This inspection took place on 25 November 2016 and was unannounced which meant the registered provider and staff did not know we would be visiting.

Arran House is a mid-terraced property situated in the centre of Guisborough. The service provides residential care and accommodation for up to four people who have learning disabilities and mental health needs. It is situated close of local bus route and within walking distance to local amenities and the centre of Guisborough. At the time of inspection there were three people using the service.

The service had a registered manager who had been registered with us in respect of the registered provider's new registration since 8 January 2015. Before this they were registered as manager for the registered provider's previous registration. 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.

During our last inspection, we found that people who used the service and others were not protected against the risks of inappropriate or unsafe care and treatment, as effective quality assurance processes were not in place to enable the registered manager to identify and minimise these risks. We asked the registered provider to take action to ensure they were meeting the regulations.

At this inspection people told us they felt safe. Risk assessments were in place for people who needed these. Some risk assessments lacked detail around specific medical conditions. However, staff were knowledgeable about the associated risks and action they should take.

Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce the risks. The registered manager reviewed all accidents and incidents on a monthly basis. Falls were also monitored to identify any trends occurring.

Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place and the registered provider had a policy in place to minimise the risk of abuse occurring. Safeguarding alerts had been submitted to the local authority when needed and appropriate action had been taken.

Emergency procedures were in place for staff to follow. A robust procedure for recording fire drills had been implemented, which recorded how each person had managed during the evacuation process.

Medicines were managed appropriately. The registered provider had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when medicines had been administered and disposed of. People we spoke with confirmed they received their medicines when they needed them and we observed this happening safely.

Certificates were in place to ensure the safety of the service and the equipment. Maintenance and fire checks had been carried out regularly.

A safe recruitment process was followed to reduce the risk of unsuitable staff being employed. Only one new staff member had joined the service in the past 12 months. An induction process had been completed with the registered provider.

Staff performance was monitored and recorded through a regular system of supervisions and appraisal. Staff had received training to support them to carry out their roles safely and training was up to date. People who used the service suffered from a variety of medical conditions including diabetes, epilepsy and learning disabilities. However, we did not see evidence of any specialist training in these areas.

People were supported to maintain their health and make independent decisions regarding food and fluid, including participating in creating a weekly shopping list. People spoke positively about the nutrition and hydration provided at the serv

We carried out our inspection on 23 February 2015. The inspection was unannounced which meant the staff and provider did not know we would be visiting.

Arran House is a mid-terraced house situated within walking distance of the local amenities available in the centre of Guisborough. It provides residential care and accommodation for up to four people who have learning disabilities and mental health difficulties. At the time of our inspection visit the service had four people living there. Accommodation is provided over three floors, with each person having a private bedroom with washing facilities and toilet facilities being available on each floor. The service provider is the long standing Miltoun House Group, which became a limited company and re-registered as Marran Ltd on 31 December 2014.

The service has a registered manager, who has been registered with us in respect of the service’s new registration since 08 January 2015. Previous to this they were registered as manager for the service’s previous registration. 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 were protected by the services approach to safeguarding and whistle blowing, with people who used the service telling us that they were safe, could raise concerns if they needed to and were listened to by staff. People who used the service told us that staff treated them well and they had not experienced any ‘nastiness’. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Safe arrangements were in place for staff recruitment and staffing levels were appropriate to the needs of the people living in the home. Safe systems were in place for storing and managing medicines, which were appropriate to the home and the needs of the people living there.

We had some concerns about risk assessment processes at the service.  For example, some risk assessments had not been reviewed as often as we would expect and we did not see any formal risk assessments documented in the individual care files we looked at. Although the provider assured us that people were safe at the service, there was still a potential risk of people not being kept safe, because the provider had not identified, assessed and managed risks relating to the health, welfare and safety of service users.

People were supported by staff that were appropriately trained and supported to carry out their role. For example, training and supervision records showed that staff received relevant training and formal support and staff told us they were well supported by their management.

People’s nutritional needs were well met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted. We also saw that people lived in a comfortable home that was suitable for their needs.

The care records we looked at showed that people who used the service had regular access with other health and social care professionals. Other professionals who had recently been involved in people’s care included chiropodists, opticians, nurses, GPs and dentists. One healthcare professional told us that they had no major concerns about people’s care and that the service had a strong staff team, who create a supportive and homely environment for the people that live there.

Staff were receiving training and demonstrated a basic understanding of the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS). Where there were questions around a person’s capacity and concerns that they might be deprived of their liberty the relevant professionals had been involved. At the time of our visit one person was subject to a DoLS authorisation and another was being assessed to see if a DoLS authorisation was needed. Staff were applying MCA principles in the care they provided, but we found that some issues around capacity and best interest decision making were not always adequately recorded in people’s assessments and care plans.

People who used the service told us that staff were caring and treated them well, respected their privacy and encouraged their independence. Some people told us that they personally got on with some staff better than others, but that this wasn’t anything to worry about. Our observations showed staff and people who used the service appearing comfortable together and interacting in a friendly and caring way. For example, staff explaining things carefully and encouraging people to be independent where possible.

People’s needs were assessed and their care needs planned in a person centred way, although we saw two examples where relevant information had not been included in people’s care plans. People who used the service told us that they were involved in reviews of their care plans and had signed their records and reviews to show this. People had access to the local community, and could take part in activities or do the things that interested them. For example, people using the service told us about their recent holidays, cinema trips and outings into the local town for shopping or coffee.

People who used the service had various opportunities to raise concerns or complaints. For example, regular residents meetings and reviews included asking people for feedback or concerns about their care and an ‘honest feedback box’ was available if people wished to use it. People who used the service and staff told us that they felt listened to.

The service had a registered manager and supportive senior management structure. People who used the service knew who the registered manager was and had various opportunities to give feedback or raise issues. There was evidence of feedback being listened to and changes being made. For example, changes to meeting arrangements to make it easier for people to raise issues and changes to meal times as a result of feedback from people who used the service. Staff told us that the manager and providers were approachable and supportive. We saw evidence of audits and checks taking place to monitor the quality of the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of the report.