What life is like for people using this service:

Improvements had been made to the service since our last inspection in 2017. There were enough staff who knew people well and promoted people’s dignity. There was a registered manager in post who had got to know the service and the people well.

People who used the service were supported safely whilst staff promoted their independence and inclusion within the community. People were supported by caring and compassionate staff who promoted choices in a way that people understood, this meant people had control and choice over their lives.

People were supported by safely recruited staff who were trained and supported to equip them with the skills and knowledge needed to provide effective support. Effective care planning was in place which guided staff to provide support that met people’s diverse needs and in line with their preferences.

Systems were in place to monitor the service, which ensured that people’s risks were mitigated and lessons were learnt when things went wrong. There were plans in place to make improvements to the design and decoration of the service. There was an open culture within the service, people and staff could approach the registered manager who acted on concerns raised to make improvements to people’s care. The registered manager was passionate about providing good quality care and staff were encouraged and supported to provide good outcomes for people.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection: Requires Improvement (published 3 November 2017)

About the service: 216 Lightwood Road is a residential care home registered to provide accommodation and personal care for up to seven people living with learning disabilities. At the time of the inspection, seven people were using the service.

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 'Registering the Right Support' CQC policy.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection.

Follow up: We will continue to monitor the service through the information we receive.

This inspection took place on 23 August 2017 and was an unannounced, responsive inspection. The inspection took place as a response to the high number of notifications we had received from the provider in July and August 2017.

Lightwood Road is a registered care home providing accommodation for up to ten people with a learning disability. At the time of our inspection there were seven people living at the home.

At the time of the inspection there was no registered manager. A new manager had started but the application process for registering with CQC had not been finalised. 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.

Although there were sufficient numbers of staff to provide a service, however recent restructuring had placed added pressure on staff to care for people safely.

People’s dignity was not always respected by the staff that supported them.

People were kept safe and secure, and relatives believed their family members were safe from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider.

People received their medicines safely and as prescribed.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

Relatives and staff were confident about approaching the manager if they needed to.

People and relatives views on the quality of the service was gathered and used to support service development.

This inspection took place on the 15 March 2016 and was unannounced. At our four previous inspections we found that the provider did not have safe systems in place to manage people’s medicines. We had begun to take enforcement action and issued the provider with a warning notice. We had further concerns about people’s care and the systems the provider had in place to monitor the quality of the service. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 216 Lightwood Road on our website at www.cqc.org.uk

At this inspection we found that improvements had been made in all areas of concern and the provider was no longer in breach of any Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service provided accommodation and personal care for up to ten people with a learning disability.

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.

People’s medicines were administered and stored safely. People received their prescribed medication at the times they needed it by suitably trained staff.

Action was taken to minimise the risks to people when an incident had occurred and people were protected from the risk of further harm.

Care was personalised and met meet people’s individual needs and preferences. People’s care was reviewed and when people’s needs changed the registered manager responded and sought advice and support from other professionals.

There were enough staff to keep people safe and to be able to support people in their chosen hobbies and activities. Pre-employment checks were undertaken to ensure that new staff were fit to work with people.

People were protected from abuse as staff knew what constituted abuse and who to report it to if they suspected it had taken place.

Staff were supported to fulfil their role effectively. There was a regular programme of applicable training. Staff told us that the registered manager was supportive and approachable.

Staff were observed to be kind and caring and they respected people’s privacy.

Improvements to the care for people, support available to staff and the environment had been made. The systems the provider had in place to monitor and improve the service were effective.

This inspection took place on the 28 October 2015 and was unannounced. At our three previous inspections we found that the provider did not have safe systems in place to manage people’s medicines and records were not kept up to date. At this inspection we found that although some improvement had been made there were further areas of concern. You can see what action we have asked the provider to take at the end of the report.

The service provided accommodation and personal care for up to ten people with a learning disability.

The service had a registered manager however they were not available on the day of the inspection. We were supported by an area 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’s medicines were not administered or stored safely. Some people did not always receive their prescribed medication. Storage of medication was not monitored to ensure that it was safe to use.

Care was not always personalised and did not meet people’s individual needs and preferences. There were enough staff to keep people safe, however there were not enough staff to be able to support people in their chosen community activities.

Risks to people were not always acted upon when an incident had occurred to minimise the risk of it happening again.

People were protected from abuse as staff knew what constituted abuse and who to report it to if they suspected it had taken place.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) is part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the principles of the MCA by ensuring that people consented to their care or were supported by representatives to make decisions.

Staff were supported to fulfil their role effectively. There was a regular programme of applicable training.

People’s nutritional needs were met. People were supported to eat and drink sufficient to maintain a healthy lifestyle dependent on their specific needs.

People were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

Staff were observed to be generally kind and caring, however they did not always respond when people requested their support. They told us that were well supported by the registered manager.

The environment did not always support people to be independent. People struggled to negotiate themselves around the dining room. Risks and hazards were not always identified around the service.

The provider completed regular quality audits, however these were not always effective in identifying and acting on any necessary improvements.

This inspection was carried out by a CQC inspector. We spoke with three people who used the service, two relatives, three members of staff, the senior service manager, senior manager and the home leader. We also reviewed records relating to the management of the service, which included three care records, medication records and staff training records. We were given information relating to the operation of the service. We used the information to answer five questions we always ask:

Is the service safe?

Robust safeguarding procedures were in place. Staff had undertaken safeguarding training and were clear about their responsibilities to report any incidents of potential abuse.

Referrals to health care professionals had produced reassessments for the provision of aids, adaptations and equipment for daily living. This meant that people had the care and equipment they needed to keep them safe.

The provider had improved the way it stored people's medication. The recording and checking of medication and staff training in medication needed further improvement. We have asked the provider to tell us how they will make improvements.

The provider had doubled the number of care and support staff on duty on the morning staff rota and increased the number of staff by 50% on the afternoon rota. Additional staffing had significantly reduce the risks to people and ensured their needs could be met at all times.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. The service had procedures in place and staff knew how to apply for this authorisation. One application had been authorised by the local authority since our last inspection of the service. This related to a restriction to ensure a person's safety and wellbeing. The person no longer uses the service. At the time of this inspection no one using the service was subject to DoLS.

Is the service effective?

We observed positive engagement between staff and people who used the service. Some people were unable to communicate verbally. We saw that staff engaged with people using their own communication style that included body language, signs, sounds, facial expressions. Some people used Makaton, a language programme using signs and symbols to help people to communicate.

Referrals to other agencies for the re-assessment of people's needs had resulted in additional equipment being brought in to support them. Referrals to speech and language therapists and dieticians had improved people's diet and the support needed to eat safely. Social workers had completed assessments of mental capacity for most people, ensuring that decisions were made in people's best interests.

Some care and support records had been reviewed and updated. We saw that new information was in place. The majority of dated and some incorrect information remained part of the care planning information. We have asked the provider to tell us what improvements they will make to ensure records contain the current information needed to support people safely.

Is the service caring?

We spoke with two relatives who told us they were very happy with the service. A relative told us, "I have no concerns about care. Staff are really nice, they always find time to talk. There is continuity, many staff have worked there for years, that is really important."

Staff were able to describe the good practices they used to ensure that people's privacy and dignity were respected. They were able to tell us in detail about people's needs and what they needed to do to support them. We observed staff treating people with compassion, kindness and respect.

We saw that staff had not always received regular training to update their knowledge and skills. This had been recognised by the provider and a planned programme of training had been arranged to address the shortfalls identified. This will ensure that staff have the training and knowledge to support people safely.

Is the service responsive?

We saw from past reviews of people's care needs and risk assessments that plans of care had not always been reviewed correctly. Reviews had not recorded evidence of positive or negative effects of the care given. This increased the risk of unsafe or inappropriate care and treatment.

The service had actively sought the re-assessment of people's needs by involving external health professionals. The assessments had been recorded and acted upon. They form the basis of people's current care and support needs and risk assessments.

Is the service well-led?

The service does not have a registered manager in post. The provider assured us that plans were in place for an application to be submitted. This will provide the continuity the service has lacked over recent months.

The provider had a system in place to monitor the quality of the service. Quality had been reviewed but the appointment of a registered manager to lead the service is key to ensuring the progress of the changes being made to the service.

The service worked in partnership with key organisations to support care provision and make improvements.

This was a follow up inspection of 216 Lightwood Road in relation to issues which had been identified on our previous inspection in January 2013. During the previous inspection we were concerned about how people were supported to make decisions. How people’s medication was administered, stored and dispensed and how accurate and meaningful some of the records were relating to people’s care and welfare.

As a result of our findings the home provided us with an action plan outlining how they would address the issues. During this inspection we saw that the action plan had been implemented. There had been improvements regarding the decision making processes and record keeping. However we found that the plan had not fully addressed the issues around medication. We found additional concerns in this area.

During this inspection we saw that people were involved in making decisions within their ability. Where they lacked understanding this was documented and decisions were made in their best interest in accordance with the Mental Capacity Act 2005 (MCA).

We found that storage for drugs did not meet British Standards. Documentation regarding stock and dispensing was not in place or was recorded inappropriately. We also saw evidence that drugs were left unattended where people who used the service could access them.

Records were now kept securely and much of the confusing material they had contained previously had been archived to make records easier to understand.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

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 some of the people were unable to tell us their experiences about the care and support they received.

People using the service had choices in all aspects of their daily living. We observed staff interacting and supporting people in a respectful and positive manner.

We observed that people were comfortable with staff. The staff interacted with people in a positive, sensitive, and respectful manner whilst attending to their needs. Staff knew the people they supported well. Two people told to us they were being well looked after. Other people indicated to us through smiling and gestures they were happy with the service.

Where people were not able to make decisions, suitable capacity assessments had not been completed. Information about who was involved and why decisions had been made was not recorded. This meant people could not be confident decisions had been made in their best interest.

We looked at the way medication was managed and saw that improvements were needed to ensure medication systems and practices were safe and suitable.