This inspection took place on 27 January 2017 and was unannounced. The previous inspection was undertaken on 22 September 2015 and at that time we rated the home as Requires Improvement in the areas of Safe, Effective, Responsive and Well-led. We made a requirement in respect of Regulation 12: Safe care and treatment. This was because there was no effective system in place to identify medicine inaccuracies. We made a requirement in respect of Regulation 13: Safeguarding service users from abuse and improper treatment. This was because the registered provider had not acted in accordance with the MCA in respect of there being no authorisations in place for people who had been deprived of their liberty. We made a requirement in respect of Regulation 17: Good governance. This was because there was no effective system in place to assess, monitor and improve the quality and safety of the service. We also recommended that the registered provider ensured care records were reflective of people’s needs, reviewed regularly and that people’s consent to their care was obtained.

On the day of this inspection we found that the registered provider had taken action to improve practices within the service following the inspection in September 2015. We found these improvements were sufficient to meet the requirements of Regulation 12, 13 and 17. This meant the service had met the breaches of regulation

The home is registered to provide accommodation for up to 12 people who have a learning disability. On the day of the inspection there were 12 people living at the home. The home is situated in Beverley, in the East Riding of Yorkshire. It is close to town centre facilities and transport links. The accommodation in the main building is on two floors and people who are accommodated on the first floor are able to use the stairs independently. There are also three bungalows in the grounds and these are for single occupancy. There is one flat that is accessed via external stairs and the person who lives in the flat is able to manage the stairs. The people who live in the flat and the bungalows can choose whether to have their meals and spend time in their own space or in the main building. Other accommodation includes a lounge, a dining room, a kitchen and an additional room that is used by people who live at the home and staff for a variety of activities. There is an enclosed courtyard garden.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 manager was registered on 14 September 2015 and they had previously managed other care services.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. This included supporting people to take part in their chosen activities. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

People told us they felt safe living at the home. Relatives also told us they felt their family members were safe living at the home and this view was supported by a health care professional who we received feedback from. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. There were effective systems in place to manage any safeguarding concerns.

Staff confirmed that they received induction training when they were new in post and tol

This inspection took place on 22 September 2015 and was an unannounced inspection. The previous inspection on 14 November 2013 was a follow up inspection and we found the regulation we assessed was being complied with at that visit.

Apple Tree house is registered to provide accommodation for persons who require nursing or personal care for up 12 people with learning disabilities. On the day of the inspection there were 12 people living at the service. The service is located in the market town of Beverley in the East Riding of Yorkshire. It is close to the local shops and offers access to local transport routes.

There was a manager in post who had registered with the Care Quality Commission (CQC) in September 2015. A registered manager is a person who has registered with the CQC 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 safely by trained staff and the arrangements for ordering and storage were appropriate. However we saw there was not an effective stock control system in place and errors were not identified.

The registered manager was able to show they had an understanding of Deprivation of Liberty Safeguards (DoLS). However, some people who used the service had been deprived of their liberty and no applications to authorise this had been made to the local authority.

People who used the service, relatives and staff told us that the home was well managed. We saw that although the registered provider had systems in place for monitoring some parts of the service they were not always effective.

We saw that people had person-centred care plans in place to instruct staff on how best to support them and meet their needs. These were clearly written. However, we saw these were not always consented to or regularly reviewed. We have made a recommendation about this.

We found that people were protected from the risks of harm or abuse because the registered manager had effective systems in place to manage issues of a safeguarding nature. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff had been employed following the registered providers recruitment and selection policies to ensure that only people considered suitable to work with vulnerable people had been employed.

We saw that people enjoyed premises that were suitable for their purpose. The environment was well maintained, comfortable and in a safe condition.

Staff confirmed that they received induction training when they were employed and told us that they were happy with the training provided for them. The training records evidenced that most staff had completed training that was considered to be essential by the service.

We found that people were cared for and supported by kind and caring staff that also provided clear boundaries for acceptable behaviour. Staff offered advice and guidance to assist people to lead a purposeful and fulfilling life.

People were supported to undertake activities and employment of their choosing and were able to complain if they felt necessary.

You can see what action we told the provider to take at the back of the full version of the report.

We visited the service to follow up on previous concerns in relation to the quality assurance systems in the home.

We found that the manager and staff had taken action in relation to meeting the regulations and that records had been updated.

People had been consulted about the support they received and risk assessments had been completed to help ensure people’s safety.

Records were now available of the maintenance work undertaken to help maintain people’s safety.

One person told us they were happy in the home. They said they were consulted about their care and knew that repairs to equipment had been completed.

Staff were aware of the recording systems in the home and the checks they were required to undertake to help maintain people’s safety.

As part of this inspection we reviewed previous areas of non compliance. We noted the manager and staff had undertaken a large amount of work to improve records, systems and staff training.

People who lived in the home told us they were happy living there and they felt that their needs were being met. They told us they liked the food provided and had plenty to do.

We observed interactions between staff and the people who lived in the home and the support offered to people form the staff. We saw that conversations were polite and respectful; reflecting a mutual interest in each other.

Peoples care plans were person centred and offered information to staff to help them support the person to live their lives.

People were provided with a varied diet and told us they liked the food provided. However there remained a lack of nutritional assessments.

Staff recruitment had improved to include the necessary checks and people who lived in the home were now involved in this process.

We saw that there was now a staff training matrix, staff told us and their training certificates confirmed that over recent months they had attended a variety of training. There remained a need to undertake specialist training in the home.

We saw that the quality assurance systems had not been developed since the last inspection and this was confirmed by the manager.It was unclear how the provider ensured that the environment met with the relevant legislation.

The Care Quality Commission (CQC) received four reports from the local authority safeguarding team about safeguarding issues in the service between February 2013 and May 2013. Concerns were raised about people who used the service not being allowed to make choices around activities, diet, visitors and bed times. The provider worked with the local authority safeguarding team to investigate the concerns. A new manager was put into post in March 2013 and information from the local authority (May 2013) was that positive changes had taken place within the service.

We found that staff were able to communicate well with people who used the service. Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations.

The majority of records were up to date but they did not have person centred care plans and the risk assessments were not robust.

We looked at staff files and staff training records as part of our visit and we found that staff training and supervisions were not up to date and that appropriate checks were not carried out by the provider before staff started employment.

We found that improvements were needed to the quality assurance system to ensure the provider identified, assessed and managed risks relating to the health, safety and welfare of people who used the service.

People told us they were happy living in the home, they told us there were plenty of activities and they liked the staff. We observed that interactions between people who lived in the home and the staff team were positive and people told us they felt safe in the home.

We saw that care planning systems took into account the views and wishes of the people who lived in the home. People's wishes and choices were recorded and staff told us how they respected these.

People were supported by adequate numbers of staff who had received training on the safeguarding of people. However the manager was on call to the home seven days a week and the provider may wish to note that this may impact on their ability to perform their role.

There were monitoring systems in the home to ensure people received the appropriate care although the formal quality assurance system had not been utilised over the last year.

People we spoke with were complimentary about living at the home. One person remarked it was clean and looked nice. Another person was enthusiastic with regard to the activities the home provided such as holidays and recreational activities.

People said they enjoyed living at the home as it was a nice place to live. They said that they were encouraged to be as independent as possible with the support of the staff. They enjoyed swimming and going to the gym and were looking forward to going on holiday in the summer. People told us that they were happy with their rooms and the cleanliness of the home. However, one person did tell us that the Hoover keeps them awake at night. Another said the kitchen was always being cleaned.

We spoke with one relative who told us that they were happy with the support provided to their daughter. One person said that they hadn’t settled at Apple Tree and that they were hoping to live in a flat soon.