We inspected the service on 5 November 2018. The inspection was announced. Adrien O’ Brien is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to two people who experience learning disabilities or autistic spectrum disorder.

On the day of our inspection one person was living at the service.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People were given choices and their independence and participation within the local community encouraged.

At our last inspection on 26 February 2016 we rated the service ‘good.’

At this inspection we found the evidence continued to support the rating of ‘good’ overall but there had been a deterioration in ‘Safe’ which is now rated as ‘requires improvement’. 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.

The registered manager and staff they employed ensured the person received care and support when they needed it and the registered manager knew how to safeguard the person from situations in which they might experience abuse. However, full background checks had not always been completed before new staff were employed.

Risks associated with the person's needs including the environment, had been assessed and planned for and these were monitored for any changes.

Medicines were managed safely and the person received their medicines as prescribed.

Staff received the training and support they required to meet the person's individual needs.

The person had access to a varied diet and was supported to maintain their nutritional needs.

The registered manager worked well with external health care professionals, the person was supported with all of their health needs and continued to be enabled to access community health services when required.

The principles of the Mental Capacity Act (MCA) were followed and the person was supported to have maximum choice and control of their lives and the registered manager supported them in the least restrictive way possible.

The person's needs were assessed and planned for with the full involvement of the person and their relatives. The person continued to receive care from staff who were kind, compassionate and who treated them with dignity and respected their privacy. The person's independence was fully promoted.

The person received opportunities to pursue their interests and hobbies and there was a process in place to enable the person and their relatives to raise any concerns or complaints they may have.

There continued to be an open and transparent and person-centred culture at the service. People were encouraged to give their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

The inspection took place on 26 February 2016 and was announced.

Adrian O’Brien is registered to provide accommodation for personal care for up to 2 people living with a learnings disability. There was one person living at the service on the day of our inspection. The service is housed in a terraced house in a residential area.

There was 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 (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is to protect them. The provider understood their responsibility and no one at the time of our inspection had their freedom restricted under a DoLS authorisation.

The person was kept safe because the registered manager undertook appropriate risk assessments for all aspects of their care, including activities outside the service.

The person was cared for by a registered manager that had knowledge and skills to perform their roles and responsibilities and to meet the person’s specific care needs.

The person had their healthcare needs identified and were enabled to access healthcare professionals such as their dentist and speech and language therapist.

The person was enabled to make decisions about their care and treatment and the registered manager supported them to enhance their skills and improve their independence. The person was treated with dignity and respect in a caring and homely environment.

The person was treated as an individual, and were supported to follow their hobbies and interests. The person was actively involved in food shopping to provide a nutritious and balanced diet.

The registered manager had effective systems in place to monitor the quality of the service, including regular audits and feedback form the person who used the service.

This was a routine inspection to check that essential standards of quality and safety were being met. During our visit we talked with people who used the service and with staff, and reviewed information sent to us by other regulators.

A person who lived at the home said “I like living here. All of the staff look after me and help me when I need it.” There was one person living at the home at the time of the inspection, with one vacancy. The parents of one person who lived at the home said “I have nothing but praise for the home” and, “It has always been a good service there for XXX.”

One person’s needs were assessed and individual care plans were followed. We looked at the personal care or treatment records of people who used the service.

Menus were rotated on a three weekly basis, and offered a wide range of meals. Discussions took place between staff and one person who lived at the home to promote awareness of nutrition and hydration. We were told the person would shop for them self once or twice a week.

One person said, “I like the food, and I help in planning the menus and in the shopping and making some of the meals myself."

We saw from staffing rotas that the home was staffed at suitable levels by people with appropriate skills and experience. We saw that there was sufficient staff at the home to provide the care people needed.

At the time of our inspection there was one person living at the home. The person’s needs were assessed; care and treatment was planned and delivered in line with their individual care plan and in a way that ensured the person’s safety and welfare.

We looked at the menus and saw they offered a wide range of hot and cold meals. The manager explained maintaining nutrition was an essential part of the menu offering. Discussions took place between staff and the person who lived at the home to promote awareness of nutrition and hydration. We were told the person would shop for them self once or twice a week.

We asked the person about the food, he said, “It’s good. I like the food. I would tell them if I didn’t like it and we would have something else.”

The home was clean and tidy. The person who used the service was encouraged to participate in cleaning and tidying activities. They commented. “I clean my room myself; I like it clean and tidy.”

We found the building had been maintained effectively. The standard of decor was good. The manager showed us the book where maintenance issues were recorded; we confirmed planned maintenance had been carried out.

The person was given information on how to complain in easy read formats. The person told us, “Yes, I know how to complain but I just talk to XXX or XXX.”

We spoke with two people who used the service 122 Scorer Street. One person had lived there for a number of years and told us they had always been happy and enjoyed living there. They said they led a fairly independent life style and enjoyed going into the local town unaccompanied. The other person we spoke with had only lived at the service for a few weeks but said that it was the best place they had lived.

Both of the people spend time at a farm that is rented by the provider, where they take part in a variety of activities including growing vegetables and caring for some animals.

One person told us “I look after 21 chickens. It’s really good. I feed them and collect the eggs.”