The inspection was carried out on 27 & 28 September 2016 and was unannounced.

Care Management Group - 4 Vallance Gardens provides accommodation for people who require personal care. The accommodation is a large house in central Hove providing support for up to ten people with learning and physical disabilities and complex communication needs. People were not able to communicate using speech and used body language, signs and facial expressions to let others know how they were feeling. At the time of the inspection there were eight people living at the service receiving support.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous comprehensive inspection of 9 February 2015 identified a breach of the regulations. We found the registered person had not protected people against the risks associated with unsafe or unsuitable premises because of inadequate maintenance. We also found a number of areas of practice that needed to improve, including improvements to audits relating to cleanliness and infection control and the management of some medicines. The provider produced an action plan to tell us what they would do to meet the legal requirements.

We undertook this comprehensive inspection on 27 & 28 September 2016 and checked whether the required actions had been taken to address the breach previously identified. This report covers our findings in relation to these requirements. Improvements had been made in the areas previously identified. However, we found breaches in relation to the care of people and in the requirement for the registered person to notify us of any incident of abuse or allegation of abuse in relation to a service user.

People's respect and dignity was not always considered. They did not always receive support from staff who initiated interaction or acknowledged the person and their needs. Staff did not always take time to speak with the people who they supported. We also observed some positive interactions and it was clear people enjoyed interacting with staff. However, not all staff interacted with people in a social way or addressed people only to provide a task. A person’s representative said, “I pointed out to staff a year ago that [named person’s] zip was broken on his jacket. Staff helped dress him in the jacket and were going to send him out in it with the zip broken. To me it’s about respect and caring what he wears.”

The registered manager had not informed CQC of a safeguarding incident. This is part of the registered person's responsibilities. By not being informed of incidents, CQC are potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe.

Improvements were needed to ensure that people’s prescribed medicine was administered as directed to protect people from potential risks associated with medicines. A medicine recorded on the Medicine Administration Records (MARs) was not given as directed by the GP.

People’s support plans were extensive but not always up to date. Not all files were updated to reflect changes or to ensure people’s safety and welfare. However, those plans that were up to date were person centred and gave staff the information and guidance they required to give people the right support. People had clear support plans and guidance in place to ensure staff were able to effectively support to help meet their sometimes complex specialist support needs. We identified these as areas of practice that required improvement.

Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Systems were in place to ensure people were pro

During our visit to 4 Vallance Gardens we observed care being delivered and viewed the care records of four people who use the service. We spoke with four care workers and two family members. Our visit was facilitated by the registered manager who for the purpose of this report will be referred to as the manager.

Some of the people who lived at the home had very specialised means of communication and we were unable to ascertain what a number people felt about their experiences in the home. However throughout the visit we saw that staff took time with people to establish their needs and used different methods to communicate based on their knowledge and understanding of the individual.

We saw that the home was clean and that people's bedrooms were personalised. We viewed communal areas that included a sensory area within the living room and a newly refurbished garden. During our visit we saw that a violinist was playing music for people and we were told that this was a regular activity that occurred every week.

Staff we spoke with told us they felt they had the time and the staff needed to care for people well. One support worker told us "We can do so much more than the basics," another told us "the quality of care is good, we focus on people's quality of life." A relative told us that while there had been some recent staffing difficulties "the care is mostly good". Another relative told us "I'm thrilled to bits with the care".

Some of the people who lived at the home had very specialised means of communication we were unable to ascertain what a number people felt about their experiences in the home. However throughout the visit we saw staff enabled to communicate freely with the group and responding promptly to their needs.

We looked at how people are cared for and noted that staff are recruited with peoples’ safety and security in mind through a thorough vetting process. They receive the correct medication on a regular basis, and are subject to many checks to ensure they receive the correct nutrition.

We noted that there had been improvements started to the fabric of the building to provide better entrance facilities and security. There is an ongoing refurbishment plan which will improve a number of areas in the home.

We also saw that the manager and staff undertake a number of checks to ensure the safety of those in the home.

During our visit, we found that people living in the home appeared settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

We were told that only two of the people living in the home have any form of verbal communication and that this is very limited. However, in accordance with their identified wishes and individual support plans, people are encouraged and enabled, as far as practicable, to make choices about their daily lives.

We completed an unannounced inspection of this service on the 9 and 10 February 2015. 4 Vallance Gardens provides support for up to ten people with learning disabilities, physical disabilities, communication and sensory impairments and complex health needs, including epilepsy. At the time of the inspection, seven people were living at the service. The age range of people varied between 52 – 86 years old.

Accommodation is close to the town centre of Hove. It was arranged over two floors with a communal lounge, dining area, large kitchen and garden.

The cleanliness of some of areas of the home such as the carpets and cleaning of walls and woodwork had not been maintained to a high enough standard. People were exposed to an environment where cleanliness was not maintained across all areas, increasing risk from poor hygiene maintenance.

Audits of cleaning had not identified the failure to complete tasks relating to cleanliness and infection control.

People’s medicines were stored safely and were administered on time. Guidance for the use of ‘as required’ (PRN) medicines were not available. We have made a recommendation about the management of some medicines.

There was a registered manager at the service on the day 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.

The registered manager explained that the service tried to meet the needs of older adults with complex needs. People were well cared for and appeared happy with the support they received. The relative or representative of one person told us, “It’s a good place for people.” A health care professional told us, “It is apparent that the staff member has a good relationship with the resident they have known for a number of years. The resident appeared well cared for and dressed in attractive clothing of their own choice.”

People received focussed, person centred support. Their needs had been assessed and support plans devised and implemented. The plans and risk assessments provided staff with the guidance they needed to for safe, effective and responsive support. Staff supported people with positivity and kindness. It was clear they appreciated the importance of people’s personal histories and had built an enduring professional relationship with them.

People went out and about, shopping and to places of importance to them. There were good opportunities for taking part in social activities. Support staff ensured people had lots of engagement and stimulation both in and outside the service.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s relatives, representatives and professionals alike spoke highly of the service provided, the staff and the manager. One social care professional told us, “I found the manager had an excellent grasp of the needs of the person I was completing a review for.” Staff understood the principles of the provider and how these permeated all areas of the service. This was reflected in the full lives people were able to lead. The manager was committed to the ongoing improvement of the service.

People’s relatives told us they felt the service was sufficiently staffed. Practice was reviewed with regard to safe ways of working and ensured people were not placed at risk.

Staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments were recorded in line with best practice guidelines and staff were aware of who was subject to a DoLS authorisation and what it meant for the individual.

There were procedures in place to assess the standards of support. Feedback was sought from people or their visiting relatives. Incident and accidents were consistently recorded and reviewed for emerging trends or patterns.

People’s privacy and dignity was upheld. Staff understood how to recognise abuse and were clear on how to raise a safeguarding alert. They spoke highly of the training opportunities provided and commented they felt supported and valued.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.