At the last inspection in March 2016, we reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the specialist training and appraisals for staff, monitoring of weight and hydration of people who used the service and quality assurance systems.

We carried out an unannounced inspection of 7-9 Third Avenue on the 6 and 7 June 2017, to see if the provider had made the necessary improvements to the service. Records showed that improvements which were in progress at the last inspection had been completed. The service was given a rating of ‘Good’.

7-9 Third Avenue is a small residential home providing intensive support for people who have learning and physical disabilities. The property is a six bedroomed bungalow and there were six people living at the service at the time of the inspection.

There is a registered manager at this location. 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.

Staff knew how to protect people against the risk of harm and abuse. Risks to people’s health and wellbeing were assessed in order to minimise them and ensure people maintained their independence. People were given their medicines in a safe and timely way.

Staffing levels in the service were appropriate to meet people's needs. Staff members did not start to work at the service until satisfactory employment checks had been completed

A programme of induction, training, supervision and appraisals for staff were in place and they had the knowledge and skills to care for people effectively. Specialist training was now being provided to staff.

Systems were in place to ensure that people’s rights were respected and protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People had as much choice and control in their lives as possible and were supported in the least restrictive way.

People enjoyed their meals and the food and drinks provided. They were involved in choosing what to eat and drink and going shopping for the household groceries. Their health needs such as their weight and fluid input were now recorded. Health and social care professionals provided specialist input for people and referrals for support were made in a timely way.

People used a range of ways to communicate and express themselves. Staff were aware of their verbal and non-verbal communication, sounds, signs and facial expressions to understand their feelings. People were relaxed and cared for by kind and friendly staff.

Feedback was obtained from people who used the service, their families, representatives and staff about the quality of the service and this was used to improve the service. People knew how to make a complaint and we saw that complaints had been dealt with appropriately.

Systems to monitor the quality of the service had been improved by implementing regular audits and better recording of information so that people received care and support of good quality.

This inspection took place on the 21and 22 March 2016 and was unannounced, which meant that the provider did not know that we were coming. The inspection was carried out by one inspector.

7-9 Third Avenue, is a small care provider providing intensive support for people who have a learning disability. The property is a six bedrooms bungalow and there are six people living at the service. All rooms have level access to the outside garden area.

There is a registered manager at this location. 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 that, people were supported to make choices about the support and care they received and staff were kind and respectful. People had access to healthcare professionals, including the GP, optician and chiropodist.

We found that staff had not always completed a thorough induction and had not received the training they needed to understand how to meet people’s needs. Staff told us that they were supported by their registered manager and received supervision. We found that staff did not consistently receive an appraisal of their work and did not understand the vision and values of the provider.

Medication was managed safely and staff members understood their responsibilities. Since returning to manage the service the registered manager had recently reintroduced medication audits.

People were regularly asked by staff if they were happy and how they wanted to be supported. People had their needs and requests responded to promptly, and were asked to give their consent before care was carried out. We found that consent was not always recorded within the care records.

Staff members understood the principles of the Mental Capacity Act 2005 (MCA) and were able to describe their responsibilities to seek the consent of the people they supported. When people were thought to lack mental capacity the provider had taken the appropriate action to make sure their care did not restrict their movement and rights under the MCA. Decisions about the care people received were made by the people who had the legal right to do so.

We saw that people had developed caring relationships with the staff that supported them. Family members told us that people were encouraged to take part in a range of activities if they wanted to, and we found that people’s independence was promoted. We found people had enough to eat and drink to meet their needs. Some people required specialist diets and staff told us they would benefit from additional training to support people to eat safely.

The arrangements to cover the absence of the registered manager did not provide consistent leadership and direction for staff. The service has had several registered managers and there has been an inconsistent approach to management.

Surveys to get views about the service was not always obtained from people, staff, visitors and families, so this information could not be used to help drive continuous improvements. Staff told us that if they had a concern they could raise this on an informal basis and the manager would listen to them. We noted that a new quality assurance system had been introduced to identify areas for improvement, feedback had not yet been obtained from people, staff, visitors or families. Staff members were unclear about what the vision or values of the service was.

We found that there were some breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we have told the provider to take at the back of the full version of the report. The overall rating for this provider is ‘Requires Improvement’.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. At the time of our visit six people were using the service. We talked with a relative of a person using the service, who also gave positive feedback.

We spoke with six staff. We reviewed three people’s care planning files and three staff personnel files. We found systems in place for effective staff recruitment.

There were procedures for staff to follow for infection control and to keep people safe. The provider had systems in place for gaining the consent of people or others involved in their care before carrying out tasks.

We observed positive, caring interactions from staff during our visit and saw that staff were responsive to people’s needs. There were processes in place for people or others to make complaints or give feedback on the service and for a response. We found that an interim manager was in place and recruitment for a new manager was in progress.

People using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible.

People’s diversity, values and human rights were respected. We looked at a sample of support plans and they contained good information about the individual’s needs, wishes and choices. They included information on the person’s cultural and spiritual needs where known. People appeared relaxed and happy in staff’s company. We observed staff treating people in a respectful and dignified way.

We looked at the system used for safeguarding vulnerable adults. There was a policy and a procedure in place and all of the staff had received training. Staff spoken with had a good knowledge of the signs of abuse and clearly described the reporting procedures.

The records showed that staff had received regular supervision and training. Staff told us that they felt well supported to do their work. The provider had carried out regular monthly monitoring visits and had prepared a report of their findings. Actions had been carried out as required in the report. The manager had completed regular audits of the home’s systems and practices.

The manager was not able to tell us when the last quality assurance survey had been carried out. They told us that none had taken place since they took up their post in October 2010.

The people that live at 7/9 Third Avenue had limited communication skills. At times they expressed their views by using facial expressions, body language and gestures.

Where people did respond it was in a happy and positive way, however, they did not respond to many of the questions that we asked about many of the outcome areas.