This inspection took place on 28 March and 13 April 2018 and was unannounced.

Bagatelle is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bagatelle provides accommodation and personal care and is registered to accommodate ten people with learning disabilities; at the time of our inspection there were six people living in the home.

At our last inspection in January 2016, the service was rated overall as good. At this inspection, we found that improvements were required and the service was overall rated as requires improvement.

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.

The systems and processes in place to assess, monitor and manage the service required strengthening. The audits in place required more detail to ensure they were effective.

Infection control and medicine auditing processes required improving to ensure they were effective.

People received care from staff that knew them and were kind, compassionate and respectful. Staff spent time with people and understood their individual needs.

People’s needs were assessed prior to coming to the home and detailed person-centred care plans were in place and were kept under review. Risks to people had been identified and measures put in place to mitigate any risk.

There were sufficient staff to meet the needs of people; staffing levels were kept under review. Staff were supported through regular supervisions and undertook training, which helped them to understand the needs of the people they were supporting.

There were appropriate recruitment processes in place to protect people from being cared for by unsuitable staff and people were safe in the home. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and /or their day-to-day routines. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

The registered manager and new manager were approachable and people felt confident that any issues or concerns raised would be addressed and appropriate action taken.

The service strived to remain up to date with legislation and best practice and worked with outside agencies to look at ways to improve the experience for people.

This inspection took place on Friday 8 January 2016 and was unannounced on this occasion. We returned on Thursday 14 January 2016 and this visit was announced.

Bagatelle is a service that provides accommodation for up to 10 people. At the time of our inspection there were nine people using the service. Care and support was provided to enable people to live as independently as possible. Accommodation is provided on two floors and people have their own bedroom plus the use of communal areas and the large garden areas surrounding the property.

There was a registered manager in place. 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 and associated Regulations about how the service is run. The registered manager had been off work for some time and a senior member of staff was overseeing the service with support from the regional manager.

People who lived at the service told us that they felt safe and staff knew them well, relatives we spoke with also confirmed this. There were some people who raised concerns about staffing levels as staff were not able to support a person in the community without prior notice. However, everyone we spoke with said that staff were caring and individual needs were always met in other areas. People also told us that staff understood their individual needs and choices. People accessed the local community with support from staff when this had been planned, or if the service vehicle was available.

Staff were aware of how to protect people from avoidable harm and were aware of safeguarding procedures. Therefore any allegations or recognised incidents of abuse were dealt with and reported in the required manner. Staff had been trained to enable them to have the skills and knowledge needed to provide appropriate support to people. We saw records that showed the training that had been completed and staff confirmed they had ongoing updated training to refresh their knowledge. Relatives said that they felt they could discuss any matters with staff and that previous issues discussed had been addressed.

People had access to healthcare professionals should this be necessary. Care plans had details of any specific conditions and how to identify any problems. The appropriate health services were contacted when necessary. Our discussions with people at the service and our review of records confirmed this.

The staff told us that they enjoyed working at the service. They confirmed that the staff team worked together at Bagatelle to try and support people with their chosen activities. Any concerns or comments from people were dealt with immediately. However, although staff stated this, there were no follow up documents that identified what action had been taken after requests from people at their own ‘People who use the service’ meetings.’

The provider and staff were aware of requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs) 2008. Our observations and review of records showed that people were encouraged to make independent decisions and choices. Our discussions with people living at the service also confirmed this.

People’s nutritional and dietary requirements had been assessed and people were encouraged to make healthy choices. People told us that they chose their meals as a group and had different meals when they wanted.

There were systems in place to assess and monitor the quality of the service. This included regular discussions with people who used the service, both in groups or individually. The provider issued yearly questionnaires to gain the opinions of individuals, the results of which were collated by head office and then shared and discussed with the staff at each location.