The inspection took place on 31 May 2018 and was unannounced. At our last inspection we had found two breaches of the regulations. We had found that some people told us a staff member was "bossy" in their manner towards them. Action had been taken to address these concerns. We had also found that fire drills had not been regularly carried out. This put people at risk as in the event of a fire as they may not know what actions to take to be safe. Finally we had found that the governance system for auditing and monitoring quality and safety was not being used effectively. The failings identified at this visit had not been picked up.

261 Passage Road 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. 261 Passage Road care home accommodates five people in one adapted building.

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.

There was a registered manager for 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 told us staff were not ‘bossy’ and were kind and caring towards them. We also saw that the staff we met were kind caring and respectful towards everyone who lived at the home.This showed that people felt safe at the home and with the staff who supported them. People were protected from abuse and the risk of harm. This was because staff were properly trained and knew how to keep people safe.

The provider’s system for the management of people’s medicines ensured they were looked after properly. When people wanted to be, they were supported to be responsible for their own medicines.

Fire drills had now been regularly carried out. This helped minimise risk in the event of a fire as it meant people knew what actions to take to be safe.

People were supported to make choices and have control of their lives. The staff team supported them in the least restrictive ways possible. There were policies and systems in use that supported staff to do this.

People were well supported with their physical health needs and their overall well-being was monitored. If it was needed the staff supported people to see health professionals promptly.

People were supported to choose what they wanted to eat and drink to maintain good health. Menus were put in place based on each person’s likes and dislikes. People were encouraged by the staff to maintain their independence. The staff team respected people’s privacy and dignity.

People were cared for by a consistent team of staff. The staff knew and understood people’s individual needs well. People looked relaxed talking with staff members and raised any issues or concerns with them.

Care and support was flexible and staff responded to people’s individual needs or wishes. Activities were personalised to people’s preferences and interests. Care plans contained useful information to help staff provide the care people need in the ways they preferred.

The quality checking system in place for auditing and monitoring quality and safety was now being used much more effectively. Failings and shortfalls in the service were swiftly picked up and addressed. For example, staff performance issues were identified as well as shortfalls in some record keeping. Actions were being put in place around both these areas.

The inspection took place on 16 March 2017 and was unannounced. The service was last inspected in January 2015 and met with legal requirements.

261 Passage Road is a care home that is registered to provide personal care for up to 5 people. There were 5 people at the home on the day of our visit.

Two people told us a staff member was "bossy" in their manner towards them. Some action had been taken to address these concerns after people had raised their views to senior staff in the home. At our inspection these concerns were repeated to us. We bought this matter to the attention of the registered manager who took action to ensure that people were safe.

Fire drills had not been regularly carried out. This put people at risk as in the event of a fire it would not be clear if people knew what actions to take to be safe.

The governance system that was in place for auditing and monitoring quality and safety was not being used effectively. The failings identified at our visit had not been picked up by recent audits.

There was a registered manager for 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.

There were systems in place to minimise risks to people and to protect them from abuse. People who lived at the some engaged in a positive and warm way with the staff that provided them with personal care and other support.

People were assisted with their care by staff that understand their needs and knew how to provide effective support. The staff we met had a kind and caring manner toward the people they supported. The staff also knew how to ensure that privacy and dignity was maintained when they were supporting people with their care.

People were well supported to eat and drink enough for their health needs. Menus were planned with choices available which reflected the likes and preferences of each person at the home.

People were supported by a team of staff who were properly trained to provide effective care The staff had been on regular training and were developed and supported in their work. This helped them to improve and develop their skills and competencies. Staff were properly supervised in their work and this helped to ensure they were competent in their work. Staff spoke positively about working as a team and the team support that existed among them.

There was a system in place in the home so that the requirements of the Mental Capacity Act 2005 were implemented when needed. This legislation protects the rights of people who lack capacity to make informed decisions.

People were being well supported to take part in a variety of social and therapeutic activities both in the home and the community. These activities were planned based on what people wanted to do each day.

There were recruitment and training processes in place that helped to ensure that staff were properly checked and were knowledgeable. This meant staff were be able to support people effectively.

The staff told us they could address any concerns or raise any matters informally with senior staff and the registered manager. The staff had received formal supervision meetings. At these meetings areas for improvement were regularly addressed with them.

Care records were detailed explained what to do to effectively assist people with their personal care needs. People were well supported with their physical health care needs. Staff consulted with external healthcare professionals to get specialist advice and guidance when it was needed.

The provider had systems in place to support people to make their views known and to make complaints about if they needed too.

Staff understood the provider’s visions and values that they expected staff to follow. One key v

The inspection was unannounced and took place on 25 January 2015. Prior to this, the last full inspection of the home took place in July 2013, when a breach of regulation relating to infection control was identified. This was followed up in October 2013 when a further breach of the regulation was found. We visited the home again in January 2014 and found that action had been taken to ensure the regulation was being met.

The home provides care and accommodation for five people with learning difficulties.

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 2008 and associated Regulations about how the service is run.

People received care that was safe. There were systems in place to protect people from abuse and this included training staff in safeguarding adults. Staff told us they felt confident in being able to recognise and report potential signs of abuse. People weren’t able to speak with us verbally about their experiences of living in the home; however we saw that people felt settled and content in the presence of staff.

Medicines were stored safely and people received support to take their medicines in line with their identified needs.

There were risk assessments in place to guide staff in providing support to people in a safe way. For example identifying the risks involved in supporting people in the community and risks associated with providing people’s personal care.

There were sufficient numbers of suitably skilled staff to ensure people’s needs were met. No recent recruitment had taken place recently; however we were told that suitable checks would be completed to help make safe decisions.

People’s rights were protected in line with Mental Capacity Act 2005. When people lacked capacity to make decisions about their own treatment, processes were followed to ensure that their best interests were considered. Where it was necessary to deprive a person of their liberty for their own safety and wellbeing, applications were made to the local authority for Deprivation of Liberty Safeguards authorisation as required.

Staff received training and support to help them carry out their roles effectively. Training was flexible to account for different learning styles and to meet the particular needs of people in the home.

Staff were knowledgeable about the people they supported and understood their individual needs and preferences. People were supported to ensure that adequate amounts to eat and drink. When necessary people were supported to see other healthcare professionals. For example, their GP and other specialist teams such as the Bristol Intensive Response Team who provide specialist support for people with learning difficulties.

Staff were kind and caring and built positive relationships with people. We observed staff offer comfort when people were upset and engage in pleasant everyday conversation.

People were supported to maintain relationships with people that were important to them by for example, sending birthday cards and visiting their homes. People were also supported to take part in activities that reflected their personal interests. For example, one person was supported to pursue their interest in horses.

People were encouraged to take part in planning their care as far as they were able. This included choosing photographs to include in their support plans. The views of relatives were listened to and recorded.

There were procedures in place for people to raise formal complaints if they wished to do so. Information about this was available in a format suited to people’s communication needs. There had been no formal complaints in the last year.

The service was well led. There were systems in place to monitor the quality and safety of the service provided. Positive action was to taken to improve the service when concerns were identified.

At our inspection on 25 October 2013 we found people had not been protected from environmental infection control risks in the home.

The provider wrote to us and informed us they would be compliant with these standards by 31 December 2013.

At this inspection we saw that action had been taken so that people were protected from environmental infection control risks. The bathroom floor had been replaced and room had been redecorated.

We also spoke with three people who used the service .People told us that the staff were “kind”. The people we spoke with told us they were happy at the home.

We also reviewed the staffing levels to see if there was enough staff on duty to meet people’s needs. We did this to check that a previous compliance action we had set in 2012 around staffing levels had been met.

The purpose of this inspection was to follow up non-compliance from our last inspection in July 2013. This was because there was a lack of monitoring in place to ensure that the home was kept clean and cross infection minimised. One communal area of the home also required some attention to ensure that it was sufficiently clean.

The provider sent us an action plan that detailed how they would achieve compliance with outcome eight of the Health and Social Care Act. During this inspection the actions the provider told us they were planning to take, had been implemented within the service. Monitoring systems were in place and staff were trained in infection control guidelines and good practice principles.

Most of the communal areas of the home were cleaned to an acceptable standard. However during this inspection we found one area of the home had not been cleaned effectively.

We did not speak with people that lived in the home directly about this outcome. However we asked people if they were happy living in home and observed staff interactions with people in the communal areas. People’s comments included “I like going on holiday”. “I went to Weston and bought Christmas presents”. “I’m going away again soon”. People were relaxed around staff and were interacting verbally and planning their day.

People living in the home were not able to able to give direct feedback about their experiences of living at passage road. However we made observations that demonstrated people received good support and were happy and settled in the home. People enjoyed spending time with staff during our visit, going out in the community and carrying out individual activities. Some of the people in the home were happy to chat with us and show us their rooms.

People's right to consent to their treatment and support was documented and the principles of the Mental Capacity Act were put in to practice. People were cared for in a clean environment, however some minor concerns were found in relation to the monitoring systems in place for cleanliness and infection control. One communal area of the home also required some attention to ensure that it was sufficiently clean.

People were cared for by staff who were well supported in their roles through training and supervision. There were systems in place to monitor the overall quality and safety of the service provided.

This was a follow up visit to review the areas of non compliance from the visit in September 2012.

We looked at four of the five people’s care records in respect of activities to determine whether compliance had been achieved with the Health and Social Care Act. We also looked at the staff rota to determine whether there was sufficient staff on duty, to enable people to take part in meaningful activities in the home and the community.

In addition, we spoke with three members of staff and met with three of the individuals living at 261 Passage Road.

People told us that they were going out more since our last visit. This included a Turkey and Tinsel weekend in Devon for two of the individuals, meals out and trips to the local shops. People continued with their structured day care.

People were supported to maintain contact with their friends and family.

This report should be read in conjunction with our report from the visit in September 2012.

We met with all four people living in the home. People we spoke with told us they liked living in 261 Passage Road.

We observed staff interacting with people in an inclusive manner. Although when we spoke to the individuals living in the home it was noted that the staff answered the questions without clarifying with the person if they were happy with what was said.

We were told that people could make decisions on how to spend their time, however we saw in care records that due to staffing people could not always go out when they wanted.

People told us they had been on holiday this year. From talking with the people in the home and the staff, it was evident that the holidays were tailored to the individuals both in terms of destination and length of stay. One person told us they had already been on holiday but were going away on a ‘tinsel and turkey’ break with staff. People told us they liked their holidays.

We met with all five of the people living in the home. People we spoke to told us they liked living in 261 Passage Road. They told us the staff treated them well.

People told us they have a named worker called a key worker who helped them to go shopping and organised and planned activities with them. The key worker in addition has the responsibility to ensure the plan of care was reviewed and support people with health care appointments and ensure that peoples’ needs were being met.

People told us they were involved in making decisions about how they wanted to spend their time including when to get up and go to bed.

We observed staff knocking on doors prior to entering bedrooms and bathrooms. People were able to lock both their bedroom and the bathroom door offering them privacy if they required.

People were observed moving freely around their home accessing the lounge and their bedrooms.

People told us they had a wide range of activities including going to church, meeting up with family, going to day centres and luncheon clubs.

People told us they were involved in shopping for the home and household chores.

People told us they were supported to go to see the doctor and attend other health appointments like the dentist and opticians.

People told us if they were unhappy they would tell the staff or a family member.