This inspection took place on the 25 September 2018 and was unannounced. At our last inspection in November 2015 the service was meeting the regulations of the Health and Social Care Act 2008.

Agnes House Flat 1 is registered to provide accommodation with personal care to one person with associate needs related to a learning disability, mental health and autism.

Agnes House Flat 1 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.

The care service has 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.

There was a manager in post. 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 and associated Regulations about how the service is run.

The person was supported by staff who knew how to manage risk and report concerns to keep them safe. The person was supported by staff at all times. The person received their medicines when they needed them and they received support to keep their home clean.

Staff had received training which enabled them to meet the person’s needs. The person’s human rights were promoted and staff obtained their consent before providing support.

Staff were observed to be respectful, kind and caring when interacting and supporting the person. Observations demonstrated that staff were responsive to the person’s needs. Staff encouraged the person to eat a healthy diet when choosing what they wanted to eat and drink. The person was supported to attend healthcare appointments to maintain their wellbeing.

The person told us they had someone they could talk to if they had any concerns. The staff knew the person well and were aware of the signs to look out for which may indicate the person was unhappy. The person had family and an advocate to ensure their human rights were being met.

The systems to monitor the quality of the service needed improvement as they did not identity some of the shortfalls we found during our visit. The registered manager took action to address some of these following our visit and an action plan was shared with us. We found some records were not readily accessible to us and we had to wait for information to be shared with us following our visit.

We visited Flat 1 Agnes House 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 spoke with the person that lived there. We also observed their interactions with staff and their body language to understand their view of the support they received. We looked at their recorded information to gain a balanced overview of the quality of the care and support that they experienced. We later spoke with a local authority representative of the person who lived there. 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 people were given choices about their care. The person that lived there that we spoke said, “I am happy here. I choose what I want to do and the staff are nice. I like it. I am safe here.”

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receive 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. 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 people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people 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?

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

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people could influence the care they received. One person we spoke with said, “I choose what I want to eat each day and where I want to go. The people that help me here are kind to me."

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

All staff spoken with were able to give us good detail about the support they provided to people. 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 people got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.

We saw that people’s cultural, dietary and linguistic needs were met by staff with the appropriate skills. For example, we saw that people were supported by care staff that were matched to their needs and understood their language or cultural requirements.

Records sampled showed that people were 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 people were supported to eat and drink sufficient amounts to meet their needs and ensure their health and wellbeing.

Is the service caring?

We saw that staff treated people with dignity and respect. We saw that were patient and caring they took their time and did not rush people. Staff were seen to be attentive and interacted well with the people they supported. We saw that people responded positively to staff.

People, their relatives and other professionals involved with the service had completed an annual satisfaction survey. We saw that relatives had made positive comments in the surveys we looked at.

People’s preferences, interest and aspirations and diverse needs had been recorded in their care records.

Is the service responsive?

We saw that people were supported to take part in a range of activities at home and in the local community. We saw that staff responded to spontaneous requests from people to do activities, or to spend their time in a way that they preferred. People had also been supported to go on holiday.

We saw that when needed staff had requested the involvement of other health professionals in people’s care and their advice was followed.

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.

All 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 home is a one bed roomed flat. There was one person living here on the day we inspected. They told us, “I am very happy here. The staff are great and help me to do things for myself.”

We met with the manager of the service who is also the manager of the sister service Agnes House. We spoke with two staff members and looked at the persons records.

We saw that staff treated them with respect and dignity. They were happy and at ease with the staff.

We saw that the person had a detailed, personalised care plan which was regularly reviewed and included advice form health care professionals involved in their care and treatment. This meant that staff had all the information they needed to support people appropriately and safely in the way they preferred.

The person told us that the staff had helped them to become more independent. They said, “I make my own drinks and meals when I want. I choose what to wear and where I go each day.”

We saw that they took part in a variety of activities such as going out to the shops or local places of interest. This meant that they were supported to lead interesting lives.

Systems were in place to ensure that they were safeguarded from harm.

Staff were trained to give them the skills and knowledge to know how to meet people’s needs and ensure their wellbeing.

People’s views were sought and were listened to. There were systems in place to monitor how the home was run to ensure people received a quality service.

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

Agnes House Flat 1 is registered to provide accommodation and support to one person with learning disabilities.

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 decisions on the food and drink they had with staff support.

We saw that staff spoke and 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.

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

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.