White Leaf Support provides care and accommodation at 215 Hughenden Road for up to six people with either learning disabilities and or autistic spectrum disorders. At the time of our inspection six people used the service.

The inspection took place on 1st and 2nd of August 2018. The inspection was unannounced on the first day. At our last inspection, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were not managed effectively to ensure people received their medicines as prescribed. The provider was also in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems were not in place to investigate immediately upon becoming aware of potential abuse.

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 in safe, effective and well-led to at least good.

At this inspection we found improvements had been made and the provider was now meeting these Regulations.

White Leaf Support is a ‘care home’. 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. White Leaf Support accommodates six people in one adapted building.

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 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 a registered manager was in post.

Relatives commented they had seen improvements in the service. One family member said, “Staff go above and beyond their duty.”

Systems were in place to assess and monitor the quality and safety of the service. We saw medicines were managed effectively.

Staff understood their responsibilities in relation to reporting accidents and incidents. Staff attended safeguarding training and knew how to report any concerns.

Recruitment procedures were robust to ensure only suitable staff were appointed. We saw there were sufficient staff available to meet people’s needs. Induction and development programmes were in place to ensure staff gained relevant knowledge and skills.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. 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.

People were supported to eat and drink to meet their needs and to make informed choices about what they ate and drank.

Social activities were available for people to take part in, to avoid social isolation. We saw people were engaged in community events on both days of our inspection.

Regular on-going health checks were carried out and people were supported to attend appointments. People were referred to health professionals when required.

Concerns and complaints were used as a way of improving the service. Staff told us they felt supported and could question practice if the need arose.

The service carried out repairs and maintenance of the building to ensure the safety of people and staff.

Robust monitoring syste

215 Hughenden Road provides accommodation, care and support for up to six younger adults with learning disabilities or autistic spectrum disorder. At the time of our inspection there were six people using the service.

At the last inspection on 15 17 and 20 June 2016 we identified a breach of Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and found improvements were required at the service. The provider did not have effective systems in place to ensure staff records were maintained accurately. Consent to care and treatment was not always sought in line with relevant legislation. The provider was issued with requirement notices for both regulations. We asked the provider to take action to address these areas. We found during this inspection the provider was now meeting these regulations.

At the time of our inspection there was 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 told us they felt safe comments were, “Yes they (staff) lock the front door” and “They (staff) help me when I need it.” Families told us they felt their family member was treated well. We received comments such as, “They (staff) are very committed and their work is very much appreciated. We are pleased overall.”

Risk assessments were in place to support people to be as independent as possible. These protected people and supported them to maintain their freedom. However, we saw one person’s risk assessment for self-administration of medicine had been transferred from the person’s previous accommodation. However, we were aware the service was in the process of putting in place a risk assessment that was specific to the service.

Fire checks were completed on a regular basis and fire drills were carried out.

We saw undated food in the fridge and the inside of the fridge was stained with food and appeared in need of a thorough clean.

We have made a recommendation that the service follows advice from a reputable source about the safe storage of food.

Management of medicines was not always followed according to best practice guidelines.

We saw secondary dispensing take place on the first day of our inspection. Secondary dispensing is when medicines are removed from the original containers and put into pots in advance of the time of administration. This removes the safety net to check the medicine, strength and dose against the medicine administration record (MAR) chart at the same time as checking the identity of the person. When ‘as required’ medicines was administered there was not always an explanation of why it was used on the back of the medicine chart and if the medicine had been effective. Some medicines were still on one person’s medicine chart when the medicine had been discontinued.

Staff had received training and were knowledgeable about the people they supported.

The service followed the requirements of the Mental Capacity Act 2005 (MCA).The recording of consent and best interest decisions meant the service complied with the MCA codes of practice requirements. People were supported to have maximum control and choice of their lives and staff supported them in the least restrictive way possible; policies and procedures in the service supported this practice.

People received adequate nutrition. However, this was not always based on their assessed requirements. We saw one person who was at risk of malnutrition did not have the amounts of food consumed documented on their daily food chart.

We found the service was caring. People told us staff were kind and considerate towards them. We observed staff were friendly and interacted well with the people they supported.

People were support

This inspection took place on 15 17 and 20 June 2016. These were unannounced visits to the service. The previous inspection took place on 3 April 2014 when it was found to be fully compliant.

White Leaf Support provides accommodation for up to six younger adults with a learning disability or autistic spectrum disorder. At the time of the inspection there were five people using the service.

At the time of inspection there was no registered manager. The last registered manager left their position in October 2015. A series of managers had been in charge of the service since then. The service was in the process of appointing a manager who had previously worked at 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.

We found a number of areas the service needed to improve on. Records were not always kept up to date and suitably maintained; people had recently had their risk assessments updated by the acting manager. However, the identified risk was not always followed through in the support plan.

Consent was not sought in line with legislation. People had not provided consent before care and treatment was provided. We spoke with the interim manager at the home about this during our feedback and they said it is ‘in progress’. We also spoke with the operations manager who visited the service on the second day of our inspection. They told us it was being addressed.

Staff did not always receive appropriate on-going training to enable them to fulfil the requirements of their role. Staff were not always supervised to demonstrate they were competent to carry out their role. We asked to see evidence of training staff had completed this could not be produced. Some induction processes were incomplete. Staff we spoke with confirmed they had knowledge and confidence to identify safeguarding concerns and had received training in this area.

The premises were clean and appropriate for the people who lived there, each person’s bedroom was personalised with personal belongings. People participated in activities that were tailored to their needs.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These were in relation to consent to care and record keeping. You can see what action we told the provider to take at the back of the full version of this report.

On the day of our visit there were two support staff and the service manager providing care and support to four people. We observed the interaction between staff and the people who lived in 215 Hughenden Road. We talked briefly with one person who received support, talked with staff and the manager and looked at a range of records. We spoke after our visit with social care professionals familiar with the service and saw records of relative's meetings and feedback on the service.

We considered the evidence we had gathered under the outcomes we inspected. We used this information to answers the questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People who lived at 215 Hughenden Road were cared for safely. Staff had the knowledge and training they required to provide safe and appropriate care. Risks to people's health, safety and welfare were assessed and plans were in place to eliminate or manage those risks. Where people received support with their medication, this was done effectively and safely. Where people received support with their finances, there were robust systems in place to protect them from financial abuse or mismanagement.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. Whilst no applications have been submitted, we found appropriate policies and procedures were in place if they became necessary. Training had been arranged to ensure relevant staff knew when an application should be made and how to submit one.

Is the service effective?

We saw feedback from relatives of people who used the service was very positive about the standard of care received. Social care professionals we spoke with told us they were satisfied the care provided was good and met the assessed needs of the people they were responsible for. We observed very positive, appropriate interaction between staff and the people who used the service. Staff had a very good understanding of the assessed needs of the people they provided care and support for and how those needs were to be met. Staff had the training and support they needed to effectively meet people's needs.

Is the service caring?

We saw staff treated people who lived in the service with respect and took account of their dignity. In a brief conversation with one person they indicated they were happy and were about to go and spend some time with their parents at home. We saw the service made sure people could understand the choices open to them and supported them to make decisions about their care and support, for example by making information available to them in ways they could easily understand.

Is the service responsive?

We saw people's needs were assessed. Care support documentation was centred on each individual; their needs, interests and preferences and how these were to be met effectively. Opportunities were actively sought to get the views of people who used the service and those responsible for them. We saw people going home for visits, being supported to go out for day care and into town for shopping and to visit the bank.

Is the service well-led?

We found systems were in place to measure the quality of the service provided. Views of people who used the service, their relatives and those responsible for their care were sought regularly. People told us they had confidence any concerns they had about the service would be dealt with promptly and effectively by the manager and provider. We found a system of checks and detailed audits were in place to identify any areas or concern and to monitor the efficient operation of the service. Care staff were supported with training and supervision to help them provide a high level of care and support.