22 St Peters Road 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.

This location provides accommodation and personal care to a maximum of four people with

learning disabilities and autism. People who lived at the service were adults below the age of thirty-five years old. People had different care and support needs and had varying communication needs.

This comprehensive inspection took place on 12 and 20 July 2018 and was announced. There was 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

The care service is delivered 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 which ensure people using the service can live as ordinary life as any citizen.

The management arrangements had not ensured quality monitoring systems had been maintained in all areas. Some quality and safety records including medicine records had not been completed in a consistent way. The registered manager took action to address the absence of records and there was impact on the care provided. Agency staff had not completed a full induction and a system to check agency staff working were suitable and safe to do so had not been established. Following a meeting with the provider they assured us action had been taken to ensure suitable checks were undertaken. Staff were not routinely issued with a job description. All these areas were identified to the registered manager as areas for improvement and two recommendations were made.

People were kept safe. Staff knew and understood their responsibilities to report any concerns under safeguarding vulnerable adults and protect people from abuse. People's medicines were managed safely. People received their medicines as prescribed by staff who had been trained to administer medicines safely.

Risks associated with people's health, safety and welfare had been identified and assessed, and guidance was in place to help staff to reduce those risks. There were sufficient staff deployed to meet people's needs and keep them safe, both at the service and when outside in the community. Recruitment procedures were followed and informed decisions to employ suitable staff.

People's needs were effectively met because staff had the training and skills they needed to do so. Staff were supported well with induction, training, supervision and appraisal. People were supported to maintain their independence and control of their lives and staff supported them in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

People were supported to have busy lives and to attend activities within the community. People had enough to eat and drink and were involved in menu planning, shopping and cooking. Everyone was supported to maintain good physical and mental health.

This inspection took place on 15 September 2015. To ensure we met staff and the people that lived at the service, we gave short notice of our inspection.

This location is registered to provide accommodation and personal care to a maximum of four people with complex needs within the autistic spectrum. Four people lived at the service at the time of our inspection.

People who lived at the service were younger adults below the age of sixty five years old. People had different communication needs. Some people were able to communicate verbally, and other people used written communications, gestures and body language. We talked directly with people and used observations to better understand people's needs.

The home 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.

There were audit processes in place to monitor the quality of the service. Where audits identified shortfalls, it was not always clearly recorded as to whether the provider had addressed these shortfalls. However this did not have a direct impact on people because staff had ensured their needs were consistently met.

We have made a recommendation that the provider explores relevant guidance from reputable websites about quality monitoring and action planning to ensure any identified shortfalls are effectively monitored and recorded as completed. 

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Risk assessments took account of people’s right to make their own decisions.

Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed and were continually reviewed.

Staff were competent to meet people’s needs. Staff received on-going training and supervision to monitor their performance and professional development. Staff were supported to undertake a professional qualification in social care to develop their skills and competence.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Three people were subject to a DoLS, and the registered manager understood when an application should be made and how to assess whether a person needed a DoLS.

The service provided meals and supported people to make meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and needs.

Staff communicated effectively with people, responded to their needs promptly, and treated people with kindness and respect. People were satisfied about how their care and treatment was delivered. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were involved in their day to day care and support. People’s care plans were reviewed with their participation and relatives were invited to attend the care reviews and contribute.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. People were involved in planning activities of their choice.

People received care that responded to their individual care and support needs. People were provided with accessible information about how to make a complaint and received staff support to make their views and wishes known.

There was an open culture that put people at the centre of their care and support. Staff held a clear set of values based on respect for people, ensuring people had freedom of choice and support to be as independent as possible.

People and staff were encouraged to comment on the service provided and their feedback was used to identify service improvements. There were audit processes in place to monitor the quality of the service.

When we visited to inspect this service we were able to meet three of the four people living there. We also met and spoke with four staff and the manager.

One person we spoke with preferred to tell us about their experiences using a questionnaire. The manager helped compile this using a widget programme that included the things we wanted to ask about. People told us that they were happy living in the house with the people they shared with. They said that staff maintained their privacy and that they felt involved in decision making about their care and support. They told us that if they had any concerns or did not like anything they felt happy to speak to staff about this.

We looked at records and saw that people's care needs and support were clearly documented and kept updated. A risk framework was in place to ensure people were kept safe. There was good evidence that people were supported to access healthcare and that their dietary needs were monitored.

When we spoke with staff they told us that they felt supported by each other and the manager. They said that they had access to a range of training and thought this was well catered for by the provider. Staff told us about some of the monitoring they did. We saw records completed by the manager of more in depth quality monitoring checks undertaken on a regular basis.