This comprehensive inspection took place on 28 March 2018 and 4 April 2018. The visit on 28 March 2018 was unannounced and we agreed with the registered manager that we would return on 4 April to complete the inspection. The last inspection of the service was in February 2016 when we identified one breach of regulations as the provider did not always respond appropriately to possible safeguarding incidents.

We carried out a focused inspection on 25th January 2017 to check that improvements to meet legal requirements planned by the provider after our February 2016 had been made. The team inspected the service against one of the five questions we ask about services: is the service safe? This is because the service was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. We found the provider had made improvements and responded appropriately to possible safeguarding incidents.

48 The Grove 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, Consensus Support Services Limited, provides support and accommodation for individuals with a learning disability, autism and complex needs. The service at 48 The Grove provides accommodation and personal care for up to eight people. When we carried out this inspection, three men and five women were using the service. People using the service had a range of complex needs and some were not able to communicate their needs verbally.

The service has 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.

At the March 2018 inspection we have rated the service as good for the five questions we ask - Is the service Safe, Effective, Caring, Responsive and Well-led?. Overall, we have rated the service as good.

The provider had systems in place to protect people using the service from abuse, staff understood these and had completed training to make sure people were safe. The provider also assessed possible risks to people using the service and staff supported people in a way that kept them safe and respected their freedom.

Systems were in place to ensure people were supported by sufficient numbers of suitably qualified staff. During the inspection we did not see any examples of people having to wait for care or support from staff. When they recruited staff, the provider carried out checks to make sure they were suitable to work with people using the service.

People’s healthcare needs were assessed and recorded and staff worked with clinicians to make sure these were met. People using the service also received the medicines they needed safely.

The provider assessed people’s care and support needs in line with best practice standards and guidance. All of the care records we reviewed included care needs assessments and these were written with reference to best practice guidelines.

Staff had the training they needed to provide care and support to people using the service and they told us they found the training helpful.

People’s care records and support plans included information about their nutritional care needs. Staff recorded what people ate and drank in their daily care notes and we saw they followed nutritional advice healthcare professionals provided.

48 The Grove is a large

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

This inspection took place on 3 and 4 February 2016. The visit on 3 February was unannounced and we told the registered manager we would return on 4 February to complete the inspection.

The last inspection of the service took place in October 2013 when we found no breaches of the regulations.

48 The Grove is a care home for up to eight people with a learning disability. When we visited, five men and three women were using the service and all had lived there for at least eight years. People using the service had a range of complex needs and some were not able to communicate their needs verbally. Consensus Support Services Limited provides support and accommodation for individuals with learning disability, autism and complex needs,

The service had 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.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not always respond appropriately to possible safeguarding concerns.

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

There were enough staff to meet people’s support needs and the provider carried out pre-employment checks to make sure new staff were suitable to work in the service.

People received the medicines they needed safely.

Support staff had the skills and knowledge they needed to support people using the service.

The provider took action to identify and manage possible risks to people using the service.

People had access to the health care services they needed.

People and their relatives told us people were well cared for in the service.

Staff treated people with kindness and patience.

Staff offered people choices about aspects of their daily lives.

The provider and support staff had assessed and recorded people’s individual care and support needs.

There was an appropriate complaints procedure and the provider also produced this in an accessible format.

Support staff were aware of the provider’s goals and values and they told us the provider’s training and support systems were “very good.”

The provider had systems in place to gather the views of people using the service and others.

The registered manager and provider carried out a range of checks and audits to monitor the service.

We carried out our inspection to ensure that standards were being met in relation to how people were involved in their care and also ensuring people were having there care needs met. We also decided to look at how people were protected from abuse, staffing and management of the home.

During our last inspection on 20 May 2013 we found people were not adequately involved in their care and were not always treated with dignity and respect. We also found that people's care was not planned and delivered in a way that met their individual needs.

We asked the provider to make improvements. They sent us an action plan on 2 July 2013 and told us they would make the necessary improvements by 30 September 2013.

During this visit we spoke with four people but due to their complex needs health conditions they were not able to tell us about their care experiences of using the service. We observed how people were cared for and looked at their records to assess whether the necessary improvements had been made.

We found that staff supported people with their communication so they could be more involved in their care. Each person had an activity plan and when they needed additional support to make choices or understand how they would spend their day, staff had developed the use of pictorial communication boards to support people.

We also found people were respected and their dignity and values were promoted. For example we saw staff encouraging people to participate in age appropriate activities. We also saw people's bedrooms had been personalised and the physical environment of the home had improved.

We looked at the care plans of three people, and found that care was planned in a way which met people's needs. For example terminology used was not complicated or vague which we had previously found. We spoke with three staff and they were able to tell us about each person's needs and how they were cared for. We also found there was sufficient staff on duty with the right skills and experiences to ensure people's needs were being met.

People were protected from the risks of abuse. Staff working in the home had received appropriate training. They also completed incident forms where required, informed the relevant authorities of incidents that had occurred and where the use of restraint was necessary there were care plans in place to ensure this was carried out in a way that was not abusive.

We found the management of the service had improved. Staff were better supported and the documentation relating to people had been updated to ensure staff had the correct guidance to care for people safely.

We looked at the care records of four people, spoke with six members of staff including the manager and operations manager. We also spoke with four people who used the service. People told us they enjoyed living at the home and felt that staff were kind. We asked people who were able to communicate how things had been since our last visit, one person told us “its ok." However, the person was upset and expressed disappointment that the home was not always an enjoyable place to live due to the behaviour of some people living in the home that challenged the service.

We observed the physical environment people lived in and how staff interacted with them. We found people were not cared for in an environment that promoted their dignity and their values. We spoke with the manager and operations manager who acknowledged our concerns. They told us they would make improvements.

We looked at the way in which care was planned and delivered. We found that people's needs were not being met and although many staff had received training in relation to supporting people with autism and challenging behaviours, they lacked understanding of how to implement the training they had received, and consequently this had limited or no impact on the delivery of safe and effective care to people

We looked at the care records of five people and spoke with three people. We also spoke with seven members of staff and relatives of people who use the service. People told us there was limited activities and they were often bored. One person told us " I enjoy college, but sometimes it can be boring here". We looked at the way people's activities were planned and found some people during our inspections did not participate in the activities that had been planned. Daily records did not support that people had been involved in the daily activities that had been planned.

Relatives of one person told us "the care is ok there" whilst another told us " I don't worry the staff always seem to know what they are doing". However all of the relatives we spoke with told us they were not involved in the planning of people's care and were not asked their views when planning holidays, activities or personal care.

We found that care assessments had been carried out and care plans and risk assessments were in place were guidance from health professionals has been asked. For example there was plans to manage and maintain people's weight.

We found people were not appropriately safeguarded from abuse because there were Incidents that had occurred which had not been reported to the relevant authorities in accordance with local policies.

We looked at training records and audits carried out in the home and found standards were being met.