We carried out an unannounced comprehensive inspection at this service on 24 January 2017. We found the service was in breach of one of the regulations. This related to the governance arrangements and the lack of robust quality monitoring systems in place to monitor the quality of the service provided to people. After the inspection, the provider wrote to us telling us what action they would take to meet the legal requirements in relation to the breach.

We undertook this focused inspection on 27 September 2017 to check that the provider had followed their action plan and to confirm that they were now meeting the legal requirements. The provider was given half an hour’s notice of our arrival to ensure someone was available at the service to enable us to complete this inspection.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Agnes House Flat 2 on our website at www.cqc.org.uk.

Agnes House Flat 2 is registered to provide accommodation with personal care to one person with support needs that include learning disability, and autism. The service provides a ‘respite service’ to people. Respite means that people are supported in a care environment rather than by family or friends for short periods of time. People use the service for varied amounts of time. Some people use it a few times a year; others on a regular basis. When people are not using the respite service they live at home in the community with their families or carers. The service is provided in a ground floor flat which has one bedroom. The provider has other small residential care homes that were located near to this service and the staff worked in all of these services. At the time of our inspection no-one was using the service.

There was a registered 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 2008 and associated Regulations about how the service is run.

We found the provider had taken action and the legal requirements had been met. We found improvements were still on-going in some areas.

The provider had made sufficient improvements to monitor the quality of the service provided. This included completing audits at the service before and after people had used it for respite. These audits included a review of the environment to ensure it was fit for purpose and safe for someone to use. It also included an audit of the medicines administered to people while they used the service. We found improvements had been made and care records had been reviewed and updated to ensure they accurately reflected people’s needs and provided staff with the information they needed to meet people’s needs. We found improvements were still needed in relation to the environment and to ensure all care records were audited following people using the service. We received an action plan following our visit telling us these outstanding areas had been addressed.

This inspection took place on the 24 January 2017 and was unannounced. At our last inspection in April 2014 the service was meeting the regulations of the Health and Social Care Act 2008.

Agnes House Flat 2 is registered to provide accommodation with personal care to one person with a learning disability, and autism. The service provides a ‘respite service’ to people. Respite means that people are supported in a care environment rather than by family or friends for short periods of time. People use the service for varied amounts of time. Some people use it a few times a year; others on a regular basis. When people are not using the respite service they live at home in the community with their families or carers. The service is provided in a ground floor flat which has one bedroom. The provider has other small residential care homes that were located near to this service and the staff worked in all of these services. At the time of our inspection one person was using the service.

There was a registered 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.

People were not supported in an environment that was safe and met their needs, and staff did not have equipment available to use in an emergency when working alone with people. The risks to people’s health and safety were not always properly assessed and action taken to reduce these risks.

Staff were aware of their responsibilities to report any concerns about people’s safety or risk of harm, and they confirmed they had received training in relation to safeguarding people from abuse. People were supported by sufficient staff that met their needs, and they received their medicines at the times they needed them.

Staff had received training which enabled them to meet people’s needs, but there had been a delay in providing updated training in a timely manner by the provider.

The registered manager had sought advice and was now aware of the timescales for completing Deprivation of Liberty Safeguarding (DoLs) applications for those people whose liberties were restricted when using this service. Although staff worked within the principles of the Mental Capacity Act and gained people’s consent before providing support, the records did not underpin and support this practice.

Relatives described staff as caring, kind and respectful and our observations demonstrated that staff were responsive to people’s needs. People were supported to eat and drink in accordance with their preferences and dietary requirements. Staff knew the action to take if people became unwell when using the service.

Representatives for people were aware of the complaints policy and felt confident the registered manager would address any issues. The staff were aware of the signs to look out for which may indicate people were unhappy. People had family or representatives to advocate for them.

Systems were in place to gain feedback from people’s representatives, to enable the service to make any required improvements.

The systems to monitor the quality of the service were not effective and did not ensure shortfalls were identified to ensure improvements could be made. You can see what action we told the provider to take at the back of the full version of the report.

We visited Agnes House Flat 2 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, care staff on duty and the relatives of the person that 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?

Relatives spoken with told us that their family member was treated with dignity and respect by the care staff. They were on home leave on the day of our inspection. Relatives told us that their family member was given choice about their care and how they spent their day. We spoke to them about their experiences and they said, “My relative loves being there. The staff make sure they are safe in the home or when they are out. Staff are really kind.” 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 when they are there.”

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 people who lived here were not deprived of their liberties.

The provider had policies and procedures in place to protect people from harm. All staff spoken showed that they 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 persons relative had had been involved in an assessment of their needs and staff had used a variety of means to establish what support people needed and their choices explored for example using pictorial or other languages. This meant that the individual had been able to influence the care they received where possible and their individuality and cultural needs 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 holistic health and emotional 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 records indicated they enjoyed the food provided. We spoke to their relative about their meals and they said, “The staff have a list of their likes and dislikes but they let my relative make choices of what to eat and when. They don’t like spicy food and they respect that choice. ” We saw that 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 records to show that the persons preferences, interests and aspirations and diverse needs of the person that lived here had been recorded in their care records and that their cultural needs were respected and met. Relatives spoken with told us that staff treated people with dignity and respect, were patient and caring they took their time and did not rush them.

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.

Is the service responsive?

We saw that the person who lived here 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 and followed their guidance.

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 no one here on the day we inspected due to their hospitalisation for a routine procedure. We were therefore unable to gather their comments, however people who use the other Agnes House services told us the staff were treated them respect and dignity and helped them to become more independent with their lives.

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

We saw that people had detailed, personalised care plans which were 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.

We saw that people took part in a variety of activities such as swimming, going out to the local disco or to the shops. This meant that people were supported to lead interesting lives.

Systems were in place to ensure that people 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.