Our inspection took place on 16 October 2018 and was announced.

16 Homeside Close 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 provides accommodation and personal care to adults with learning disabilities or autism spectrum disorder. The care home accommodates eight people in one adapted building.

The care service had 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.

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 safe, effective, responsive and well-led to at least “good”. The service has made improvements, which included compliance with a previous breach related to good governance. The ratings for key questions responsive and well-led have therefore improved to “good”. Further improvement is required for key questions safe and effective.

The provider is required to have a registered manager as part of their conditions of registration. 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 the time of our inspection, there was a manager registered with us.

Staff reported accidents and incidents. However, documentation of actions to check people were safe and to prevent recurrence of injuries were not always recorded. The house was generally clean and tidy but improvements were required to mitigate the risks from infections. New care risk assessments were in place and more were to be implemented to cover other areas of care, such as people’s moving and handling.

The service did not ensure they followed the requirements set out in the Mental Capacity Act 2005 on every occasion. We made a recommendation about this. People’s health and social care appointments were not always followed-up in line with requirements from their own health action plans. More staff supervision and training had occurred, to ensure people were supported by care workers with appropriate knowledge and skills. We made a recommendation about recording staff performance appraisals. Changes made to the premises ensured a better environment for people who used the service.

People received kind, compassionate care from dedicated staff who knew them well. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems at the service supported this practice. People had an active say in how the service was operated and managed.

The introduction of new care plans had increased the service’s focus on person-centred care planning and delivery. More information was provided and available to people in a way they could understand it, including photos, pictures and symbols. This could be further improved. End of life care planning was evident for only some people; more documentation about people’s preferences for a peaceful, dignified death is required.

The governance of the service had improved. A better-quality assurance programme was in place to check, measure, log and act on areas for improvement. There was more oversight from the provider, and increased support to the registered manager. Staff continued to support people in a positive workplace culture. Staff were encouraged to be more included in the operation of the se

16 Homeside Close is a care home without nursing and provides accommodation and support to adults with learning disabilities or autism. The care home is located within a residential area of Maidenhead, Berkshire. There are two floors. On the ground floor are communal areas, kitchen and laundry and some people’s bedrooms. The first floor has more people’s bedrooms, communal bathrooms and a staff office. In accordance with the current registration, the care home can accommodate up to eight adults. At the time of our inspection eight people lived at 16 Homeside Close.

The service had a registered manager. 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 were not always safe from risks related to the building. Although a comprehensive range of checks were conducted for health and safety risks, the reports were often not noted or acted on by the provider. Remedial actions, such as repairs, were not communicated, planned or completed. We found a number of instances where important repairs or changes to the premises were missed.

People’s care risks were assessed by staff and recorded within their care documentation. Care risks were not always appropriately recorded or reviewed and required improvement.

There were long standing vacancies of permanent care workers. The provider had no underlying system to calculate what a safe number of staff to deploy was. Staff routinely worked overtime, cancelled their annual leave or dedicated training and there was ongoing use of agency workers.

Medicines were managed safely, but some improvements were required to ensure robust systems were in place.

The service required some improvements with staff training, supervision and performance appraisals. These were sometimes not completed or overdue. Consent and ability to make decisions was recorded in people’s care plans, although there was some conflicting information. People had good provision of food and drinks. People’s care was supported by healthcare professionals from the local area.

Some areas of the premises, like the communal bathrooms, were refurbished to a high standard. These helped people complete daily hygiene and encouraged their independence in the process. Attention was required on areas which were a risk to people, such as the first floor carpet and external paving. The kitchen, although clean, required redecoration.

Staff were kind and caring. They knew people’s likes, dislikes and preferences well. Staff respected people’s privacy and dignity. Staff told us they enjoyed supporting the people who used the service.

Care plans were in place for people, but contained outdated information. Care plans also conflicted with each other in some cases. There was a complaints procedure in place, and feedback was sought from relatives. No feedback was captured from people or community healthcare workers.

The provider’s systems of measuring the safety and quality of care were not robust. Processes for care quality management since the change of registration in 2017 were not in place. Audits and checks that were completed were not focused on driving continuous improvement. Best practice in caring for people with learning disabilities or autism were not considered or put into place.

Staff liked working at the service and told us there was a positive workplace culture. They felt the registered manager and deputy manager had supported them well. They felt more contact with the provider’s senior management team would enable them to better understand the organisational expectations.

We found one breach 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 th