About the service: Packington Avenue is residential care home that provides personal care for up to five people. Care and support is provided to people with learning disabilities and /or mental health needs. At the time of the inspection five people were living at the home.

People’s experience of using this service:

¿ People received safe care. Medicines were managed safely; infection control arrangements were effective in reducing cross infections. There were enough staff to support people and keep them safe.

¿ People were supported by staff with the right knowledge and training.

¿ Staff involved people in decisions about their care and obtained the necessary consent for the care and support provided.

¿ Staff ensured people had access to healthcare services by making appropriate and timely referrals and following their recommendations and advice.

¿ Staff had respectful, caring relationships with people they supported. They respected people's dignity and privacy and promoted their independence.

¿ People's care and support met their needs and reflected their preferences. The provider upheld people's human rights.

¿ People were involved when their care plans were reviewed and were actively involved in decision making in relation to their care and support.

¿ People felt supported and it was apparent from our discussions with staff and what we saw throughout the inspection, that staff cared about people and their well-being.

¿ There was a positive, open and empowering culture but the service was not consistently managed and well-led. This was because the provider had not ensured their rating was displayed on their website.

Rating at last inspection: Good (Report was published on 5 September 2016).

Why we inspected: This was a planned inspection based on the ratings at the last comprehensive inspection. The rating has remained Good overall.

Follow up: We will continue to monitor the service through the information we receive until we return, as part of the inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 7 and 8 June 2016 and was announced. We gave short notice because the location was a small care home for younger adults who are often out during the day and we needed to be sure that someone would be in. At our last inspection on 1 May 2015 the provider was assessed at that time as Requires Improvement overall. The provider had not always followed recruitment procedures to ensure that only suitable staff were employed and repairs were not always addressed in a timely manner and staff did not always feel listened to.

At this inspection we found that the provider had made improvements to the arrangements for staffing and improvements had been made to the systems in place to monitor the service and therefore address repairs in a timely way.

306-308 Packington Avenue (Packington Avenue) is a residential care home providing accommodation and personal care for up to eight people with learning disabilities. At the time of our inspection seven people were living there.

The home is made up of two converted houses adjacent to each other. There are two people residing in one of the properties and five people living in the other.

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 responsibilities for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Not everyone that lived at Packington Avenue was able to tell us their views verbally. We used other methods to get a view of the care provided including speaking with relatives, observing people’s body language and facial expressions. We also observed interactions between staff and people.

Staff understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. The provider had systems and processes in place to protect people from the risk of avoidable harm.

We found that there were enough staff available to respond to people’s needs and that they were attentive when support was requested.

People were supported to receive their medication safely as prescribed.

We saw that staff had received appropriate training to learn the skills they required in order to meet people’s needs.

People told us that staff respected their decisions and sought their consent. People were supported to eat and drink sufficiently varied meals to remain healthy.

People received care from staff that were caring and knew them well. Staff respected people’s privacy, dignity and individuality.

People were involved in planning their care and activities. Relatives felt that their family member’s needs were being met. No complaints from people or their relatives had been received by the registered manager recently.

Systems were in place that were effective in ensuring all staff were up to date with people’s current care needs.

There were systems in place to gather the views of the people that used the service and their relatives.

The registered manager carried out internal audits, monitored staff performance, reviewed care records and completed a quality assurance checklist to assess the performance of the service provided.

The inspection took place on 1 May 2015 and was unannounced. We had brought forward our planned inspection in response to concerns we had received. At our last inspection of 19 August 2014 the provider was meeting all the regulations assessed at that time.

306-308 Packington Avenue is a residential care home providing accommodation and personal care for up to eight people with learning disabilities. At the time of our inspection seven people were living there.

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 responsibilities for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Not everyone that lived at 306-308 Packington Avenue was able to tell us their views verbally. We used other methods to get a view of the care provided including speaking with relatives, observing body language, facial expressions and relationships between staff and people.

People were protected from harm because staff were able to identify abuse, were aware of the procedures and able to raise their concerns so that people were protect.

There were procedures in place to assess and manage risks associated with people’s care.

There were sufficient staff available on duty to support and meet people’s needs.

Recruitment checks were undertaken Staff recruitment was not sufficiently robust to ensure that staff were suitably recruited people were fully protected.

People received care from staff that were caring and respected their wishes, privacy, dignity and independence.

People were involved in assessing and planning their care and staff knew the people they supported and people felt their needs were being met. People were able to raise their concerns or complaints.

Systems were in place to monitor the quality of the service; however, repairs were not always addressed in a timely manner and staff did not always feel listened to.

The inspection was carried out by a single inspector. On the day of our inspection we were told that there were seven people using the service. We spoke with four members of staff and the registered manager, who is also the provider, six people living at the home, one family member, one advocate and one community nurse who visited on the day of inspection. We also reviewed records relating to the management of the service which included three care records, risk assessments and care plans, staff files, training records and quality assurance information. We used the information to answer the five questions we always ask:

Is the service safe?

The provider had a system in place to monitor the quality of the service and ensure that people received safe care.

Infection control arrangements were in place to minimise the risk of infection and people were cared for in a clean and hygienic environment.

Risk assessments included moving and handling, continence, managing challenging behaviour, medication and the risk of pressure sores. Risk assessments had been reviewed regularly to reflect people’s changing conditions.

Is the service effective?

There were arrangements in place to gain peoples consent for care. Where people were unable to consent there were arrangements in place to ensure their best interests were acted upon.

We saw evidence that risk assessments were used to ensure that care was individual and effective in meeting people’s needs.

Staff had appropriate induction and on-going training and were supported to ensure they had the skills and competencies to care for people effectively.

Relatives and external support workers told us that the care provided was good. One relative told us “They couldn’t do anymore.”

Is the service caring?

We saw that people who used the service were treated individually and that staff were considerate and caring towards them. We witnessed staff making different lunches for each person and saw that activities were arranged to support their interests.

People who used the service told us that staff were kind. One person told us, “I really like it here” another told us that they felt supported, their concentration was much better and they had done, “Really well” in school since living at the home.

Is the service responsive?

Care records and risk assessments detailed the individual needs and interests of each person who used the service. Each person had a keyworker so that any changes that were required could be responded to.

We saw that other health and social care professionals were involved regularly so that changes in health or circumstances could be addressed quickly.

Is the service well-led?

The provider ensured that monthly audits of various aspects of the services operations were completed. We saw notes of where audits had identified concerns and action plans detailing actions to be taken.

There was evidence of staff receiving monthly supervision, regular training and a staff questionnaire.

We saw that people using the service, relatives and staff were asked for their feedback and that action was taken as a result.

We spoke with relatives and external support workers who were complimentary about the management of the service and felt that the registered manager did a, “Really good job.” Staff we spoke with said that it felt like a family and that they were clear about their roles and responsibilities. One person said, “It feels like a family.”

During this inspection we looked to see if improvements had been made following our previous inspection in June 2013. We spoke with the manager.

We found that appropriate arrangements were in place to obtain medication for people and keep medication safe. The manager told us, "We have ordered a new lockable cupboard."

We found that improvement had been made.

On the day of our inspection we were told that seven people were living at the home. During our visit, we looked at three care records and spoke with the manager and three members of staff. We also spoke with six people living at the home and three relatives / advocates. We later spoke with two care staff.

Care plans were personalised and risk assessments were in place so that staff had the information they needed to meet people's identified needs. One person told us, "I like living here".

Arrangements were in place to ensure that people were safeguarded against harm.

Appropriate arrangements were in place for obtaining people's medication but we found some improvements were still needed to protect people against the risks associated with the unsafe use and management of medicines.

Effective recruitment procedures were in place. One staff member told us, "I enjoy my job because I like to see the people I support happy".

We saw systems, including easy-read guides, in place so that people could raise a concern or make a complaint about the services that they received. We saw systems in place to audit and monitor the quality of the service being provided.

There were five people living at the home on the day of our inspection. No one knew we would be inspecting that day. We spoke with people living at the home and one relative. One person told us,” I like it here, it is good”. The relative we spoke with said,” The manager and staff gave us advice and support before they moved in. I think it is a good place”.

As people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. We observed good interactions between staff and people living there.

We saw that support plans instructed staff how they should care for people in the way they wanted and to keep them safe.

We identified that medication systems were not as robust and as safe as they should be to prevent people being placed at risk of ill health.

Recruitment processes had not been as thorough and safe as they should have been to give assurance that only suitable staff had been employed.

Records and staff both confirmed that systems had been used to monitor how the home had been run to benefit the people who lived there.

We found that the two people living at 308 Packington Avenue were happy with their home. People told us that they liked living in the home and they got on well with the staff "They (staff) are always kind to me.” Resident’s also said that they can talk to the staff telling us that “We have a good chat and ‘X’ (member of staff) listens to me.

On the day of our visit one of the residents had been out to the hairdresser for a hair cut with the support of a carer. When the resident returned they looked happy and said that they were pleased with their hair act.

At the time of our visit there were no family members visiting the home therefore we did not get the opportunity to speak to relatives. The manager told us that relatives and other family members visit the home regularly. Residents also visit their relatives and also spend weekends with their relatives.