The inspection took place on 11 December 2017 and was unannounced.

Anderson Close 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. Anderson Close accommodates three people in one adapted bungalow.

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.

At our last unannounced inspection in June and July 2016 we identified four breaches of relevant legislation. These related to fire safety, consent, lack of staff supervision and appraisal and governance. During this inspection we found the provider had made improvements to the service although further improvement was required with regard to governance.

During this inspection we saw that the service was working within the principles of the MCA. We saw evidence that where people lacked capacity to make decisions, the provider had considered the least restrictive option and consulted appropriately with people to make best interest decisions, however this was not robustly recorded.

The service had 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.

People told us that they felt their relatives were safe living at the home and that they were well cared for. The provider had measures in place to protect people from avoidable harm and abuse. Staff received training in this regard and demonstrated clear understanding of responsibilities and procedures.

We found that safe administration of medicines was taking place, however we saw that on the day of inspection the keys were not securely stored. We discussed this with the registered manager and they confirmed they would remind staff of the correct procedures.

Risks associated with people’s care had been assessed and were kept under review. There was a process to record accident and incidents. Although none had occurred since 2013 staff were aware of the actions they should take if an accident occurred.

The provider followed safe recruitment procedures including checks with the Disclosure and Barring Service (DBS). The DBS helps employers make safer recruitment decisions and prevent unsuitable staff from working with vulnerable people.

Staff had good understanding of the needs of people living at Anderson Close. Relatives were happy with the care their family member received.

At the last inspection we saw that staff had not received regular supervision and appraisal. During this inspection we found that staff felt supported in their roles and had received appropriate supervision and appraisal.

Staff said they received the training they needed to carry out their roles and were able to attend courses presented by the local authority. The provision of staff hours meant that people always had access to support when they needed it.

We saw that staff knew the needs, preferences, likes and dislikes of people living at Anderson Close well. Staff were observed to be friendly, caring and attentive at all times during the inspection and showed regard to dignity and respect. Care planning was person centred and care plans contained essential information and risk assessments.

The provider had a complaints policy in place and relatives told us that they knew how to raise a concern and who to contact should the need arise. There had been no comp

The inspection took place on 28 June 2016 and 08 July 2016 and was unannounced.

The home was last inspected on 02 & 07 May 2014 and did not meet the required standard for assessing and monitoring the quality of service provision, as the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We made a further visit on 13 August 2014 and found that the required improvements had been made.

Anderson Close is a small three bedded care home providing support for young people with learning disabilities. On the day of our visit three people lived in the home. This service is owned by Community Care Matters.

The service is registered for accommodation for persons who require nursing or personal care. It is a domestic style bungalow/property located within the local community in Padgate, Warrington. The service is fully equipped for people needing assistance with hoists and wheelchair access. A large drive way offers accessible access and parking facilities.

The home had a Registered Manager. 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.

At this inspection we identified four breaches of the relevant regulations in respect of safe fire evacuation drills, staff training supervision and appraisal, consent and quality monitoring . You can see what action we told the provider to take at the back of the full version of the report.

We found that whilst the administration, storage and disposal of other medications were safe, the staff administering medicines had not attended recent training.

Some staff had not received current training to protect vulnerable people from abuse.

Fire fighting equipment and alarm testing was in place to support people safely in the home, however staff had not undertaken practice drills for some years to evacuate the premises in the event of a fire.

The experiences of people who lived at the home were positive and they led active lives.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications to the supervisory body. However the provider was not always working in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice.

People’s needs were assessed and plans were developed to identify what care and support people required to maintain their health and wellbeing and foster their independence where possible. Staff had in depth knowledge of individual’s needs as they had supported them over a number of years.

Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s dignity at all times and interacted with people in a caring, respectful and professional manner.

Staff and families supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Staffing levels in the home enabled people to be flexible in their choices, activities and lifestyle.

During our previous inspection on 7th May 2014 we found improvements were needed in respect of quality and management as the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

We carried out this inspection to follow up on action taken by the provider to ensure the quality of services were assessed and monitored and that people who lived in the home were able to contribute their views about the running of the home.

We spoke with the officer in charge and two staff members who told us that all policies, procedures and monitoring systems had been updated to ensure the home was run in the best interests of the health, safety ad wellbeing of people who lived there. Records viewed confirmed this.

We found that there were positive interactions with people and that staff spent time sitting and chatting with people who used the service and it was clear that individual's care needs were well known. At this visit we found that appropriate arrangements were in place in relation to medicines administration and recording.

We saw that all areas identified in our last report had been repaired and decorated. The home looked clean and tidy.

The service is homely but has a good range of equipment and adaptations to aid the staff to support people living there and to aid staff in moving people safely such as manual hoists and ceiling hoists. The garden area has been improved so that people could sit more comfortably in the fresh air.

We looked at staff files for the three most recently appointed staff members. From the staff records we looked at we were able to see that the staff currently working for the home had been appointed correctly.

The staff members we spoke with were very positive about the home and the quality of care it was providing to people. Staff spoken with said "it is a great place to work" "we ask people what they want and support them to do it."

We saw that the provider had a range of checks completed by the manager and staff on a regular basis.

We met two people living at Anderson Close throughout the day.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us about their experiences.

“We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.”

People living at the service looked content: happy and comfortable with the staff supporting them. They looked happy when seeing staff they knew and they used non verbal signs to communicate with staff who knew their needs.

We saw many examples of good communication and patience by support staff, who interacted with people they were supporting in a positive manner. Staff were friendly and respectful to the people they were supporting.

People who live at the service were seen making decisions on, for example; whether they spent time in their bedrooms or in the communal lounges or in going out.

We observed staff being respectful of people’s privacy and dignity.

We spoke to four relatives who were all very positive about the service and the standard of care provided. They made various positive comments such as;

“We have no concerns they are excellent, this is the best we have ever seen her to be.”

“The staff are so kind, nothings too much trouble, they go out a lot.”

“We are very pleased they are all well looked after, it’s really good here.”

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff told us they had one to one staff to help them to safely meet the individual needs and choices of each person living at Anderson Close.

Staff had received updated training in safeguarding and felt confident in being able to maintain people's safety. Staff were confident they would be listened to by the provider and supported with reporting procedures to safeguard people living at the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, the staff did have a good knowledge base regarding these safeguards. However they did not have access to appropriate policies and procedures in place including guidance on the 'Mental Capacity Act.' These policies and legislation are necessary to ensure the protection of vulnerable people who lack ability to consent on various issues

Is the service effective?

One relative told us they were very happy with the care that had been provided to their relative and they felt their needs were being met. We observed the support being provided and it was clear the staff were knowledgeable of people's needs, in particular specialist forms of communication.

Staff discussed the individual needs of each person they supported. Staff described the support they provided on a day to day basis including daily choices with meals and social activities and in regard to the facilities and environment to ensure people were comfortable and doing what they chose to do.

Is the service caring?

We observed staff speaking respectfully to people as they approached them so they were aware who was supporting them. Staff were friendly and helpful to the people they were supporting. We observed that people being supported were relaxed and happy in the company of their support staff.

We spoke with two relatives of people living at the service. They made various positive comments such as:

"We feel the staff go above and beyond to provide care for our relative" and "It's a home from home, we have piece of mind when we walk away."

Is the service responsive?

Each person living at the service had a person-centred support plan in place to help to show how their needs would be met at the service. These records were detailed and showed that people’s choices, interests and diverse needs were being met and were regularly reviewed and updated to meet their needs.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and that they felt well supported by the provider.

Relatives told us they were always kept informed and updated regarding their relatives support and needs.

A range of policies were in place and accessible by all staff. However some policies were out of date and in need of review. These policies created risks to the staff team who needed updated information to ensure the safe management of the service. The organisation and provider oversight of quality checks at the service required development to help improve the monitoring of the service specifically with the management arrangements of fire safety, safeguarding and general incidents.