We carried out an unannounced comprehensive inspection on 24 November 2018.

55 Langaton Lane provides care and accommodation for up to four people. On the day of our inspection there were four people living at the service. The home provides residential care for people with a learning disability.

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.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

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

At the last inspection on the 13 and 14 April 2016, the service was rated Good. However, it was rated Requires Improvement in Well led. The service has now improved to Good in Well Led. At this inspection we found the evidence continued to support the overall 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.

Why the service is rated Good:

People were not able to verbalise their views therefore they were not able to tell us verbally about their experience of living there. Therefore, we spent time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. This helped us gain a better understanding of people and the care they received at the service.

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the Disclosure and Barring Service (DBS) ensured they were suitable to work with vulnerable adults. Staff agreed that there were sufficient numbers of staff to meet people’s needs and help to keep them safe.

People had their risks assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely. People continued to receive their medicines in a way they preferred. Staff completed regular training and competency checks to ensure their knowledge and their skills in relation to medicines, were up to date and in line with best practice.

People were supported by staff who had received training to meet their needs effectively. Staff said meetings, one to one supervision of staff practice, and appraisals of performance were regular completed. Staff, new to care, completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the equality and diversity and the human right needs of people.

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.

People's h

This inspection was unannounced and took place on 13 and 14 April 2016. The inspection was carried out by one inspector.

The service provides accommodation and personal care for up to four adults with physical and/or learning disabilities. On the day of this inspection there were two people living there. The service was last inspected on 11 May and 2 June 2015. At that inspection we found the service was not well managed. At this inspection we found the management of the service had improved and the service was fully compliant, although we have recommended improvements are made to the provider's quality monitoring and improvements systems. There was a registered manager in post who also managed another two care homes on behalf of Regents Park Limited. 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 people living at 55 Langaton Lane had limited verbal communication skills and were unable to answer questions about the service. Therefore we relied on our observations of their interaction with the registered manager and a care worker during out visit. They were relaxed and smiling and appeared comfortable in all interactions with the registered manager and care worker.

The provider had introduced new quality monitoring systems since the last inspection to ensure the home ran smoothly and to identify where improvements were needed. We saw many examples of improvements to the service, such as care plans, and staff training. However, the monitoring systems were not fully embedded and needed further adjustment to ensure the provider is pro-active in identifying and addressing all issues promptly. We found some areas where further improvements were needed, for example, assessment of dependency levels to determine safe staffing levels.

Recent staff rotas indicated there had been at least two occasions recently when only one member of staff had been on duty during waking hours. The provider did not have procedures in place to measure the dependency levels of the people living in the home. This meant they were unable to identify the safe level of staffing needed to ensure the two people’s support needs were met safely. We have been given firm assurances there will always be sufficient staff on duty in the future.

New staff were recruited by the provider through their head office for the three care homes and one day centre they operated. Checks and references had been carried out before new staff began working with people. The registered manager interviewed and appointed staff. We were given verbal reassurance that a risk assessment procedure was followed where recruitment checks identified issues that may indicate the applicant was unsuitable. However, this had not been recorded.

Medicines were stored and administered safely.

The registered manager and staff showed caring and understanding of each person’s individual needs. They had an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted where relevant. Staff understood the importance of seeking consent before carrying out care tasks. We observed a member of staff seeking consent from people before carrying out any tasks for people.

People had been involved and consulted in drawing up and agreeing a plan of their support needs. Their care plans were comprehensive, well laid out and easy to read. The care plans explained each person’s daily routines and how they wanted staff to support them. The plans were regularly reviewed and updated. The care plans and daily notes provided evidence to show that people were supported to maintain good health.

Staff had received training, supervision and support to enabl

55 Langaton Lane is a small residential home which provides care and support for three younger people with a learning disability. We talked with all the people who lived at the home, four staff working in the home, the manager and the provider as well as a visitor to the home. We looked at the care records of all the people living in the home and the records of three staff.

There were three people living in the home at the time of our inspection. People appeared comfortable whether in the kitchen/diner, in the garden or in their rooms. We saw that staff had a good knowledge of peoples’ needs. Staff were heard to address people by their preferred names and were polite and respectful at all times. They checked that people were happy to do things before supporting them.

We saw that people were safe in the home and their care and welfare was managed in accordance with their care plans. Staff were knowledgeable about the needs of people and the abilities they had. They were appropriately skilled and received regular support and development. Peoples’ safety was assessed and supported in accordance with risk assessments and the provider’s safeguarding vulnerable adults policy.

There were improved systems in place to routinely monitor the quality of service provided and the environment it was provided from.

We (The Care Quality Commission) carried out an unannounced inspection on 10 August

2012. The purpose of this visit was to review compliance actions issued at the last

inspection of the service on 5 August 2011. We also reviewed information we have

received about the service since the last inspection.

At the time of this inspection there were three people with learning disabilities living in the home. They had limited or no verbal communication skills and therefore we were unable to ask them about their daily lives. We observed their interactions with the two care workers who were on duty and we saw each person was smiling and relaxed. We saw evidence to show that the care workers who were present during the inspection understood each person's non-verbal communication methods, and responded appropriately to each person's requests.

The three people had received appropriate support with their personal care needs. We

saw, and heard about, the things people enjoyed doing every week. We found they

enjoyed range of activities according to their interests and preferences. One young adult regularly attended school and another person attended a day centre. We also heard about recent outings and leisure activities including swimming and walking. There was also evidence of these activities in their care plans, including photographs.

We sat with people during their evening meal. The care workers offered them choices of food and drinks. Each person was able to eat their meals independently, with the use of special cutlery or plates where necessary.

The guidance for care workers on the use of a restraint procedure did not contain sufficient detail, had not been fully reviewed, and there was no plan in place to show that the home was working towards a reduction of the use of the restraint. This means that there were insufficient systems in place to ensure people were protected from the risk of unnecessary or excessive restraint.

The care workers told us they enjoyed their jobs and felt well supported. They told us there were good communication systems in the home, and good teamwork. We talked to them about the training they had received since they began their employment with Regents Park Ltd. We also looked at the records held by the provider of training the care workers had received. We found that some care workers had not received essential training on topics relating to health and safety or the care needs of the people living in the home. This meant that the provider was unable to demonstrate that care workers had the skills or knowledge to meet people's needs fully, or to keep themselves or people living in the home safe.

After our inspection we received information from care managers who had visited the

service recently. They told us that whenever they had visited they found the staff very

welcoming, and the home was inviting, staff liked to be asked questions. They had found the people living there looked well and engaged well with care workers. The home had generally followed all recommendations made by care managers.

Systems for monitoring the quality of the services provided to people were not fully

effective.

We carried out this review on 5 August 2011 following a safeguarding strategy meeting that had met to look at concerns regarding the care of a person who lives at 55 Langaton Lane. The meeting concluded that there were practice issues that should be addressed by the management team of Regents Park Ltd, and they asked the matters should be followed up by the Care Quality Commission. Therefore the purpose of this review was to look at the concerns that had been raised and ensure they had been addressed.

There were two people present during our visit. Both had no verbal communication skills. We observed the care provided to one person during our visit. The second person spent much of the day in bed apart from a brief period at lunchtime and therefore we were unable to observe their care. Instead we looked at the records held in the home relating to their care needs, and we also talked to two care workers and the manager of the service.

We saw care workers communicating with one person. Despite the lack of verbal communication the care workers talked to the person to offer choices, and they were able to understand the person’s responses. The relationship between the care workers and the person was cheerful, relaxed and friendly. The care workers treated the person in a respectful manner. The person responded to the care workers positively.

There were two care workers present at the time of our visit plus the manager for two people who were present. We heard that when necessary additional staff have been provided to ensure people have adequate support.

The inspection took place on 11 May 2015 and was unannounced. We also visited the provider’s main office on 2 June 2015 to look at records held there.

55 Langaton Lane is registered to provide accommodation with personal care for up to three people who have learning disabilities and physical disabilities. At the time of this inspection there were three people living in the home with complex care and communication needs. None of the people were able to engage in conversations and they had little or no verbal communication.

There was a registered manager in post who also managed two other care homes in the Exeter area. 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 registered manager was not aware of the requirement to notify the Care Quality Commission of any incidents or accidents that occurred. For example, during this inspection we heard that a person had suffered a broken ankle when using the garden swing which we had not been notified of. This meant there was a risk serious accidents or incidents may not be adequately investigated by external agencies and professionals who have a legal responsibility to ensure people’s safety and well-being.

Where people were subject to restrictions, Deprivation of Liberty Safeguards (DOLS) applications had recently been submitted. The provider and registered manager had recently been made aware of changes in legislation by members of the local authority safeguarding team. This meant the provider and registered manager had not kept up-to-date with changes in legislation or good practice guidance.

People were able to make choices about their main meals and drinks. Individual preferences of food and drinks had not been assessed or recorded in care plans. People were supported to choose the main meals they wanted using pictures to help them plan weekly menus. Meals were varied and suited individual dietary needs. There was a good supply of fresh fruit readily available .

People were safe. There were sufficient staff to meet each person’s needs. As we were unable to communicate verbally with people we relied on our observations of care and our conversations with staff and other professionals to understand their experiences. People were smiling and relaxed and responded positively when staff offered support. Staff knew each person well and understood the non-verbal ways in which they communicated, for example by pointing at objects or pictures. We saw staff offering people choices and checking their responses before providing care or support.

People led active lives. Two people attended a day centre every weekday that was operated by the provider. One person had chosen not to attend the day centre and instead chose activities at home or in the local community that they enjoyed. People were able to go out in the evenings or weekends, or stay at home and do activities of their choice.

We looked at staff recruitment, supervision and training records held at the provider’s head office. These showed staff had been carefully recruited by obtaining references and carrying out checks on their suitability before they were offered employment. Staff received relevant training which meant staff had the skills or knowledge to help them support people effectively Staff received regular supervision and support. Staff meetings were held regularly. Staff said they worked well together as a team.

Medicines were stored and administered safely. Staff had received adequate training on safe administration of medicines.

Staff knew how to protect people from the risk of abuse. They had received training on safeguarding adults and knew who to contact if they suspected abuse may have occurred. Systems were in place to ensure people’s cash or savings were managed safely. This meant people were protected from financial abuse.

People were supported to maintain good health. Risks to people’s health and welfare had been assessed and reviewed regularly. Staff were given guidance and training on how to recognise and reduce risks.

The property was a bungalow with level access to all areas. All rooms were well maintained, comfortable and homely. Bedrooms had been personalised to suit individual tastes and interests. At the time of this inspection building work was in progress to convert the roof space to create further bedroom and living areas.

Support plans provided clear and up to date information about all areas of each person’s health and personal care needs. The plans had been drawn up to include photographs to enable people to be as involved as far as possible in planning their support needs.

There were systems in place to monitor the daily routines in the home. Daily reports on all aspects of the support given to each person were completed by staff. The reports were returned to the provider’s head office each month to be checked by the provider and registered manager. However, the registered manager did not regularly work in the home and there was a risk some poor practice or ineffective routines were not picked up or addressed, for example systems for booking and recording medical appointments.

We found 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