This unannounced inspection took place on the 17 January 2017. The service was last inspected in November 2015 where two breaches of regulation were identified in relation to some aspects of the registration of the service and in relation to the oversight and management of risk. We looked at these areas as part of this inspection and found that improvements had been made and the provider was no longer breaching regulations.

Arthur House provides accommodation for a maximum of six adults who are living with autism and learning difficulties and who require support with personal care. There were four people living at the home at the time of the inspection. Arthur House also provides a supported living service and at the time of the inspection eight people were accessing this service.

There is a registered manager at the service who was present throughout the inspection. 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 felt safe living at the service. Staff were aware of safeguarding procedures and how to recognise possible signs of abuse. We saw there were sufficient staff available to support people promptly.

People received safe support with their medicines although the management of prescribed creams needed to be improved.

People were happy living at the service and we observed staff supporting people in a kind, respectful manner. People were able to say how they preferred to be supported which was recorded in their care plan. People were encouraged to be as independent as possible in many aspects of their lives.

People were involved in making daily choices about their care and staff told us how they ensured consent was sought from people. Systems in place did not always follow the principles of the Mental Capacity Act (2005).

People were involved in planning and preparing meals of their choice. People had regular access to healthcare professionals to maintain their health.

Staff felt supported in their roles and told us they had received training in areas specific to people’s needs to ensure they supported people safely.

People had the opportunity for daily activities based on their interests. People regularly accessed the local community for activities.

Care was reviewed with people at regular intervals to ensure it continued to meet their needs.

The provider had ensured that there were processes in place for people to raise concerns and complaints. We saw concerns and complaints were responded to in a timely manner.

People and relatives were happy with how the service was managed. We found that improvements had been made following our last inspection and the service had quality monitoring systems in place.

This inspection took place on 18 November 2015 and was unannounced. The home was providing accommodation and personal care for six people with learning disabilities and /or autistic spectrum disorders. At the time of the inspection there were three people living in the home.

At our last inspection on 11 November 2014 we found the service required improvement and had two breaches of regulation. The home had been found not to have adequate infection control equipment and had not made suitable arrangements to lessen the risk of infection. In addition there was lack of appropriate responses to complaints and incidents and accidents and the monitoring of the performance of the home. Although we found improvements had been made further improvements were needed.

In November 2014 we found there needed to be improvements in the continuity and management of the service and relatives, staff and professionals were not happy about how the home was run. We found that systems needed to be improved to ensure that risks to people were managed effectively.

In November 2015 we found that there had been improvements in how complaints were managed and efforts had been made to ensure that people were given a voice for their concerns and worries. People and staff we spoke with were happier with the care provided. However relatives and professionals we spoke with varied in their views. We found that the management of the home was not consistently good. Improvements were needed in the provider’s understanding of their conditions of registration. Appropriate systems needed to be in place to ensure the safety of people when they moved. Information needed to be available when judgements about the planning of care for individuals and about the home the home need to be made. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014

There had been no registered manager in place for over six months. 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 and the current manager assured us that an application for the current manager to become registered was going to be submitted. In addition the provider had allowed the offices of another of their services which provided personal care in people’s homes to be operated from Arthur House. They had not applied to have the registration of Arthur House to be amended for this to happen. Although we found that the provider was making efforts to make applications for this to happen following our visit, this was not registered at the time of our visit. These issues were breaches of the conditions of registration under Section 33 of the Health and Social Care Act 2008.

People were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. Medicines were well managed and this helped to keep people well. People were supported to attend appointments about their physical health.

People were supported by enough staff to keep people safe and to give support when requested. There were recruitment and induction processes in place to ensure new members of staff were suitable to support the people who were living in the home. People were happy with how staff supported them. However the home was unable to demonstrate that staff had appropriate knowledge to ensure people were supported effectively and safely.

The care manager and staff we spoke with were aware of the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing support and at times this meant that some people made unwise decisions or refused support that would help them. People’s rights were protected as they had control over their lives unless action had been taken to legally restrict their liberty.

People were supported to plan for, budget, buy and cook suitable meals to keep them well where this was possible. People were given support to gain specialist advice about their diet and given support to eat where needed.

People were happy about the relationships they had with the staff that supported them. We observed that staff interacted with people well and tried to alleviate their concerns.

The inspection took place on 11 November 2014 and was unannounced. This was the home’s first inspection since it was registered in January 2014.

The home provides accommodation and care for six people with learning disabilities who may also have autistic spectrum disorders. At the time of the inspection there were three people living in the home.

There was 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.

However, the registered manager for the service at the time of the inspection was also managing the setting up of two of the provider’s other new services. Interim managers were appointed to manage Arthur House and one of the other new services and at times other staff had to manage the service when these interim arrangements failed.

The changes in management had led to failings in how the home was managed. People were at risk of harm because there was a lack of clarity about the systems for referring and recording of safeguarding incidents. Safeguarding referrals to the local safeguarding authority were incomplete and did not always contain the information required to protect people from immediate harm.

Staff, a relative and health professionals had raised concerns with staff and managers and felt their concerns and / or advice were not listened to and acted upon. This had resulted in some inconsistencies in how risks to people were managed. For example, some people’s care had not been planned in a way to lessen their anxieties; this not happened despite requests from health professionals. Where people’s levels of anxiety had resulted in incidents these were not consistently recorded and had not been monitored so that plans could be adjusted. Staff did not have consistent advice how to manage these incidents. Some of these incidents should have been reported to us and had not been. Systems of monitoring risks to people were not in place to lessen the risks to them.

The provider’s audit in October 2014 showed that that the management had not ensured that staff had been given appropriate induction, training and supervision to meet the needs of people who lived in the home. Staff and health professionals had concerns about the turnover of staff and whilst agency staff were used this increased the risk of people receiving care from staff who did know or respond appropriately to their complex needs.

We found in a person’s record information that a person did not have showers on two occasions as there were no clean towels available. We looked at the reasons for this and found that people who lived in the home and staff had not been protected from the risk of getting an infection. The home’s washing machine had been unavailable for several weeks and soiled laundry was being stored in a room which was also used to store frozen food. Unwanted and stained mattresses were being stored in rooms used for training posing health risks for staff. Clinical waste, that could attract vermin, had not been put in the locked clinical waste bins. The maintenance of the cleanliness of the home needed to improve.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with two of the three people who lived in the home and they told us they were happy with the support they were receiving and that they chose and enjoyed the meals they had. They were supported to be involved in preparation of food and / or drinks but there was not enough information about healthy eating available. They told us that staff were kind, treated them like adults and they were listened to. People said they were supported to have contact with relatives and be involved in any interests.

We saw that staff interactions with people were kind and that there were enough staff available to support people. There was a clear process of helping people understand the decisions they were making where this was possible and to act in people’s best interests where this was not possible. Staff did not start work unless checks said that were safe to work in residential care.

Since the provider’s quality assessment in October 2014 there had been improvements in how medicines were administered, plans had been made to improve the level of staff supervision and training.