods including observations and conversations to help us understand the experiences of people who lived in the home. People had complex needs which meant they were not fully able to talk to us about their experiences. In order to understand what it was like for people living at 121 Watleys End Road we observed staff support, looked at records and spoke with staff who supported the people living at the home. We also spoke with a visiting relative.

People were encouraged and made day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with four members of staff during our visit. Staff were very motivated and caring and attentive of the people in their care. One member of staff told us "I like it, it can be busy but we have a really good team and it is a good place to work".

We found people were supported by sufficient skilled and experienced staff. One relative told us, "The staff are always very kind and helpful, they always keep me informed and involved in all areas of my sons care”.

The provider had an effective system in place to record and address any complaints that were made.

In view of the communication difficulties of people who use the service, we relied on

observations between the staff and people who use the service in order to understand their views of the service.

Following our visit to the home we contacted two relatives and asked them about the care their relative received. Both people were extremely complementary about the service that their relative received. They told us that they had confidence in the manager and staff team and believed that the home were doing a “wonderful job” in caring for their relative. Other comments made to us included: “I can honestly say, hand on heart that the care my relative receives at the home is amazing, the staff know my relative so well, they provide excellent care and treat my relative with love and respect”, “The home keeps me updated and informed and I feel lucky that my relative is being supported at the home”. “My relative leads such a good life, they are always out and about, I would recommend the home to anyone!”.

A visiting professional to the home told us the staff were responsive to people’s changing needs and would contact other professionals as required for example the doctor, occupational therapist or the speech and language therapist.

We observed staff offering people choices about how and where they wanted to spend their time, and what food and drinks they wanted.

As well as the registered manager we also spoke with five other staff during our visit. Staff were very motivated, caring and positive about working in the home and demonstrated a sound understanding of the needs of the people they were supporting.

This was an unannounced inspection, which meant the staff and the provider did not know we would be visiting. The inspection was carried out by one inspector on the 25 August and 2 September 2015.

121 Watleys End Road provides accommodation, nursing and personal care for 14 people. People who live at the home have learning and physical disabilities. There were 12 people living at 121 Watleys End Road at the time of the visit with complex and high support needs.

There was 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.

Due to the registered manager having a period of absence a temporary registered manager from another service was supporting the home.

People were being supported with activities both in the home and the community but this was not always being recorded. Staff demonstrated a commitment to providing people with opportunities to go out into the community, participate in social clubs and activities in home.

However, it was acknowledged that they did not always have the staff to be able to do this due to the high support needs of the people they supported. Therefore, people were not always receiving their funded day care hours. This was discussed with an area manager who provided us with an action plan by the second day of our inspection. The plan was clear and demonstrated how they would be addressing this shortfall. This included providing additional day care staff to support the team in providing activities for people.

People’s medicines were managed safely. People were protected from abuse because staff had received training on safeguarding adults and they knew what to do if an allegation of abuse was raised. Recruitment processes were robust ensuring people were protected against unsuitable staff supporting them.

People had a care plan that described how they wanted to be supported in an individualised way. These had been kept under review. Care was effective and responsive to people’s changing needs. Staff used different forms of communication to enable them to build effective relationships with people. This was important as many of the people used non-verbal communication to express how they were feeling.

People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was positive in respect of the care being provided.

People were treated in a dignified, caring manner which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. The registered manager had submitted applications to the appropriate authorities to ensure people were not deprived of their liberty without authorisation. People were supported to maintain contact with friends and family.

Staff were knowledgeable about the people they supported and spoke about them in a positive and caring way. Staff had received suitable training enabling them to deliver safe and effective care and this was kept under review taking into account the changing needs of people.

The service was well led. Staff confirmed they received support and guidance from the management of the service. Checks were being completed on the quality of the service, with action plans being implemented to aid improvement.