This inspection was announced and took place on the 27 and 30 July 2018. This service 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. Arshad Mahmood is registered to provide accommodation for up to four people living with learning disabilities. At the time of the inspection there were three people living at the home.

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. We found that the service promoted these values. There was not a registered manager in post. This was because the registered provider managed the service and there was a small staff team providing care and support to people.

At our last inspection on 12 July 2016 we rated the service as ‘requires improvement’ in all key questions. This was because staff required further training and development in relation to safeguarding, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We also found that quality assurance systems had not been used to identify shortfalls, develop action plans and drive improvement. At this inspection we found improvements had been made in relation to these areas.

People were supported by staff who knew them well and there were enough staff to meet their needs. Individual risks to people were assessed and staff knew how to minimise them. People were protected from risk of harm because staff knew how to spot signs of abuse and how to report concerns both within the organisation and externally from it. People received their medication as prescribed and staff were trained to give medication safely. The provider had a system in place to ensure safe recruitment.

People were supported by staff who had up to date training and the skills required to meet people’s needs. Staff sought consent from people before providing support and people were supported to make their own decisions. People were supported to meet their nutritional needs. People had access to the relevant professionals when required and people and relatives were kept up to date about any changes in people’s needs.

People were supported by kind and caring staff who knew their likes, dislikes, preferences and personal history. People were encouraged to be as independent as possible and had goals in place to achieve with the support from staff. People’s privacy and dignity was maintained. People were communicated with in their preferred way. People were supported to meet their religious and cultural needs.

People were supported to engage in meaningful activities, both as a group and individually. People and relatives were informed of the complaints process and relatives we spoke with confirmed they knew how to complain. People and their relatives were involved in the review of their care and care plans and risk assessments were updated to reflect any changes to people’s needs.

There were quality assurance systems in place which had been analysed to identify areas for development and actions had been implemented. People and relatives feedback was sought on a regular basis and people were involved in the development of the service. Staff and relatives we spoke with told us the registered provider was approachable and supportive.

Our inspection took place on 12 July 2016 was announced. The provider was given 24 hours’ notice because the location provides a service to a small number of people who often go out and we needed to be sure that someone would be in.

At our last inspection on 29 January 2014 the provider was meeting all the regulations we assessed.

The service is a registered care home providing accommodation and personal care for up to four people with learning disabilities. At the time of our inspection there were two people living at the home.

The leadership in the home had not ensured that the service and staff were developed so that people were supported with activities that were meaningful, and that developed and stretched the life experiences of people.

The quality assurance system was not robust and did not always identify shortfalls in the service, or develop action plans that ensured that improvements in the quality of the service were made.

People were supported by staff that had received training, but this was not always up to date training.

People felt safe using the service and they were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse. However this system was not always effective in ensuring all staff knew what actions to take in the event of an allegation or incident of abuse

There was a system in place which showed that when complaints were raised these were listened to and addressed, but the records did not always show what actions had been taken. There was no analysis of the complaints received to determine whether there were any trends or themes that needed to be resolved so that the quality of the service could be improved.

Staff were not always clear about how people’s rights to make decisions was safeguarding under the Mental Capacity Act. Staff were supporting people to make choices and ensure that the correct agreements were in place where people’s liberty was being restricted. However, staff were unclear about what restrictions had been approved and when authorisations needed to be reviewed.

People’s representatives were complimentary about the kindness of staff and felt fully involved in people’s care.

People were supported by staff that were kind and caring. Some staff understood people’s needs well.

Risks associated with people’s needs had been identified and management plans put in place but they were not always sufficiently detailed to ensure that staff were aware of how to keep people safe.

There were enough staff to support people safely. People received support from a stable staff team that had got to know people well.

People were supported to take their medicines and have their healthcare needs met.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed eating.

There were three people living at the home on the day of our inspection. Due to their complex needs they were unable to tell us their opinion of the service they received. We therefore spoke with the relative of a person who used the service and a person who regularly visited people who lived at the home. They all told us that that they felt the people who used the service were well looked after. One person told us, “It’s very good there, they look after [person’s name] really well.” We also spoke to the deputy manager and three members of staff. We observed care and looked at records.

We saw that people were treated with dignity and respect.

Care was planned and designed to meet people’s individual health and welfare needs.

People received sufficient quantities of food and drink to meet their needs and were supported to make choices about what they ate and drank. A member of staff told us, “We know what people like to eat but they can choose what they want every day.”

The provider had recruitment procedures in place to ensure that people employed at the service had the necessary skills, qualifications and knowledge to meet the needs of the people who used the service.

The provider had robust systems in place to assess and monitor the quality of the service provided.

When we visited 56 Carlton Road we met with the people who lived at the home. We met and spoke with the deputy manager, a senior member of staff and three staff members. We had telephone discussions with a relative and a friend of two of the people who lived at the home about the care delivered at Carlton Road.

The people who lived at the home had high needs which meant they were not able to tell us about their experience of living there. When we met with them they smiled when we asked them how they were. We found that staff knew people as individuals and understood their personal needs and ways of communicating those needs. We saw that people were relaxed and at ease with staff and within the home environment.

The people we spoke with by telephone told us they were happy with the care their family member and friend received. We were told, “Carlton Road is not like a care home, more a home from home” and ““We are quite pleased. It is a good service.”

Each person had a care plan, which was written in a way that was easy for people to understand with the use of photographs and symbols.

We found procedures in place to protect people from harm. Staff we spoke with described what these were and how they would report any suspicion that a person who used the service had been at risk of harm.