We carried out this unannounced inspection on the 22 October 2018.

81 Agnes House is a ‘care home’. 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. 81 Agnes House provides care and support for a maximum of two people. There was one person living at the home at the time of the inspection.

We checked to see if 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. We found that people living at 81 Agnes House were able to live in a homely environment that had been created to meet their needs.

At our previous inspection on 12 and 13 August 2015 we rated the service as ‘good’ in four of the five questions we ask and was rated good overall. At that inspection we identified that staff needed to have training on Mental Capacity Act, 2005 (MCA) and DoLs. At this inspection we found that although the service was rated ‘good’ in four of the five questions we found improvements were needed to the well led question. As a result of our findings we found that the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We rated the provider as requires improvement overall. You can see what further action we have taken at the end of this report.

There was a registered manager in post at the time of our inspection, but was away from work at the time of our inspection. 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.

There were systems in place to monitor the quality and safety of the service provided. However, these systems needed improvement as they had either not identified issues we found at our inspection or the registered manager and provider had not acted promptly on their own findings.

Staff sought consent from people before caring for them. Staff had some understanding of the principles of the Mental Capacity Act, 2005 (MCA). Where people were deprived of their liberty, processes had been followed and applications applied for.

People were supported to have enough to eat and drink and to manage their health care needs to maintain their wellbeing. People were supported to enjoy a range of activities. People were encouraged to maintain their independence and live active and fulfilling lives. People could maintain relationships that were important to them.

Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them. It was evident that people had developed positive relationships with staff and there was a friendly and calm atmosphere within the home.

Staff knew people’s needs and how to manage risk and report concerns to keep them safe. People received their medicines as prescribed. Staff had received some training which enabled them to meet the person’s needs.

The staff knew the person well and were aware of the signs to look out for which may indicate the person was unhappy.

We visited Agnes House 81 and carried out an inspection there. On the day of our inspection, the registered manager told us that one person lived there. We spoke with the registered manager and care staff on duty. We were unable to speak with the person that lived there so we observed their interactions with staff and their body language to understand their view of the support they received. We later spoke with a local authority representative of the person who lived there. We looked at their recorded information to gain a balanced overview of the quality of the care and support that they experienced. We considered all of the evidence that we had gathered under the outcomes that we inspected. We used all the information to answer the five questions that we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We observed that people were treated with dignity and respect by the care staff. We saw that the person who lived there was given choice about their care and how they spent their day. We saw that they moved freely around the home without interruption or restriction.

The local authority representative for the person that lived here, that we spoke with told us that they were very happy with the care and support the person received. They told us, “They (the individual) are safe and well cared for by very committed staff. Their safety, health and wellbeing is promoted and protected. They are settled and happy.”

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receive their care and were able to make informed decisions. The registered manager told us and records showed that all staff had received DoLS and Mental Capacity Act 2005 training. This ensured that staff understood their responsibilities and the provider had taken the appropriate action to ensure that the rights of people were protected.

The registered manager told us and we saw records which showed that applications had been made to the local authority for them to consider. The local authority determined that no one who lived here was deprived of their liberties. The provider had policies and procedures in place to protect people from harm. People who lived here had complex support needs, with some difficult to manage behaviour. All staff spoken with understood what safeguarding people meant. Staff all had up to date training on how to protect vulnerable adults and how to support a person when they displayed behaviours that may harm themselves or others. This meant that the safety of people who lived there and of others was promoted and protected.

We saw that the person that lived there had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to them in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

We saw that systems were in place to make sure that learning takes place from accidents, incidents, complaints and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

The representative that we spoke with confirmed that they could visit throughout the day. We saw that facilities were available so that people could meet in private if they wanted to.

Records sampled showed that the person who lived here had been involved in an assessment of their needs and staff had used a variety of means to establish what support people needed for example using pictorial methods. This meant that the individual had been able to influence the care they received and their individuality had been respected.

We saw that representatives and where appropriate, relatives were involved with people’s care. One representative told us, “They always ensure that my client’s health care needs are well met, they involve other health professionals and inform me what is happening.”

All staff spoken with were able to give us good detail about the support they provided. People’s health and care needs were assessed and care plans told staff what people’s care needs were so they could support people consistently. Referrals had been made to external professionals so that the person they supported got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.

Records sampled showed that the person who lived here was encouraged to eat a healthy and nutritious diet. We saw that they had a choice of what to eat and enjoyed the food provided. Their weight was recorded regularly. This is important as a significant loss or gain of weight could be an indicator of an underlying health need. This meant that they were supported to eat and drink sufficient amounts to meet their needs and ensure their wellbeing.

Is the service caring?

We saw that staff treated the person who lived here with dignity and respect. We saw that were patient and caring they took their time and did not rush them. Staff were seen to be attentive and supportive and interacted well with them. We saw that the person responded positively to staff.

We saw that the preferences, interest and aspirations and diverse needs of the person that lived here had been recorded in their care records.

Is the service responsive?

We saw that the person was supported and encouraged to take part in a range of activities at home and in the local community. We saw that staff responded to spontaneous requests from them to do activities, or to spend their time in a way that they preferred. We saw that when needed staff had requested the involvement of other health professionals in their care.

Is the service well lead?

The home had a manager who was registered with us, CQC. They were experienced and knowledgeable about the needs of the people that lived in the home.

We found that robust systems were in place to regularly assess the quality of the service that people received. Records showed that regular spot checks on staff skills and work practices were by carried out by the manager. We sampled the findings and saw that they were detailed and feedback was provided to staff following these checks. Supervision and training records showed that supervision and staff training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.

Staff that we spoke with were clear about their role and responsibilities. They had a good understanding of the ethos of the home and the systems in place to monitor quality assurance. This ensured that people received good quality of care.

The inspection took place on the 12 and 13 August 2015 and was unannounced.

Agnes House Flat 81 is registered to provide accommodation and support to two people with a learning disability. At the time of our inspection one person was using the service.

There was a registered manager in post responsible for the home and the services delivered within the community. 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.

Medicines were administered as prescribed

Staff understood the different types of abuse and knew what action they would take if they though a person was at risk of harm.

Staff were available to support the person where required

We found that the person living within the supported living complex had full capacity so the requirements of the Mental Capacity Act 2005 (MCA) did not apply in this instance. However, staff skills and knowledge was limited due to not having received appropriate training in the MCA and the Deprivation of Liberty Safeguards.

The person was able to make the appropriate decisions needed in determining what food and drink they had.

We saw that what the person wanted was what they had, staff listened to the person in a manner that was compassionate and showed they cared.

The person’s privacy and dignity was respected.

The person was able to socialise how they wanted and were supported to practice their religion how they wanted.

We were told by the person that they would complain to the registered manager if they had a problem.

The person’s healthcare needs were monitored regular by health care professions to ensure where they needed intervention this would be done in a timely manner.

We saw evidence that a questionnaire was being used to gather the views of the person, their relatives and staff on the service provided.