A comprehensive inspection took place at 199 Burton Road on 13 and 21 February 2018. The first day was unannounced.

The home had previously been inspected on 6 January 2017 and was rated requires improvement overall and in the key questions of safe, effective and well-led. The home was rated as good in the key questions of caring and responsive.

We identified a breach of the regulations relating to good governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions. On this visit, we checked to see if any improvements had been made.

199 Burton Road is a residential care home registered to provide personal care for up to four people who have a diagnosis of a learning disability and/or mental health. 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 home is a detached house located within secure gardens. There are four private bedrooms with en-suite facilities, a communal kitchen, dining room, lounge, a separate laundry/domestic room and an administration office. There were four people living at the home on the day of 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.

The service had 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.

During this inspection, we found sufficient improvements had been put in place which meant the registered provider was now compliant in respect of the breach of regulation identified at the last inspection.

Relatives of people who used the service told us their relatives were safe living at 199 Burton Road. Staff had received safeguarding training and knew what to do to keep people safe. Individual risks had been assessed and identified as part of the support and care planning process.

Staff were recruited safely and thorough checks were completed before staff started working at the home. We saw there were sufficient numbers of staff to ensure people’s care needs were met. Staff had received training, supervision and appraisal to ensure people received effective care and this also enabled the development of good practice.

Medicines were stored and managed safely. Regular medicine audits were undertaken.

People were supported with their hydration and nutrition needs. The home had been awarded the highest food hygiene rating of five for good hygiene practice when handling food.

Care plans were person centred and reflected people’s likes, dislikes and interests. Staff were aware of peoples’ preferences. People had regular access to health and social care professionals.

Staff had undertaken training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Staff were able to explain how this legislation related to the people they supported, which meant people’s rights were being protected.

People enjoyed a range of activities and were encouraged to maintain life skills and have maximum control over their lives. A car was provided by the service to enable people to have an ease of access to a wide choice of places. Staff supported people to retain their independence.

Peoples’ personal records were stored confidentially in a locked room.

The home had good management and leadership and the registered manager was visible working with the

This inspection took place on 6 January 2017. The inspection was unannounced. An unannounced inspection is where we visit the service without telling anyone we are visiting.

199 Burton Road is a residential care home registered to provide personal care for up to four people who have a diagnosis of a learning disability and/or mental health. The home was full at the time of the inspection.

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 and associated Regulations about how the service is run. Staff told us they felt the service was well-led.

At the last inspection on 8 and 14 May 2015 the service was rated good, but there was a breach of regulation in regard to consent to care and treatment. On this inspection we checked and found sufficient improvements had been made to comply with the breach of regulation identified at the last inspection, but another breach of regulation was identified. You can see what action we told the provider to take at the back of the full version of the report.

People 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.

Staff received induction and training relevant to their role and responsibilities, but some staff training required updating to ensure staff had up to date knowledge of current good practice. Staff received regular supervision and felt supported, but not received an annual appraisal, which meant there was no system in place both to assess staff performance in the last twelve months and focus on future objectives, opportunities and resources needed.

The registered provider had a system in place to assess and monitor the quality of the service provided. We found this had been ineffective to ensure the service was compliant with regulations and ensure action was taken within specified timescales.

Recruitment procedures were in place, but all information and documents of the required checks had not always been obtained before staff started work.

Assessments, support plans and risk assessments were in place and reviewed, but these did not always include up to date information. We saw information in people’s care files that health professionals were contacted in relation to people’s health care needs, which included involvement from doctors.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities, but the range of activities could be improved. The home encouraged and supported people to maintain contact with family and friends.

Systems and processes were in place to protect people from harm. Staff told us they were aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen to them and respond.

Systems were in place to manage risks to individuals and the service, for example, individual risk assessments and maintenance of the building.

A flexible system was in place to identify the required numbers of staff on duty and staff spoken with felt there were sufficient numbers of staff to meet people’s needs.

The home had effective systems in place to manage medicines in a safe way and to ensure there were sufficient quantities of medicines available to meet people’s needs.

People had choice and control over what and when they ate and people were supported to eat and drink enough. The service encouraged people to eat a healthy diet.

Conversations with staff and our observations showed staff to be caring, person centred and knowledgeable about the needs of people who used the service.

There was a system in place to ensure people could raise concerns or make complaints if necessa

People were asked for their consent before care or support was provided and staff acted in accordance with people’s wishes.

People received the care they needed to meet their needs. A family member told us it was ‘refreshing’ to see the admission process that Aspire undertook and that they didn’t just accept they could meet their family member’s needs. They explained how a number of visits to the service had taken place, a number of meetings had taken place to assess their family member’s needs and they were included in reviews. They also said their family member was undertaking much more meaningful activity. They said, “in all, we’re very pleased with how staff have handled things.”

The environment was clean and people were protected from the risk of infection.

An effective system of recruitment and selection was in place.

A complaints system was available, so that people could raise concerns and they would be listened to.

Two people were living at the home at the time of this inspection. One of these people was able to express their views of their experiences of living at the care home, the other person we had difficulty communicating with. Because we had difficulty talking with this person we used different methods of gathering their experiences during the site visit. We observed care practices and saw how staff and the person interacted with each other.

The atmosphere in the home was relaxed, warm and homely. Staff were seen giving support to people and interacting with them . We saw that people living in the home had a friendly relationship with staff members. The staff knew people very well and were aware of people’s individual communication styles. We observed that people were listened to by staff and requests made about their welfare were, where possible, accommodated. People were able to make decisions and take reasonable risks in relation to life choices. We saw people reacting positively to staff interactions, including smiles and laughter.

We observed the body language of the person who we couldn’t verbally communicate with. Their facial expressions and actions conveyed they were at ease with staff.

During our visit we found that people were provided with support when they needed it. There was clear and respectful communication between staff and people who used the service and staff treated people in a professional and friendly manner.

We saw that people’s welfare was maintained and their wellbeing promoted through meeting their physical, mental, social, emotional and day time activity needs, as described in their care files. Staff members were attentive and provided support when needed. People’s morning personal care needs were supported and met. Following this people living at the service were then involved in meaningful day time activities, such as going to school and shopping. Staff used appropriate communication skills throughout these tasks. We saw that staff demonstrated genuine affection, care and concern for people using the service.

People had regular contact with their family and friends and were encouraged and supported by staff to maintain these links.

The registered manager and two support workers were on duty at the time of the inspection providing care and support to the two people using the service.

This inspection took place over two days on 8 and 14 May 2015. On 8 May 2015, the inspection was unannounced. An unannounced inspection is where we visit the service without telling the registered person we are visiting. On 14 May 2015 we gave the service short notice that we would be visiting. This was because we needed to look at information that was kept at the registered persons head office.

199 Burton Road is a residential care home registered to provide personal care for up to four people who have a diagnosis of a learning disability and/or mental health. At the time of our inspection three people were living at the service.

The service had a registered manager although they were no longer managing the service at the time of the inspection. A new manager commenced on 1 September 2014 and has submitted an application to become the 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 and associated Regulations about how the service is run.

The service have had one previous inspection on 4 November 2013 and were compliant with the regulations inspected at that time.

Systems and processes were in place to protect people from harm. A relative we spoke with did not raise any concerns about mistreatment or inappropriate care provision of their relative. Staff told us they were aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen to them and respond.

Safe systems of work were in place to manage risks to individuals and the service, for example, individual risk assessments and maintenance of the building, but improvements were needed with fire safety.

We found a system was in place to identify the numbers of staff on duty and staff spoken with felt there were sufficient numbers of staff on duty to meet people’s needs.

Recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

The home had effective systems in place to manage medicines in a safe way and to ensure there were sufficient quantities of medication available to meet people’s needs. Improvements were needed with support plan documentation to correspond with this.

Staff received induction and training relevant to their role and responsibilities. Staff had received regular supervision and an annual appraisal.

The registered manager had received Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguard (DoLS) training, but we found that the arrangements in place for obtaining consent for decisions did not follow the principles of the Act.

Meals were based on a weekly menu for each person, considering their preferences and what they would eat. The service worked with people to encourage a healthy diet.

Although assessments, support plans and risk assessments were in place and reviewed, we found some inconsistencies and gaps in the plans. There were detailed plans for people with behaviour that challenged. This meant that staff had guidance to reduce the distress causing the behaviour and minimise any risks. A relative told us they had been included in the completion and reviews of their relative’s support plans and in response to any changes in the support provided. We saw information in people’s care files that health professionals were contacted in relation to people’s health care needs, which included involvement from doctors.

We saw that staff interactions with people were patient and caring in tone and language. People’s rooms reflected their needs, personalities and interests. Staff told us they enjoyed caring for people living at the service and were able to describe people’s individual needs, likes and dislikes and the name people preferred to be called.

A relative, all health professional and a social care professional made positive comments about the staff and told us staff treated people with dignity and respect.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities.

A complaints process was in place and concerns and complaints were taken seriously.

Quality assurance systems were in place to monitor and improve the quality of service provided. However, we found there were no clear audit schedules, and the audits seen had been completed in an ad hoc manner, which meant that information was difficult to retrieve. The audits did not identify the person responsible for any actions, the timescale for actions to be completed and confirmation that the improvements had been achieved.

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 the full version of the report.