The inspection took place on 15 February 2017 and was announced. As this is a very small service, and people regularly go out into the community, we announced the inspection shortly before the visit to make sure someone would be available at the home to assist in the inspection. The home was previously inspected in July 2015 when breaches of legal requirement were identified. The provider sent us an action plan outlining how they would meet these breaches. You can read the report from our last inspection, by selecting the 'all reports' link for ‘54a’ on our website at www.cqc.org.uk.

54a provides accommodation and personal care for up to three people who had a learning disability. People using the service are supported to live as independently as possible. The service has a self-contained flat for one person and two bedrooms in the main house. The home is close to local amenities.

The service had a registered manager in post at the time of our inspection. 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 service had procedures in place to ensure people’s medicines were managed in a safe way. We looked at the storage of medicines and found they were kept in each person’s room in a locked cabinet which was accessible by staff. Some medicines, prescribed on an ‘as and when’ required basis were recorded but a record was not always kept of the effect the medicine had on the person.

Risks associated with people’s care had been identified. However, the service did not have any Personal Emergency Evacuation Plan’s (PEEP) in place for people who may not be able to evacuate the service quickly in an emergency. We spoke with the registered manager who told us they would address this and devise a personal plan if required.

Through our observations and by talking to people who used the service, their relatives and staff, we found there was enough staff available to support people.

Staff we spoke with were knowledgeable about safeguarding people from abuse. They knew how to recognise and respond to abuse. All staff we spoke with were confident the registered manager would address any situation brought to their attention.

We looked at records in relation to staff training and saw that staff had certificates in their personal file. We also saw a training matrix, which was a record of training received, due and overdue. This was completed by the deputy manager. Some training was out of date in relation to what the company expected. However, training was sought and booked during our inspection.

People were supported to eat healthy meals based on their likes and dislikes. People discussed the menu on a weekly basis and devised a shopping list, helped to buy the food and where appropriate assisted in the preparation of meals.

The service was meeting the requirements of the Mental Capacity Act 2005. Staff were knowledgeable about this subject and supported people well.

People were referred to healthcare professionals when required. Staff took on board advice given and updated support plans to reflect this.

During our inspection we observed staff interacting with people who used the service. We saw that staff had developed positive, caring relationships with people based on their individual preferences and choices. It was evident that staff knew people very well. We saw that staff maintained people’s privacy and dignity.

We looked at care records belonging to people and found they reflected the support people required and the support staff were offering. An initial assessment was carried out to ensure the service was able to meet people’s needs.

People were involved in community activities and events within the service. People had an activity planne

The environment in which people lived promoted their privacy and dignity and supported their rights to choose and retain a level of independence. Each person using the service had their own bedroom which was furnished and decorated as they requested.

We spoke to two people who lived in the home. One person said “I like living here. I go out to more places than I did before. I have a girlfriend and sometimes she comes here and sometimes we go bowling. I go to the youth club every week”.

We looked at a range of records. These contained information about the persons preferred name and identified the person’s usual routine. One member of staff said people do have a regular routine but if they want to change it they can, otherwise the service could become very regimented and it should not be like that, people should have choice.

People who used the service said they were consulted about the care they received and were able to give their views about the care and treatment.

We saw that health and social care professionals were involved in the care planning process and that people had access to primary healthcare services such as GPs.

We saw that training records had information on staff attending training in areas such as medication, food hygiene, first aid, moving and handling and restraint techniques.

We saw information on staff having regular supervision and yearly appraisals this helped ensure staff were competent and/or highlighted when further training or support was needed to ensure high standards of care were met.

We asked how the provider monitored the quality of the care they delivered. The manager said that the provider normally carried out staff, service users, family and healthcare professionals surveys on the quality of the service provision but because the home had been opened for less than a year this had not yet been carried out. The manager did say however, that an informal opening day had been held in April where family and friends had been invited to have a look around and talk to staff.

We saw that a monthly report was recorded which gave information on the general overview of each service user, monitored all incident reporting including safeguarding referrals and complaints. It was noted that there had been no complaints recorded.

This inspection took place on 10 July 2015 and 13 July 2015 and was unannounced. We previously inspected the service on 3 December 2013. The service was not in breach of health and social care regulations at that time.

54a is a home registered to provide care for a maximum of three people. The home specialises in providing care for people with learning disabilities or autistic spectrum disorders. The home aims to promote people towards independent living. The accommodation comprises of a one-bedroomed self contained annex and two further bedrooms in the house with a shared lounge, kitchen/dining area and bathroom. There is a garden to the rear of the property.

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

People told us they felt safe living at 54a and the family members we spoke with also said they felt their relatives were safe.

Staff were able to demonstrate they understood different types of abuse and what to do if they had any concerns that someone was being abused. However, some staff did not have up to date training regarding safeguarding adults.

Medication was not managed appropriately. Some medication was received and not recorded and other medication was administered and not recorded.

We found that safe recruitment procedures were followed and safe numbers of staff were employed at the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. We found that staff had a thorough understanding of these safeguards. Authorisation had been appropriately sought when people’s freedom or liberty was being restricted.

Staff at 54a were caring and attentive to people’s needs. We saw evidence of this in the way that staff and the people who lived at the home interacted with each other. Staff knew the people who used the service well.

People received personalised care and there was a variety of activities for people to participate in, taking into account people’s likes and dislikes. People were empowered to be as independent as possible.

There was a clear vision and ethos within the organisation as a whole, which included working ‘with, not for’ people. The staff we spoke with were aware of this and this was embedded into their day to day practise.

People’s views were not always appropriately sought and there were mixed views regarding whether the service was well led.

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