Beckdale House provides support for up to nine people who had a learning disability. At the time of our inspection there were eight living at the service. At the last inspection, in June 2015, the service was rated Good overall. At this inspection we found that the service had remained Good.

There was a registered manager at the service. 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 continued to receive safe care and we found there were enough staff to provide support to people that met their needs. We found that people were consistently protected from the risk of harm and received their medicines safely. The provider had safe recruitment procedures in place to ensure that staff were of a good character and suitable to support people who used the service.

People continued to be supported to make decisions about their care and staff sought people’s consent before they carried out support. 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 the provider had in place supported this practice.

People’s health and wellbeing was maintained and staff sought advice if people were unwell. People were involved in meal planning and preparation and people were able to choose what they wanted to eat and drink. Staff received training to enable them to support people’s needs effectively.

People were treated with dignity and staff were caring and kind. People’s privacy was respected an upheld. Staff encouraged people’s independence and respected people’s choices. Staff understood people’s individual communication needs and supported people to maintain relationships with relatives.

People were supported with interests and hobbies that were important to them. People and their relatives were involved in the planning and review of their care. Staff knew people well, which meant people were supported in line with their preferences. People understood how to complain if they needed to because complaints procedures were in a format that people understood. Complaints that had been received had been acted on.

Effective systems were in place to assess and monitor the quality of the service people received. People and staff were involved in the service and encouraged to provide feedback about the service was run. The registered manager was approachable to both people and staff and the registered manager led the team well.

We carried out an unannounced inspection of this service on 9 June 2015. When we last inspected the service on 26 June and 1 July 2014 we found that the provider had not taken proper steps to ensure people who used the service had access to information in a suitable format to support their autonomy and independence. We also found the provider did not have sufficient arrangements in place to ensure that people were protected from the use of control or restraint that was unlawful and there were no proper risk assessments in place relating to the care and welfare of people who used the service.

Following the inspection on 26 June and 1 July 2014 the provider sent us an action plan to tell us the improvements they were going to make.

At the inspection on 9 June 2015 we found that satisfactory improvements had been made to promote people’s autonomy and independence and found that people were protected from the use of unlawful control and restraint.

We found improvements had also been made to the format of the risk assessments although we made recommendations that they should be more person centred and enabling to support people’s autonomy and independence in line with their wishes.

Beckdale House is a residential care home providing 24 hour personal care and accommodation for 9 people from 16 years of age, with a learning disability and associated health needs. The accommodation is based over four floors which are split into six single self contained flats and one shared flat for three males. At the time of the inspection, seven people lived in the flats and there were two vacancies.

There was a registered manager in post at the time of this 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.

Support staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm.

A limited system was in place to identify and assess the risks associated with providing safe care and support. We found more work was needed to ensure there were risk assessments in place to enable people to achieve their goals as well as to support them with associated risks through behaviours. We saw risks had been discussed with the people who used the service and action agreed to keep people safe from accidental harm. Where people did not agree this had also been recorded. We have made a recommendation in line with National Institute for Clinical Excellence (NICE) guidance.

Staff working in the home understood the needs of the people they supported. They supported people in making choices and their own decisions as much as possible. Three people living in the home said they were generally happy with the care provided.

Staff understood people’s communication needs and supported people to make choices about the food they wanted to eat and activities they wanted to participate in.

We observed that people were supported to carry out household tasks and two people using the services were supported to access the local community during our inspection.

People who used this service received safe care and support from a trained and skilled team of staff. New staff received a comprehensive induction along with regular support and mentoring from more senior staff following their appointment. Staff fully understood their caring responsibilities and they demonstrated respect for the rights of the people they supported. We observed positive interactions between people and staff. We saw staff being kind and thoughtful, involving people in conversations. Healthcare professionals such as general practitioners (GPs), dentists, opticians, psychologists and psychiatrists were also involved in people’s care.

During our visit we saw examples of staff treating people with respect and dignity. People using the service and their relatives were consulted and involved in assessments, care planning and the development of the service. Staff told us their managers were approachable and treated them as part of the team. We have made a recommendation about individual assessments and paperwork.

We saw evidence that many aspects of the care and support were based on best practice guidance, such as the recent appointment of infection control champions, whose responsibility was to ensure high standards were maintained by the staff team. The registered manager had developed an effective system of quality assurance, which measured the outcomes of service provision. Staff, and relatives had been included in this process and their feedback had been used to make improvements to the way the service was provided.

We looked at the care files of four people who used the service. We found three care files contained signed consent to care plans, risk assessments and service user’s agreement forms.

We saw a pictorial easy read ‘my plan, my choice, my prospect’ had been used in some instances to help people explain their needs and preferences.

We observed staff engaging with people who used the service in a supportive and compassionate manner. Staff spoke to people in a friendly manner and knew each individual well.

We spoke with a visiting social worker who told us; “I think the care and support is of a good standard".

We saw evidence of formal mentoring of support staff by senior staff in areas such as medication administration.

We found the provider had comprehensive systems in place to monitor the quality of the service they provided.

People were provided with the opportunity to express their views and concerns about the service. We looked questionnaires completed by professionals and relatives. Comments included; “Excellent staff providing quality support at Beckdale House,”

We sampled five staff personnel files. We found each file was current and fit for purpose and contained detailed records which demonstrated that staff had been safely and effectively recruited.

We examined six care files of the people who used the service. These plans had been written in a way that recognised each person as an individual with their own needs. Each file provided individualised instruction to staff on the personal care required and what action to take in the event of a person missing, displaying challenging behaviour, verbal and physical aggression.

These instructions provided clear guidance to staff on being pro-active in respect of preventing incidents escalating. Each file contained a ‘Service User Daily Entry’ record which was up-to-date containing detailed information about the person.

We had some concerns about the number of safeguarding notifications that had been made by Beckdale House to the commission in recent months. We reviewed this outcome to assess if the provider had a proactive approach in managing safeguarding in the home. We spoke with two people who used the service and comments included “I do feel safe here, I am happy”, “The staff are fair, if you do something wrong, that’s fair enough” and “I like the staff and I feel safe”.

We checked how medicines were handled and recorded. Medicine administration records (MAR) were maintained in an appropriate manner. We reviewed charts and found entries were recorded as required.

There were three service users in the care home at the time we visited. Two people said they did not want to speak to us and one person was happy to talk to us about their day whilst care staff were present.

All three service users looked well, appeared happy and relaxed in the company of care staff. Service users had a good rapport with care staff.

We observed people being supported in one to one activities of their choice.

People told us that they liked the care staff at Beckdale House.

They told us they had key workers to whom they could speak if they had any issues. People told us that they felt staff listened to them.

One person living at the service told us that some of the other people living at Beckdale House argued a lot and it was 'getting them down'. They said they didn't like the way some of the people living at the service spoke to staff and that they liked the staff.

One person told us that they liked the staff and said they were well treated.

One person living at the service told us that they had been involved in staff interviews and they liked this.

Two inspectors visited this service on 26 June to carry out an inspection and a follow up visit was carried out by one inspector on 1 July. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During this inspection we were unable to speak with everybody who lived at Beckdale House as they did not want to meet with us. Therefore our judgements are based on the feedback from three people we did speak with, the review of records and feedback from other people we spoke with. We spoke with one relative, three care staff, the manager and the deputy manager. Following the inspection we also contacted two external health professionals. Below is a summary of what we found.

Is the service caring?

The people we spoke with were happy with the care and support provided by Beckdale House. We were told the staff helped them to complete their daily routines such as meal planning and cleaning. People told us their privacy was respected and they liked the staff. Comments included; "The staff are really helpful", and "The staff are really good here you can have a laugh with them. We spoke with one relative who confirmed they were happy with the care and support provided.

During the inspection we looked at three care records. In two of the records we viewed we saw they were not always written in a way that promoted people’s independence or dignity, encouraged understanding of the care and support in place or considered the individual communication needs of people who lived at the home. We spoke with two people who told us they did not understand the written information within the records. We considered that improvements were required in this area.

Is the service responsive?

We looked at three care records and saw that when appropriate, people were supported to seek advice from other health professionals such as their GP and that people had individual care packages in place. For example care records suggested some people received three hours support a day and this was used to plan budgets or complete household tasks. We saw recorded that other people received continuous support which was provided on a one to one basis. We were unable to speak with people receiving one to one support on the day of our visit as they did not want to talk with us so were unable to ascertain their views or the effectiveness of the support they received

The people we were able to speak with told us they were happy with the care and support they received. We also spoke with one relative and following the inspection we spoke with two external health professionals who expressed no concerns regarding the care provided by Beckdale House at the time of our visit.

Is the service safe?

We saw that some systems were in place to ensure people were safe. We saw that overall, staff had access to training activities to enable them to maintain their knowledge and competence.

During the inspection we asked for the homes policy on physical intervention and asked two staff members if they had read this. They told us they had not. This was a concern to us as staff should be knowledgeable of policies in order to provide care and support in a way that meets the home’s aims and objectives. We considered that improvements were required in this area to assure people’s safety and wellbeing.

Is the service effective?

We spoke with three people who lived at the home who told us they were happy with the care they received. One person discussed their care with us and told us they felt they had progressed well. We spoke with one relative who told us they were “confident that (my family member) is receiving really good treatment.”

Is the service well led?

We looked at a sample of audits and saw there were some systems in place to identify when improvements were required. The staff we spoke with told us if any actions were required, these were discussed with the manager and at supervisions, so improvements could be made. We spoke with one relative who told us they found the manager approachable and they would speak with them if they had any concerns. However we noted that some documentation was not always completed and it was therefore not possible to review incidents effectively to identify any triggers. We considered that improvements were required in this area.