We carried out a comprehensive inspection of Care Management Group, 287 Dyke Road on 12 April 2018. The registered manager had been informed of the inspection 24 hours prior to us undertaking the inspection. We gave the registered manager 24 hours’ notice of the inspection because the service is small and staff are often supporting people with activities in the community. 287 Dyke Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home provides accommodation and support for up to eight people, primarily young adults, aged 18-30 with profound learning disabilities, physical disabilities, communication and sensory impairments and complex needs such as epilepsy. 287 Dyke Road currently has one person outside of this age group, but who meets the criteria of support that the service provides. At the time of the inspection seven people were living at the home with one person about to move to 287 Dyke Road from another service. The home accommodates those it supports within one self-contained building. The building has eight ensuite bedrooms over three floors, two connecting communal areas, a dining room and large gardens. The home had a lift that allowed access to each floor and each room is adapted with ceiling tracking hoists.

At the last inspection on 5 January 2016 we rated the service as Good. At the last inspection we had identified a breach, (areas of practice that needed to improve) because medicines were not always managed safely. At this inspection we found that improvements had been and that medication management and administration was being managed safely and effectively, and in accordance with guidance and regulations.

People and their relatives were happy with the care provided by staff who held a detailed working knowledge of each person’s needs and requirements. One relative told us, “They judge what level of assistance he needs at that time. They know when to keep out of his face as he gets cross sometimes. They know him so well.” Another relative commented that, “The staff have given me back my confidence in the care system”.

Staff had been recruited in line with regulations and good practice and had received training appropriate to their roles and responsibilities. There were enough staff to care for people safely.

Staff were knowledgeable about safeguarding procedures and aware of what action they needed to take when they suspected abuse or harm had occurred. Staff had a good understanding of equality, diversity and human rights.

People’s needs had been assessed appropriately. People’s care plans and daily activities had been developed in a person-centred way that placed them at the forefront of their support. People’s rooms had been decorated and personalised to a high standard that reflected their cultural, ethnic and lifestyle preferences.

Risks associated with care and support, environment and the use of equipment within the service had been appropriately identified and assessed. The service was effective in the management of risks to people with complex needs within the service to ensure they remained safe. One relative told us, “They judge what level of assistance he needs at that time”

The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Applications for DOLS had been made where appropriate.

People’s nutritional and hydration requirements were managed well and in accordan

We inspected Care Management Group, 287 Dyke Road on 5 January 2016. It provides accommodation and support for up to eight people. Accommodation is provided over three floors and all bedrooms were en-suite. The building is located within a residential area.

The service provides care and support to adults living with profound and multiple learning disabilities, physical disabilities and complex health needs, including epilepsy. There were the maximum permitted eight people living at the service. We last inspected the service on 10 February 2014 where we found it to be compliant with all areas inspected.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 person in charge during the inspection was the registered manager of another Care Management Group location nearby. They were appointed manager of this location following the retirement of the previous registered manager. They will be the registered manager of this location from January 2016.

The administration of a medicine was not recorded correctly and a medicine was not disposed of in line with regulations. The record for one controlled drug did not match the quantity found in the medicine cupboard. We also saw a medicine prescribed and then discontinued after one dose in July 2015. The medicine was in an unlocked box in the medicine room and we could not see where this supply of a medicine waiting for disposal was recorded. We have identified this as an area of practice that requires improvement.

People appeared happy and relaxed with staff. It was clear staff had spent considerable time with people, they knew them well and had insight into their needs. Staff knew people’s personal histories and had built a rapport with them. A relative said,” I can’t speak highly enough of the staff; they know [my relative] and know what they are doing.”

There were sufficient staff to support people. When staff were recruited, their employment history was checked, references obtained and an induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. A range of specialist training was provided to ensure staff were confident to meet people’s needs.

People’s needs had been assessed and detailed support plans developed. They contained risk assessments for a wide range of daily living needs. These included, for example, what equipment or aids were required to be taken by staff when they escorted the person outside, in the local area or further afield. People consistently received the support they required and staff members were clear about people’s individual needs. Care and support was provided with kindness and compassion. Staff members were responsive to people’s changing needs.

People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance. A healthcare professional told us, “Considering the high level of health need of the residents, staff are always approachable and very good at following care plans and reporting back any concerns. They will contact me if there are any significant health changes in residents.”

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People were provided with opportunities to take part in activities in-house and to regularly access the local and wider community. Support plans were in place to ensure people received support and healthcare that was personalised to meet their needs, wishes and aspirations. One relative said, “The care is good. The staff are very gracious about their care and treatment of people. [My relative] has complex health needs and needs a lot of specialised care. The staff have been good at watching him and giving him the care he needs.”

Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working with people as part of a team. They were positive and optimistic about the management of the service. The management undertook regular quality assurance reviews to monitor standards in the home and drive improvement.

At the time of our visit to 287 Dyke Road there were seven people using the service. We spoke with five staff members including the registered manager, and we spoke with two relatives. We observed staff caring for and interacting with people in a way that respected their dignity. Through observation of people's body language and their interaction with the staff supporting them and speaking with relatives we determined that people were happy living in the home. We saw from care records that people's preferences were identified where possible and they were given choices and involved in their activities as much as they could be.

We viewed the care records of three people who use the service and saw their needs were assessed and their care and support was planned and delivered accordingly. We saw that support and advice was sought in relation to people's health and wellbeing and that external professionals were involved in people's care.

Staff told us that the way the service was delivered enabled them to get to know people well through a keyworker relationship and that this helped them to understand people's non verbal communication. Relatives we spoke with told us they were happy with the care that people received. One parent told us "He's happy. Of all the homes he's lived at this has been the best." We viewed records of activities and weekly activity plans and saw that people were supported to participate in activities both within and outside of the home.

There were eight people living in the home at the time of the visit. Two people were out at day care activities. Six people that we spent time with indicated that they were happy living in the home. We determined this by our observation of their body language and their interaction with the staff supporting them.

There were processes in place to support people to make informed choices about their care and support wherever possible.

Each person living in the home had a detailed plan of care in place that included people’s individual needs and wishes and also recorded people's physical and emotional healthcare needs.

The home’s staff worked with a variety of healthcare professionals including district nurses, dieticians and the local learning disability team.

We spoke with staff and reviewed records which showed us that people were protected from abuse and their care was planned and delivered in a safe manner.

Recent improvements had been made to the environment and the home was warm and homely. People had the specialist equipment they needed to support their healthcare needs.

People were protected by their being a robust staff recruitment and selection process in place and staff had the skills needed to safely support people.

Comments we received from a healthcare professional included. “The people living in the home have high support needs, there are very good relationships with the staff and they support people well.”

People who use services had special communication needs. They expressed themselves by using sounds, body language and pointing to objects. They indicated that the staff treated them with respect and that they felt reassured to be in their company. They indicated that they received the health and personal care they needed and that they were comfortable in their home.

A carer (relative) said, 'The staff are very good to my son and they always give him the care he needs. He always looks neat and clean and I can tell as his mother that he is being very well cared for in a hundred different little ways. He seems to be happy in himself and I'd soon know if there was anything wrong, which there isn't.