The inspection took place on 14 and 19 March 2018 and was unannounced. The service was last inspected on 9 March 2017, where we found the provider to be in breach of one regulation in relation to good governance. At the inspection on 14 and 19 March 2018, we found that the provider had made sufficient improvements and were no longer in breach of a legal requirement.

37 Coleraine Road is registered to provide accommodation and personal care support for up to four people with a learning disability, autistic spectrum disorder, younger adults and mental health needs. The service is set in an adapted house providing accommodation to people over three floors. The ground floor communal areas comprise of a kitchen, a dining room and a living room. At the time of our inspection, four people were living at the service.

37 Coleraine 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.

The provider is also registered at this location to provide personal care support. This service provides care and support to people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our 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.

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

People and their relatives told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. People’s risk assessments were individualised, regularly reviewed and gave sufficient information to staff on how to provide safe care. Staff kept detailed records of people’s accidents and incidents, and the registered manager analysed the records to learn lessons from them to reduce similar future incidents. These lessons were shared with staff during staff meetings, handovers and supervision. Staff wore appropriate protection equipment to prevent the risk of spread of infection. The premises adaptations met health and safety and people’s individual needs.

Staff knew people’s individual needs and were provided adequate training to meet those needs. Staff told us they felt supported by the registered manager and received regular supervision. People were supported to meet their dietary needs and told us they liked the food. Staff assisted and supported people to access ongoing healthcare services to maintain healthier lives. 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. Staff understood people’s right to choices and asked their permission before providing care.

People told us staff were caring and respected their privacy. Staff knew how to support people in a dignified way and treated everyone equally. People were supported and encouraged to remain independent. Staff knew the importance of confidentiality.

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This comprehensive inspection took place on 9 March 2017 and was unannounced.

37 Coleraine Road is a care home providing care and support to up to four adults with learning disability and mental health needs. The provider is also registered at this location to provide personal care at two supported living units nearby. Each person has their own room and share a communal lounge, dining area and bathroom facilities. At the time of our inspection there were two people using the service at Coleraine Road and six people living in supported living. The provider had four services within close proximity

At the time of our inspection the service did not have a registered manager in post. A new manager had been appointed in February 2017 and planned to apply to become the 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.

At our last focused inspection in April 2016 we found breaches of legal requirements in relation to the service meeting people’s individual needs and preferences and suitability of the premises.

During this inspection we found the service had invested in a people carrier to enable people to take part in activities. The service appointed a floating support worker to work across the services when additional staff were needed, including assisting people to meet their individual needs in the community. We saw that the provider had purchased a portable ramp to make adjustments to the building to make this wheelchair accessible for one person who used a wheelchair.

Records relating to people using the service were not always accurate and updated. At our last inspection in April 2016 we found health action plans (HAP) also known as 'my purple book' (book containing up to date information about peoples’ health needs) were not always up to date. During this inspection we found this was still an issue.

People were protected from the risk of abuse because staff were knowledgeable and knew what action to take to protect people. Staff were subjected to the necessary checks to ensure they were safe to work with people.

People were treated with dignity and respect and their privacy respected. During our inspection we saw that staff spoke to people in a respectful manner and respected their opinions.

People's nutritional needs were being met and people were given choice.

We found a breach related to records for people were not accurate and up to date. For example, risk assessments were in place, including triggers to observe and how to manage any risks posed. However, we found a risk assessment was not in place for one person at risk of choking and not updated as recommended by the speech and language therapist (SALT).

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced focused inspection on 15 April 2016. We last inspected the home on 29 July 2015 and 30 July 2015 and breaches of legal requirements were found. This was because we found that the service was not always providing person centred care, recruitment of staff was not always safe and there were not always effective systems in place to ensure records were accurate and of a good standard.

We undertook this unannounced focused inspection on 15 April 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this matter. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for 37 Coleraine Road on our website at www.cqc.org.uk.

37 Coleraine Road is a care home providing care and support to up to four adults with learning disabilities and mental health needs. The provider is also registered to provide personal care at a nearby supported living service. Each person had their own room and shared a communal lounge and dining areas. At the time of our inspection there were four people using the service at 37 Coleraine Road and three people using the supported living service.

At the time of our inspection the registered manager was on leave. 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.

During this inspection we saw that some improvements had been made. Staff recruitment practice had improved and key audits had identified areas where action had been taken to improve the quality of the service. However, we found further improvements were required to ensure that all care records are accurate and up to date and people’s individual needs were met.

We found the provider was no longer is breach of Regulations in relation to recruitment of staff and quality assurance. However, we found the provider was in breach of Regulations relating to premises and equipment and continued breach of Regulations relating to person centred care.

You can see what action we asked the provider to take at the end of this report.

This inspection was on 29 and 30 July 2015 and was unannounced. We informed the registered manager on the first day of our inspection that we would be inspecting the nearby supported living service where people were supported with personal care. This is because the location provider a domiciliary care service and we needed to be sure that someone would be in.

37 Coleraine Road is a care home providing care and support to up to four adults with learning disabilities and mental health needs. The provider is also registered to provide personal care at a supported living unit nearby. Each person had their own room and shares a communal lounge and dining area. At the time of our inspection there were six people using the service. Two of which were part of the supported living service.

The registered manager had been in post since June 2014. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider

At our last inspection in July 2014 we found breaches relating to standards of cleanliness, maintenance of the building, staff support and quality assurance. People were put at risk of unsafe premises because the service had not maintained standards relating to the building and cleanliness and hygiene. Although most staff said they felt supported by the new manager, they had not received regular supervision and some staff did not feel they had the support they needed. We also made recommendations for the service to consider Department of Health guidance on Health Action Plans and Hospital Passports. In light of the above concerns we asked the provider to take action to make improvements. We received an action plan from the provider stating that these actions would be completed by end of January 2015. We saw that most of these actions had been completed at the time of this visit.

During this inspection we found that the provider had made improvements as outlined in their action plan. We saw that the environment at the home was clean and safe for people living at the home. Window restrictors had been installed on upper level windows at the home to ensure that people were safe and new systems in place to monitor safety at the service. However, topical medicines such as creams were not properly managed and staff did not know what people’s medicines were for. We saw that staff had started to review the person centred plans (PCP) for people living at the home. This involved other healthcare professionals and relatives. This had been followed up by the registered manager, but further work was required to ensure that these were fully completed. However, we found a number of gaps in care records, therefore we could not be confident that people always received care in accordance with their care plan.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This inspection was on 21 July 2014 and was unannounced. At our last inspection in January 2014 we found the service was compliant with the standards inspected.

37 Coleraine Road is a care home providing care and support to up to four adults with learning disability. Each person has their own room and shares a communal lounge and dining areas. At the time of our inspection there were four people using the service.

At the time of our inspection the service did not have a registered manager in place. The provider appointed a new manager in June 2014 who is yet to submit an application to be registered. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider

We spoke with people living at the home. One person told us, “I like living here, it’s my home.” Another person told us, “I can go out when I like.” We observed some positive and caring interactions between staff and people using the service. People were treated with dignity and respect. We saw that staff knocked on people’s doors before entering their rooms and explained what they were doing before assisting someone with personal care.

However, we found breaches relating to standards of cleanliness, maintenance of the building, staff support and quality assurance.

People were put at risk of unsafe premises because the service had not maintained standards relating to the building and cleanliness and hygiene.  Although staff said they felt supported by the new manager, they had not received regular supervision or an appraisal for some time.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We found that this service involved the people who used it in all aspects of their care and treatment. We also observed that the staff respected the rights and autonomy of everybody who used the service. The people we spoke to told us they were happy and that staff listened to them and treated them with respect. We observed that this was the case when staff interacted with people.

We found that the service planned for the effective delivery of people's care and support and that staff received guidance in the care and support that people needed. We concluded that people who used this service were kept safe and that their welfare was important to the service.

Relatives of people who used this service told us that although they had been concerned when there had been a change in provider at the home, everything had gone smoothly. Relative's feedback about the service was excellent, with one relative saying "we are ecstatic".

We found that the service supported staff effectively and that they had effective systems in place to monitor the quality and effectiveness of support which was provided.

We carried out this inspection to follow up on concerns found at the previous inspection in May 2012. At the time of this inspection visit two people were living in the home (both of whom had lived there for several years). They were supported by a staff team who also supported people living at 30 Coleraine Road.

People experienced care, treatment and support that met their needs and protected their rights. Improvements had been made regarding records of support provided to people with their finances, and regarding support to help address their individual goals.

People we spoke to were positive about the support they received, and told us that they were provided with the care that they needed, and were given choices. They had formed good and supportive relationships with staff and management.

They told us that they liked the food, and had opportunities to go out as often as they wished. They described a number of activities available to them within and outside of the home including yoga, dance, football, snooker, bus rides, and meals out. Each person had an individual activity plan in place for them. Both had enjoyed trips to the Paralympics and the seaside over the summer.

There had also been an improvement in the home's quality assurance procedures to ensure that when improvements were needed these were put in place without delay.

At the time of the inspection visit two people were living in the home (both of whom had lived there for several years). They were supported by a staff team who also supported people living at 30 Coleraine Road.

People we spoke to were positive about the support they received, and told us that they were provided with the care that they needed, and were given choices. They had formed good and supportive relationships with staff and management. One person noted ‘I like the staff – they’re ok.’

They told us that ‘the food is very nice,’ and had both enjoyed holidays with staff support. One person had been to Gran Canaria, and the other to Centre Parks. They told us ‘we go out for dinner sometimes, and play football.’ They described a number of activities available to them within and outside of the home. However there was room for further development of individual activity plans for them.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. Their privacy and dignity was respected and they were protected by appropriate safeguarding procedures.

There was insufficiently clear management of people’s spending, and support provided for them to achieve chosen goals. There were also insufficiently rigorous quality assurance procedures in place to ensure that any improvements needed were put in place without delay.

People were positive about the home, indicating that they were provided with the care that they needed, were given choices, and had formed good and supportive relationships with staff and management.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. They were happy with the food served in the home, and the variety of activities available to them. Their privacy and dignity was respected and they were protected by appropriate safeguarding procedures.

The service had only recently been transferred to the current provider, and it was therefore inevitably an unsettled time for people living and working at the home. However the continuity and consistency of staff working with people at the home, had clearly alleviated this.

A small number of improvements are needed regarding the management of people’s finances, and staff training in particular areas.