About the service:

• Alphonsus House is a small care home providing personal care and accommodation for up to 19 people who have a learning disability or sensory impairment. At this inspection 19 people lived within the service.

What life is like for people using this service:

• People continued to receive safe care. People were safe and staff received training and knew how to keep them safe. The provider had a recruitment process in place to ensure they had enough staff to support people safely. People received their medicines as it was prescribed. Infection control guidance was in place, which staff followed and they had access to personal protective equipment. Accidents and incidents were noted and trends monitored to reduce the amount of accidents.

• People continued to receive effective care. Staff received support and had the skills and knowledge to meet people’s needs. People were supported to have maximum 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. People’s nutritional needs were met and they received enough to eat and drink to ensure they had a healthy diet. People’s health care needs were met.

• People continued to receive care from staff who were kind and caring. People were supported and encouraged by staff to make decisions as to how their needs were met. Staff were caring, compassionate and kind. People’s privacy dignity and independence were respected by staff.

• People continued to receive responsive care. People’s support needs were assessed and a care plan was in place to show how people would be supported. People received support that was personalised and reviews were carried out. People took part in activities that interested them and related to their assessed needs. The provider had a complaint process which people were aware of to share any concerns.

• The service did not continue to be well managed. Spot checks and audits were taking place to ensure the quality of the service was maintained but were not effective in identifying the nurse call system was not always accessible to people in an emergency. People and their relatives could share their views by completing a questionnaire about the service. However the outcome and actions resulting from previous questionnaires had not been routinely shared with people. The environment was welcoming and comfortable.

More information is in the Detailed Findings below.

Rating at last inspection:

• Rated Good (Report published 22/03/2016).

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

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

Our inspection was unannounced and took place on 29 February 2016.

At our last inspection of June 2013 the provider was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver personal care to 18 people. At the time of our inspection 13 people lived at the home. People lived with a learning disability and/or other related needs.

The home was divided into three units. There were two separate houses joined together and a bungalow to the rear where people lived.

The manager was registered with us as is required by law. 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.

The provider had systems that staff followed to ensure people were not at risk of harm or abuse.

The staff had been trained to manage medicines safely. Medicines were given to people in the way that they preferred and as they had been prescribed.

The staff were kind and caring and were provided in adequate numbers to meet people’s needs.

The recruitment processes the provider followed ensured that unsuitable staff were not employed.

Staff received induction training and the day to day support and guidance they needed to ensure they met people’s needs and kept them safe.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were encouraged to make decisions about their care. If they were unable to, their relatives were involved in how their care was planned and delivered.

Staff supported people to have the meals that they enjoyed and met their needs.

People received input from a range of health care professionals which helped to promote their good health.

People engaged in recreational and occupational activities that they enjoyed and met their preferred needs.

Processes were in place for people and their relatives to raise their concerns or complaints if they had a need.

People, relatives and staff all felt that the service was well run. Quality monitoring systems were in place and feedback forms were used that ensured that the service was run in the best interests of the people who lived at the home.

During our inspection of this home in April 2013 we found non-compliance with a number of outcome area including staffing levels, cleanliness, and safety concerning building work that was being undertaken at that time. We identified that improvement was needed as people were very much being placed at risk of high stress and injury due to the non-compliance. We carried out this inspection to find out if improvements had been made and found that they had.

People we spoke with were all very positive about their home and the staff. One person said, “I really, really like it here. The staff are good and they took me on holiday”. Another person said, “It is good here. I like living here”.

We found that the reassessments of people’s needs were being undertaken and that care plans were being reviewed. We found that action had been taken by staff which made sure that people’s needs were being met and that their good health was being promoted.

Since our last inspection staffing levels had been improved particularly at night which had helped to increase people’s safety and ensure that their needs could be met.

We saw that significant improvements had been made concerning the environment. The building work had been completed. This had improved the living standards for people new furniture, fittings and carpets had been provided throughout. We found the environment to be clean and tidy. We saw that equipment that had been required had been purchased and was available. People living at the home used words such as, “Great”, “Better”, and, “Lovely” to describe the newly refurbished environment.

We found that the registered provider had taken action which had improved the overall running of the home, safety, and quality of service provided to the people who lived there

People we spoke with were complimentary about the home. One person said, “I like it here. The staff allow me to do things for myself and I go to church regularly”. Another person said,” I like my bedroom and the staff”. However, people also told that the refurbishment work had affected them, one person said, “The mess and the noise has really stressed me out”.

We carried out this inspection as we had been told by a number of people that they were concerned about the way in which current refurbishment of the home was being managed and undertaken. We were told that this had disrupted people who lived at the home and had put people’s safety at risk due to items such as fire extinguishers not being put back in their proper place after painting and a cooker being left at the bottom of a stair case. We found that the information we had been provided with was correct which placed people’s safety and well being at risk.

We had also been told about a lack of equipment that had been assessed as being needed, inadequate staffing levels and concerns about the provision of meals during the time of refurbishment. Our observations and the evidence that we gathered showed concerns in all of these areas.

The situation regarding the refurbishment and the impact of this on people using the service did not give assurance that quality processes, monitoring and senior management support had been adequate to prevent risks to the health and welfare of people living at the home.

We carried out an inspection of this home on 6 March 2012 and judged it to be compliant with the standards we assessed at that time. In May 2012 a person told us about concerns regarding a range of areas including rising and retiring times, medication and activity provision. We carried out this inspection so that we could look at some of these issues.

Because the people living at this home had complex needs not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of these people which included observation. We spent time sitting in communal areas to observe the care that people received. We saw good interactions between the staff and people who live at the home and we saw that people were given choices.

There were 14 people living at the home on the day of our visit. No one knew we would be visiting. We spoke with six people who lived at the home, three members of staff and the registered manager.

One person living at the home told us “I like living here, they look after me and I like the staff”.

Another person said "I really like it here. I have been here for years. I have got friends here. I go out and do the things I want to".

We found that the atmosphere of the home was relaxed and friendly. Our observations showed that people were at ease with the staff. We saw that staff treated people with respect and dignity and understood how to communicate with them.

Staff we spoke with were able to tell us about people’s needs so that they receive care in a way that they want to.

People are given choices about the food and drinks provided. We saw that adequate stocks of food was available. People told us that they enjoyed the food. We found that weight monitoring processes could be improved which would give people greater confidence that risks in this area are being identified and managed.

We saw that the management of medication was effective and that medication processes were safe.

We saw that the environment is in need of redecoration and that the garden needs better maintenance. The manager told us that the registered provider has made money available so that a refurbishment can start. Adequate decoration and the garden being maintained will make the home a brighter and more pleasant place for people to live in.

There were systems in place to monitor how the home is run to ensure people receive a quality service. The manager told us ”The operations manager is very good, they visit often. They are supportive and they are getting work done to make the home more attractive and safe”.