This inspection took place on 27 April 2017 and was unannounced. At the last inspection of the service in March 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People using the service were not able to leave without support from staff. The provider did not always obtain authorisation before some people were deprived of their liberty as they had not applied to the local authority under the Deprivation of Liberty Safeguards (DoLS). At this inspection we found that the registered manager had applied to the local authority for DoLS authorisations, where they required these to keep people safe in the service.

89 Hampton Road East is a care home providing accommodation and personal care for up to seven men and women with a learning disability. At the time of this inspection, six people were using the service.

The service had a registered manager who also managed a second location for the provider, situated next to 89 Hampton Road East. 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 provider had systems in place to protect people. Staff were trained and understood and followed the provider’s procedures.

There were enough staff on duty to meet people’s care and support needs and the provider carried out checks on new staff to make sure they were suitable to work in the service.

The provider carried out checks on the environment and equipment used in the service to make sure people were safe.

The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were not deprived of their liberty unlawfully.

Staff had the training and support they needed to care for people using the service.

People’s nutritional and health care needs were met in the service, staff worked well with other agencies and professionals and people received their medicines safely.

The atmosphere in the service was relaxed and support staff interacted positively with people using the service.

Staff, including the registered manager, had a good understanding of each person’s care and support needs, daily routines, preferences and behaviours.

People’s relatives told us they were involved in planning the care and support their family members received.

Support staff reviewed each care plan area monthly and there was evidence that people had been involved in discussions about their care, support and any risks that were involved in helping them live their lives.

The service had a registered manager who was appointed in September 2015 and registered by the Care Quality Commission in March 2016.

The registered manager was able to tell us about each of the people who lived at the service including their support needs, significant people and events in their lives and their preferences and daily routines.

The registered manager engaged fully with our inspection and we saw they had positive relationships with people using the service and staff.

The provider had systems in place to monitor quality in the service and make improvements.

This inspection took place on 1 and 4 March 2016. The visit on 1 March was unannounced and we arranged with the manager to return on 4 March to complete the inspection. The last inspection of the service was in June 2014 when we judged it was meeting all of the standards we inspected.

89 Hampton Road East is a care home providing accommodation and personal care for up to eight people with a learning disability. When we carried out this inspection, six men were using the service. All had a learning disability and complex needs. The service had a registered manager who was appointed by the provider in September 2015 and registered by the Care Quality Commission in March 2016. 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.

People using the service were not able to leave without support from staff. The provider did not always obtain authorisation before some people were deprived of their liberty as they had not applied to the local authority under the Deprivation of Liberty Safeguards (DoLS).

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

The provider carried out checks on new staff before they worked with people using the service. This included taking up references, checking the person’s identity and obtaining a Disclosure and Barring Service criminal record check.

People received the medicines they needed safely. The provider had systems in place to manage people’s medicines and staff had the training they needed to support people with their medicines.

Support staff had the training, skills and knowledge they needed to work with people using the service. Staff understood people’s care needs and how they communicated these.

People had access to the health care services they needed because the provider assessed and recorded their health care needs. Staff knew people using the service well and took action when their care or support needs changed.

Staff treated people with kindness and patience. They gave people the care and support they needed promptly and efficiently and people did not have to wait for staff to help them. Staff worked well together as a team to make sure people did not wait for care and support.

Staff offered people choices about aspects of their daily lives. For example, people were offered choices about the clothes they wore, the food they ate and the activities in which they took part.

The provider’s care planning systems were centred on the person. The registered manager and support staff assessed and recorded people’s individual care and support needs and based people’s support plans on these assessments.

People using the service and others had the information they needed to make a complaint about the care and support they received. There was an appropriate complaints procedure and the provider produced this in an accessible format.

The provider, registered manager and support staff carried out a range of checks and audits to monitor quality and safety in the service. Where audits identified the need for improvements, the provider took action.

The provider had systems in place to gather the views of people using the service and others. The registered manager said they would arrange with the provider to send out feedback surveys for relatives and people using the service to make sure they had up to date opinions and people’s experiences.

We spoke with a member of staff, the registered manager and received comments from three relatives via email after the inspection. We were unable to speak with the people using the service who were available during the visit as they had complex needs. At the time of the inspection there were five people using the service.

The inspection was carried out by an inspector during one day. This helped answer our five questions;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Support plans had details of people's needs and how these were to be met. These plans were regularly reviewed by staff. Risk assessment related to the support being provided and were regularly reviewed to ensure people's individual needs were being met safely.

The medicines prescribed to people using the service were stored in a secure appropriate manner. We saw that the Medicines Administration Records (MAR) charts for some of the people using the service were correct and information was clearly recorded. The use of some emollient cream was not recorded accurately but the manager made changes to the handover process within 24 hours of the inspection to resolve the issue.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that the service had clear processes in place if they required to access the Deprivation of Liberty Safeguards that managers and staff could follow.

Is the service effective?

The families of people using the service told us they had been involved in reviewing their relative’s care plans. However, this involvement had not been recorded to confirm this.

People received support from staff who were trained and supported by the manager. We saw that staff completed a range of mandatory courses identified by the provider each year that they deemed essential to meet the support needs of an individual.

Is the service caring?

We saw that people were supported by kind, attentive staff who treated them with respect and dignity. People were supported and encouraged to be actively involved in their daily care and activities.

Is the service responsive?

During our previous inspection in March 2014 we saw that an appropriate needs assessment had not been completed before a person moved into the home. During this inspection the manager confirmed that the assessment process had been reviewed. Additional information was obtained and senior staff were involved when considering the dynamics of the home in relation to people already using the service and if a new person would fit in. The reviewed assessment process also looked at whether the home, local authority and health services could provide appropriate support for the person should they move into the home.

Is the service well led?

The service had a quality assurance system in place. Records showed that any issues identified in relation to the quality of the care provided were addressed. As a result the quality of the service was continually monitored to make sure improvements took place.

Regular audits of the care plans and risk assessments were carried out and any identified actions had a completion date. This enabled staff to identify if the care provided met the needs of each individual using the service.

The manager told that the provider sent out a questionnaire for the people using the service and their relatives every year. They explained that if a person needed support to complete the questionnaire their keyworker or relative could assist them.

We carried out this inspection after we received information of concern that the home had admitted a new person without carrying out a full needs’ assessment. This had resulted in staff failing to meet the person’s needs and placing staff and other people who use the service at risk.

We reviewed information sent to us by the provider. We also spoke with other stakeholders prior to our visit who informed us that the provider was not working in collaboration with other service providers to plan for admissions. The home had an arrangement with the local community disability team that all admissions would be managed jointly. On this instance the home had not followed this arrangement.

During our inspection we spoke with the home manager who acknowledged the concerns that were being raised. The manager understood the importance of the current admissions arrangement and we were told that this arrangement would be followed in all future admissions.

We spoke with one person who used the service, two members of staff and the operations manager during our visit. Many people were out during our visit at local day centres or participating in activities within the community. Other people who were at the home during our visit were not able to communicate with us due to their complex needs. We observed how people were cared for and spoke with staff and senior management so we could understand their experiences of care.

We found at a previous inspection on the 12 February 2013 that the provider was failing to effectively plan and deliver care in accordance with people's assessed needs. We asked the provider to send us a plan detailing how improvements would be made.

We carried out this recent visit to check that improvements had been made but also because we had concerns raised about the service by members of the public due to an incident which had occurred in the community. We also needed to establish the staffing arrangements as the Registered Manager had left the service. The service at present does not have a Registered manager.

People we spoke with talked positively about the service, they told us about their involvement with planning their care such as deciding what activities they wanted to participate in. We also found people were well integrated into their local community and received support to be as independent as possible.

We found care planning and risk assessment had improved, the service had used its in-house behavioural support team to assist in the writing of guidelines for people's care so staff working with people could understand their needs and manage complex behaviours effectively.

People who used the service were protected from the risks of abuse because staff had been trained in identifying abuse and knew what steps and procedures to follow should they have concerns. People who used the service told us they felt safe but they did not know how to report any concerns if they felt they or anyone else may have been abused.

The service had a quality and monitoring system which ensured people received safe and effective care. The service carried out a range of audits to look at care planning, medication and the environment. However we did find that there were some minor improvements needed with regard to the physical environment that we have brought the attention of the management.

We received information of concern that lead to an unannounced inspection being carried out. We were unable to speak to people using the service during our visit due to their complex needs, we therefore spoke with staff and looked at there care records and the providers records to establish people's experience of the service.

We found where people had complex needs and behaviours that challenged the service people's care was not always planned effectively to ensure there health and well-being.

During our visit to 89 Hampton Road East we were unable to talk to the people who use the service due to their limited verbal skills. However, we contacted some relatives of people who use the service and some health and social care professionals to give us their feedback about the service. We also observed what people did and different interactions during our visit.

People were treated with respect and we observed a good rapport between the staff and people who use the service.

The staff received training for supporting people, though some staff felt this needed to imporve to increase their confidence. Some also felt improvments could have been made in this area.

We did not speak to people who use the service when we visited the home on this occasion. Our visit formed part of a review which was carried out in response to concerns raised by professionals who have an involvement with the home, anonymous concerns received by CQC and a high volume of incidents reported by the service, including referrals to the local authority safeguarding team.