We undertook an unannounced inspection of Cardell House on 11 September 2018.

When the service was last inspected in February 2016 we found that the service was compliant with the regulations at that time.

Cardell House 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

Cardell House provides personal care and accommodation for up to 12 people. People at the home had learning disabilities and some were living with dementia. At the time of our inspection there were 11 people living at the home.

Staff were now trained in their work. There was a training programme in place to ensure staff knew how to meet people’s needs effectively. Staff were supported by daily 'on the job' informal supervision. Staff also met with the registered manager to review their performance, and how effectively they met people's needs.

The registered provider's systems used to monitor and check the quality and safety of the service provided were up to date. This meant these systems were being used to drive up and support improvements.

People received their medicines when they were needed. There were systems for medicines that were to be given only when required and these were safe. There was guidance to inform staff when to give people these medicines at the times they were needed.

People's care plans were reflective of what each person’s current needs were. Care plans were up to date and had been regularly reviewed. This was to ensure that key information staff needed to have was up to date. This in turn was to ensure that people were supported safely.

People were supported to eat and drink food and drinks that they enjoyed. This support helped them to maintain optimum health and wellbeing. The menu options were chosen based on each person’s likes and dislikes. People told us they enjoyed the meal choices served at the home, and they appreciated being offered food they liked.

We undertook an unannounced inspection of Cardell House on 16 February 2016. When the service was last inspected in August 2014 we found that one standard was not being complied with. The provider had not been acting in accordance with the legal requirements when people did not have the capacity to consent to their care.

Cardell House provides personal care and accommodation for up to 12 people. People at the home had learning disabilities and some were living with dementia. At the time of our inspection there were 11 people living at the home.

A registered manager was in post at the time of our 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 told us they felt safe. Staff received training in safeguarding and were aware of the procedures to follow. The registered manager referred any concerns to the local safeguarding team.

Medicines were administered safely. Staff had appropriate training and practical assessments ensured staff were competent.

Risks were identified and managed through assessments which promoted independence. Safety checks of the environment and equipment were undertaken.

Staff received regular training to ensure they were suitably skilled in their role. They were supported through effective induction, supervision and an annual appraisal.

People’s health needs were met as the home worked in partnership with their local GP who visited weekly. People had access to a range of healthcare professionals when needed. Systems were in place to monitor people’s health and well-being.

People lacked stimulation through organised activities within the home. Regular support was not available for those that required help to access the community when they wished.

People received personalised care. Staff knew people’s individual preferences well and these were reflected in the care records. People and relatives had access to the complaints procedure and felt comfortable raising any concerns.

People told us the home was well led and managed. People said the registered manager did a good job and was effective. The registered manager communicated with staff through team meetings and written records.

The home had systems in place to monitor the quality of care. People were asked for their feedback on the care and support they received.

At the time of the inspection there were 8 people living at the home. A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. At the time of the inspection the registered manager for the service had left without cancelling their registration with us. Their name appears on this report. However, a new manager was in place and in the process of registering with us and this is who we refer to when we use the term 'manager' in the report.

Is the service safe?

We observed staff working with people in a way that respected people’s rights and dignity. Staff knew about people’s risk management plans and people were not put at unnecessary risk. One person told us “staff make sure I don’t fall."

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to improve.

The systems in place ensured people were given medicines safely.

Staffing levels were being calculated based upon the levels of people’s risks and needs within the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People told us that they were happy at the home and liked their rooms. One person told us, “I like this place” and another person told us, “I think it’s ok really." People told us about the various activities they were supported to do. One person told us, “I go out Tuesday, Thursday and Friday. We go down Fishponds, Kingswood, draw money out. I go out with (staff member). We get on ok."

It was clear from our observations and from speaking with staff that they understood people well and the support they provided met people’s individual needs.

Where people did not have capacity to consent to care, policies were not being followed to assess their capacity in line with the Mental Capacity Act 2005. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people’s capacity to make decisions about their care and support.

Is the service caring?

We observed staff interacting with people in a kind and attentive way, encouraging them to be as independent as possible. People told us they thought staff were “alright”.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. One person told us, “It’s up to me what videos I have in my bedroom. I choose what clothes to wear."

Is the service responsive?

The service worked well with other agencies and services to make sure people received care in a coherent way.

We noted that where one person’s behaviour had been changing, a health specialist had been alerted and was now involved in monitoring the person’s behaviour. This meant that the home was adapting to the person’s fluctuating needs and staff had enlisted support to enable them to keep the person and others in the home safe.

We noted that people’s care plans were reviewed and amended as people’s needs changed. This meant that staff had up to date information about how best to support people.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and where issues arose these were escalated and actioned appropriately.

Records such as the complaints folder showed that identified problems and opportunities to change things for the better were addressed promptly.

There were nine people living at the home. People were busy and had plenty of activities arranged for the day. We met and spoke with four people and two members of staff. People were happy and told us they liked living in the home. The manager supported the inspection throughout the day. It was evident throughout the inspection that the manager had people's best interests at the centre of their care.

We watched staff interact with people throughout our visit. Staff were patient and kind and offered reassurance when one person became restless and anxious. One staff member told us “I wouldn’t work here if I didn’t think people were looked after well. There are no fixed routines here, the care is individualised and person centred and people are empowered”.

We visited Cardell House on 30 and 31 August 2012 to carry out a routine inspection.

Concerns had been raised in March 2012 resulting in a safeguarding referral. The local authority safeguarding team investigated these concerns. Further concerns were also raised with us prior to the inspection.

When we visited the home we spoke with people who lived there. They told us that staff cooked their meals; they liked the meals and were given meal choices. People said staff talked to them in a 'nice' way. People confirmed that they liked living at Cardell House.

During our visit we saw staff treating people in a respectful way, however there had been institutional approaches that had been practiced. This meant that an individual approach was not always being taken when caring and supporting people. People had not always been given appropriate information about their support to help them make decisions about their care.

We looked at peoples' care files and saw that although their needs had been assessed, their care and treatment was not always planned and delivered in line with their individual needs. Care plans did not always have up to date information for staff to follow so that people were supported consistently.

We found that not all people benefited from a structured activity plan. Staff did not have the time to involve those people who stayed at the home during the week with regular meaningful activities of their choice. This was because staff were occupied with carrying out household tasks.

We looked at other records to ensure that people’s safety was being maintained. These included up to date health and safety management audits and staff training records. We saw that some staff needed to update some training. We found that staff had not always had the opportunity to access other training that was specific to some of the needs of the people in their care.

We spoke with two staff and found that some staff had not been supervised regularly.

We saw that staff treated people respectfully and that people were supported to make their own decisions about aspects of their daily lives. During the visit most of the people were at the home at different times. Some people went to their day service, work placement or were supported individually to access the local community. There were four people who did not have any planned activity during the day and stayed at the home.

People spoken with told us they had been involved with cooking and had made cakes. That they helped with some of the household tasks such laying the table, preparation of vegetables and the vacuuming.

People spoken with told us they liked the staff and that they helped them with cleaning their bedroom, and were taken out to buy clothes.

There are twelve people who live at Cardell House who have a learning disability. The needs of the people are different. There is one person who has been diagnosed with dementia while others may need support with their mobility. Some people were independent in areas such as looking after their personal care, using public transport and making snacks. There were people who are able to express their views clearly, and with others who either did not want to or were unable to.

People told us that “Staff are nice, I like them” and “They help me look after myself.”

“I take some of my medication on my own. I know when I need to take it”

“Staff help me with taking medication when I can’t take it on my own.”

“I was taken to buy a new coat and new boots. I chose the ones I wanted.”

“I went on holiday with my sister.”

“I’d like to go on holiday again.” (with Cardell House)

When we visited the home on 30 and 31 August 2012 we saw that that an individual approach had not always being taken by staff when caring for people. When we visited on 3 and 7 January 2013 we found that improvements had been made. Staff had received training in person centred planning and had involved people with their care. A positive change was seen in some of the practice with staff openly promoting people’s independence. Although we found improvements had been made with more in house activities offered, we did not see that all people had been offered regular access to the local community.

At our previous visit we found that care plans did not always have up to date information for staff to follow. At this visit we found that improvements had been made. We found that some risk assessments would benefit from further development to provide more clarity.

Staff we spoke with had a good understanding of people's needs and had supported people appropriately. We found improvements had been made in the way staff had been trained to support people’s needs and that they had received supervision more regularly.

At our previous visit we found systems in place to assess and monitor aspects of the quality of service that people received had not always been effective. At this visit we found that improvements had been made for people's care to be monitored regularly, We found that further development of a system to audit areas such as risk assessments was needed.