22 Levick Court 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 personal care to a maximum of 16 people who have a learning disability. The service has eight residential beds and eight respite beds over two floors. The service also supports an active transition plan from children’s services to adult’s services from the age of 16 working closely with partners from Children and Families Services. On the first day of the inspection there were seven people who lived at the service permanently and three people receiving respite care. On the second day of the inspection there were seven people who lived at the service permanently. Respite beds had been booked but people were not coming in for respite until after we left.

At our last inspection in October / November 2015 we rated the service as good. At this inspection on 6 and 26 March 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. However, we did rate the responsive domain as outstanding and this section is lengthier to reflect our findings.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received feedback from people, relatives and professionals which was exceptionally positive about the progress and quality of life that people experienced. Professionals consistently praised the support provided by the service during the transition of young people from children’s to adult’s services. Professionals involved in people's care confirmed that the service was able to meet people's high level of needs. Support was totally tailored to each individual, and staff understood the best way to support each person with their complex needs. Activities and outings were plentiful and based on the individual interests of people who used the service.

Care plans were extremely well organised and contained information relating to all aspects of people's care and support needs.

The premises were well maintained and were regularly checked to make sure they were safe. An artist had painted many areas of the service with people’s favourite soaps stars, other television characters, television programmes, sporting people and areas of local interest. We were told how this had brought comfort and reassurance to people.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place.

People and relatives told us there were sufficient numbers of staff on duty to ensure people’s needs were met. Regular agency staff were used to support one person with their additional one to one hours. Pre-employment checks were made to reduce the likelihood of employing people who were unsuitable to work with people.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed all accidents and incidents to determine any themes or trends.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes an

An adult social care inspector carried out this inspection. The focus of the inspection was to review the action the provider had taken to address the compliance actions set during the previous visit on 2 April 2014. During the visit the inspector spoke with one person who used the service, the manager and a member of the care staff.

Previously we obtained answers to our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We found that action was needed to ensure the service was safe and responsive.

During the inspection in April 2014 we found that nutritional screening had not been carried out for people who used the service. This meant that there was a potential risk that people did not receive timely and appropriate intervention if they lost weight. In one of the care files we looked at we saw that the person who used the service had lost weight. Staff recorded the initial weight loss but failed to weigh the person again until eight months later when further weight loss was noted. We asked staff to make a safeguarding referral to the local authority in respect of this, which we followed-up.

At this inspection we found that the provider had taken action to ensure the service was compliant and staff appropriately oversaw people who used the service care and welfare.

The inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans and risk assessments were in place and were updated as people’s needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

We found that nutritional screening had not been carried out for people who used the service. This meant that there was a potential risk that people did receive timely and appropriate intervention if they lost weight.

People were supported to have adequate nutrition and hydration.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

Recruitment practice was safe and thorough. Appropriate checks were carried out on staff before they started work.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing the nutritional needs and risks of people who received care.

Is the service effective?

People we spoke with during the inspection told us that they were happy with the support and care that they received and that their needs were met. One person said, “They are very kind and thoughtful.”

In general people’s care needs were assessed and care plans were in place, however care plans were not written in a format that people who used the service could understand.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. One person we spoke with said, “They do everything they can to help me.”

People who used the service, their relatives and friends completed satisfaction surveys. Where shortfalls or concerns were raised (however small) these were taken on board and dealt with.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. One person said, “You can talk to the staff about anything.” Discussion with the manager and assistant manager during the inspection confirmed that any concerns or complaints were taken seriously.

In one of the care files we looked at we saw that the person who used the service had lost weight. Despite an initial weight loss staff had failed to weigh the person again until eight months later when further weight loss was noted. We have asked the service to make a safeguarding referral to the local authority in respect of this.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the welfare of people.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. However, the provider had not undertaken regular visits to the home to audit, assess and monitor the quality of the service provided.

During the inspection we spoke with three people who used the service. We also spoke with the manager, a residential support worker and a senior residential support worker. People we spoke with told us that they were happy; felt looked after; and that they were involved in making choices about their care. One person said, “I go out most days. Today I went to a café for coffee. I like to go to charity shops and look round.” Another person told us that they could get up and go to bed when they wanted and that they liked to watch television.

We saw that staff treated people with dignity and respect. Staff were attentive, gave reassurance and interacted well with the people. We saw that staff communicated well and explained everything in a way that could be easily understood. Staff encouraged and supported the people to be independent.

We found the premises that people, staff and visitors used were safe and suitable.

We found there was an effective complaints system in place at the home.

We inspected 22 Levick Court on 28 October and 13 November 2015. This was an unannounced inspection on the first day which meant that the staff and registered provider did not know that we would be visiting. We did announce the second day of inspection.

22 Levick Court can accommodate a maximum number of 16 people who have a learning disability. The service is situated in a residential area of Linthorpe in Middlesbrough. The service is divided into two units, one for people requiring residential care the other for people requiring respite care. There are communal lounges, dining areas, bathrooms and toilets on both floors. Bedrooms are for single occupancy and contain ensuite facilities which consist of a toilet, sink and shower or a bath.

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.

The registered manager was on leave on the first day of inspection however an experienced senior residential social worker was able to assist us. The registered manager met with us on the second day of inspection.

People told us they felt safe. There were policies and procedures in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with told us how they keep people safe and were able to explain the whistleblowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

Risk assessments were in place for people and they had been personalised to each individual and covered areas such as going out in the community, use of public transport, choking, health and behaviour that challenged. This helped staff to have the guidance to manage the risks to people and to keep them safe.

We saw that staff had received supervision and appraisal, however this was not on a regular basis.

People told us there were always sufficient staff on duty to meet their needs. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood and had received training in the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We saw safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

There were appropriate systems in place for the storage, administration and management of medicines so that people received their medicines safely.

We saw positive and caring interactions between people and staff. We saw that staff treated people with dignity and respect. People told us they felt cared for and were looked after. We spoke to staff who demonstrated that they knew the individual needs of people well. We saw staff being responsive to people’s needs.

We saw that people were provided with a good choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Alternatives were offered if people did not like what was on the menu. The menu was displayed daily on a chalkboard in the dining room.

People were supported to maintain good health and had access to a variety of healthcare professionals and services. People were supported and encouraged to have regular health checks. People told us that staff or their relatives accompanied them to these appointments if needed. We saw that people had hospital passports. A hospital passport is a document sent with the person on admission to hospital. The hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health.

We looked at people’s care plans and saw they were very person centred and written in a way that we could see the person had been involved in putting them together. They explained the support and care the person needed and also their likes and dislikes and how they liked to spend their day from start to finish. These were regularly reviewed, evaluated, and updated.

People had many and varied hobbies and interests which were individual to them or some were group activities. We saw that there were also outings arranged and that people who used the service went on holidays at home and abroad. We saw and were told that where it was needed staff supported people to access activities within the community.

We saw that the service had a policy and proceedure for responding to people’s concerns and complaints. However, the complaints procedure was not in easy read format but there was a nominated member of staff working on this. People were regularly asked for feedback verbally, in residents meetings and through questionnaires. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were looked after by a named individual. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were systems in place to monitor and improve the quality of the service provided, however this needed to be developed further. We saw there were audits carried out by both the registered manager and senior staff within the service however we did not see a record of provider visits or action plans. We saw that the views of the people using the service were regularly sought and changes made based on their feedback.

People and staff told us that the registered manager had an open door policy and that the culture was open and inclusive. People, staff and relatives spoke very favourably of the registered manager.