About the service:

92 North Street provides accommodation to people who have learning disabilities and complex health needs. The care home is a purpose built building and is registered to provide care for up to 12 people. At the time of our inspection visit there were 11 people living at the home. This is larger than current best practice guidance, because the service was developed and designed prior to Registering the Right Support. However, the service applies the principles of the guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

• Improvements had been made since our previous inspection to the way the quality of the service was managed and processes had improved to ensure people were supported in accordance with the Mental Capacity Act 2005 (MCA).

• People felt safe using the service.

• Staff recognised the risks to people’s health, safety and well-being and understood how to identify and report abuse.

• People had access to support from staff when needed.

• Staff recruitment processes included a check of their background to review their suitability to work at the service.

• People received support with the medicines. Regular checks were undertaken to ensure people received the correct medicines by staff who were competent to support them.

• Staff understood and practised infection control techniques and had access to protective equipment to promote this.

•The registered manager ensured people’s care was based on best practice and staff had training to meet people’s needs.

• Staff training was reviewed and guidance on people’s needs was also shared through supervision meetings and group staff meetings.

• People were supported to have enough to eat and drink to maintain their well-being.

• People were supported to obtain advice from healthcare professionals, which was incorporated into people’s care.

• People had 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.

• Staff understood the importance of supporting people with empathy and compassion and provided reassurance when people became anxious.

• People were treated with dignity and their independence was promoted wherever possible.

• People and those important to them, were involved in planning their care with support.

• Staff supported people with activities that reflected their interests.

• People and their families understood how to complain if they wanted to.

• There had been staffing changes since our last inspection, including new senior management. Staff were positive about the changes and improvements to the service.

• The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

We found the service met the characteristics of a 'Good' rating in all areas; More information is available in the full report.

Rating at last inspection:

Requires Improvement with breaches of the Health and Social Care 2008 (HCSA 2008) Regulations 9 and 11 (report published 24 October 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The inspection was to monitor improvements to the service the provider had promised to make to address breaches of regulations 9 and 11 HSCA 2008 (Regulated Activities) Regulations 2014.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details

This inspection took place on 24 and 31 October 2017 and was unannounced. At the last inspection, we rated the service as good overall and asked the provider to make improvements to the systems used to monitor the quality and safety of the service. At this inspection, we found some improvements had been made but further action was still needed. We also found new concerns with the availability of staffing, the safe management of behaviour that challenged and supporting people who lack the capacity to make certain decisions.

92 North Street provides accommodation and or personal care for up to 12 people. People living at the home have a learning disability and receive varying levels of staff support dependent on their assessed needs. On the day of our inspection 12 people were living at the home.

There was a registered manager at the home. 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. On the first day of our inspection, the registered manager was absent from the service and we were assisted by the deputy manager. The registered manager was at the service on the second day of our inspection. We have referred to the deputy manager and registered manager in the body of the report.

We found some improvements had been made to the provider’s quality assurance systems. However further action was needed to ensure the systems were consistently effective in identifying shortfalls and making improvements where needed. There were sufficient staff to keep people safe but staffing shortages meant people were not always supported to engage in activities that met their assessed needs and personal preferences.

Risks to people’s safety and wellbeing were not consistently managed; improvements were needed to ensure staff were suitably trained and supported when people presented with behaviour that challenged themselves and that of others. People were kept safe from the risk of abuse because the provider followed recruitment procedures and staff understood their responsibilities to identify and report any concerns. People received their medicines when they needed them.

Staff obtained people’s consent before providing care but improvements were needed to ensure the provider followed the legal requirements and people’s rights were protected when they lacked the capacity to make certain decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, the provider had not always applied for the appropriate approval.

Staff had caring relationships with people, respected their privacy and dignity and supported them to be as independent as possible. Staff knew people well and provided personalised care. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People were supported to review their care to ensure it continued to meet their needs. People were involved in choosing and planning their meals and supported and encouraged to eat and drink sufficient amounts to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

There was an open, inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported by the management team and were encouraged to give their views on the service to improve people’s experience of care.

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.

We carried out an unannounced inspected at this service on 21 December 2015. At the last inspection on 5 March 2014, the provider was meeting the legal requirements.

92 North Street is registered to provide accommodation and personal care for up to 12 people, most of whom had a learning disability. On the day of our inspection, the home was full.

There was a registered manager at the service. 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. On the day of our inspection, the registered manager was not at the home but we were assisted by the deputy manager, who had recently started working at the home.

Improvements were needed to ensure people’s support needs were consistently identified and plans put in place to manage any identified risks. People were involved in planning their meals and the provider had recognised that improvements were needed to ensure they were supported to make choices that promoted healthy eating. People were supported to have enough to eat and drink and staff followed advice to support people with their specific dietary needs.

The provider did not have systems in place to monitor the quality and safety of all areas of the service to ensure shortfalls were identified and improvements made. People and their relatives were asked for their views on the service, but the provider could not show how their feedback was being used to make improvements where required.

There were enough staff on duty to meet people’s needs. The provider ensured the staff were suitable to work with people and staff recognised their responsibilities to keep people safe from harm. Staff received the training they needed to meet people’s needs and an induction programme was in place to support new staff to understand their role. People received their medicines safely.

The manager and staff sought people’s consent and supported people to make decisions that were in their best interest. People told us they were able to make choices about their support. People told us staff treated them with kindness and understanding and we observed positive, caring relationships between people and the staff. Staff supported people to maintain their independence and promoted their privacy and dignity.

People were able to follow their interests and had opportunities to take part in social activities both inside and outside of the home. The complaints process was accessible to everyone and people and their relatives felt able to raise concerns.

When we completed our last inspection in June 2013 the provider was not compliant with all the regulations. We identified concerns about poor infection control practices. We also had concerns about the arrangements for storing a medicine that needed to be stored in a refrigerator. The provider sent us an action plan telling us the actions they would take to improve the service. We carried out this inspection to check on the progress the service had made to address the concerns we raised at our last inspection visit.

During our visit we observed how people were being cared for, spoke with seven of the eleven people who used the service and talked with staff who worked at the home. Some people had limited communication due to their varied levels of learning disability. We saw that staff knew how best to communicate with people living at the home. This involved the use of gestures, signs or pictures. We saw that staff treated people kindly and respectfully. People told us that they were happy living at the home.

We saw that improvements had been made following our last visit to the service. A specialist bath was being fitted. This meant that everyone living at the home could choose whether they had a bath or shower.

We looked at the care records for two people and saw that both people had appropriate care plans in place. We talked with staff who demonstrated they were aware of people's care and support needs.

We observed poor infection control practice when two care workers carried dirty linen and clothing in their hands through one of the lounges.

We saw that the arrangements for storing a medicine that needed to be stored in a refrigerator did not ensure that it was stored within the required temperature range.

We saw that the decor and furnishings at the home respected the age group of the people that lived there. This meant that people had a homely, living environment that they felt comfortable to live in.

Before our visit we received anonymous concerns which told us that people that lived in the home had no daily activities and were unhappy. They raised concerns about the ability of the manager to run the home, poor staffing levels and told us that staff were unhappy. We asked the provider to investigate these matters. The provider shared the outcome of their investigation with us. We saw that they had carried out a thorough investigation. They found that there was no evidence to substantiate the concerns. We looked at these areas as part of our visit. We could find no evidence to confirm the complainant's concerns.

We were not able to speak indepth with all the people who used the service because of their complex needs which meant they were not able to tell us their experiences. We saw that staff treated people kindly and respectfully. Two people we spoke with told us that they liked living in the home. One person told us “’X’ (care staff) is always there for me”.

We looked at the care planning documentation for two of the people who lived in the home to see how their care was provided and managed. We talked with staff who demonstrated they were aware of people's care and support needs.

We saw that people’s bedrooms and communal areas were decorated and presented in a way that promoted their individuality and age group. One person who helped to show us round the home told us “It’s my bedroom, I love it. They (staff) let me choice my things. I like red”.

We undertook a review of the service to establish that people's needs were being safely met.

We spoke with five people that lived at the service and observed some people who could not tell us about the service. Everyone we spoke to said they were happy living at the service. Comments included, "I like living here" and " I go to the cinema, bowling and shopping, the staff help me wash my hair".

Everyone had a plan of care that was specific to them and covered their individual needs. Plans covered people's health and personal care needs as well as showing the things they liked to do.

People had their health care needs met. They went to the doctor, dentist and the optician as well as having support from health care specialists. People were dressed appropriately and they went to the hairdresser.

People were encouraged to do as much for themselves as possible. We saw people baking, emptying the dishwasher and making drinks.

People's social and educational choices were encouraged. People said they went out shopping, to discos, to the theatre and to the cinema. Some people went to college.

Systems were in place to review and monitor people's care. People's care was reviewed every month. Weekly meetings were held to get the views of the people that lived there. The provider also undertook a number of audits to check on the care people received.