About the service:

19 Wheelwright Road is a residential care home, spread across two adjoining houses; in one house four people shared communal facilities and in the other house people lived in two self-contained single occupancy flats. The home provided personal care and support to six people aged under 65 at the time of the inspection.

The care home had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The home had been registered before such guidance was produced. The guidance focussed on values include choice, promotion of independence and inclusion so that people with learning disabilities and autism using a service can live as ordinary a life as any citizen. However, it was clear that people living in 19 Wheelwright Road were given such choices and their independence and participation within the local community had been and was continuing to be encouraged and enabled.

Peoples experience of using this service:

At this inspection we found that people who used the service continued to be supported in a safe way. Wherever possible people were supported to have choice and control over their daily lives.

Staff were kind and compassionate and knew people well. People received their medicines safely. Aspects of people’s safety were protected and promoted throughout the home.

People continued to receive care and support that was personalised to meet their individual needs. Potential risks to people had been assessed and managed to lessen any risks related to people’s daily lives.

The home continued to have effective systems in place to check that the service was effectively managed and that people had a good quality of life. People were supported by staff who were well trained and keen to help people live fulfilled lives.

The was no registered manager at the home since the previous manager had left. We were told of steps the provider was taking to recruit a new manager. The acting manager was experienced, knew the people well and afforded a good degree of continuity for people living in the home. The acting manager shared the provider’s clear vision of how people were to be supported. The acting manager shared this enthusiasm with staff who supported this way of working.

Audit processes were in place and used by the provider to check and ensure that people were being supported to receive good quality care.

The home continued to meet the characteristics of good in all areas; more information is available in the full report.

Rating at last inspection: The home was rated Good (report published in June 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

This was an unannounced inspection, which took place on 23 June 2016.The service was rated as requiring improvement overall. At this inspection we saw that the improvements had been made.

The home is made up of two linked terrace houses located in the Erdington area of Birmingham and provides care and support for up to six adults who have a learning disability. One of the houses is divided into two flats, with ground floor facilities, that could be adapted for people with restricted mobility, should the need arise. At the time of inspection there were six people living there.

There was a registered manager 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 received a safe service. Procedures were in place to ensure that people received a service that was safe; staff followed the procedures to ensure the risk of harm to people was reduced. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured the risk to people was minimised.

People received care and support from staff that were trained and supported to be effective in their role. People’s rights were protected and they had choices in their daily lives. People were supported to maintain their diet and health. People’s privacy, dignity independence and individuality was respected and promoted at all times.

People received care from staff that were suitably recruited, supported and in sufficient numbers to ensure people’s needs were met.

People were able to raise their concerns or complaints and processes were in place to ensure complaints were investigated and responded to, so people could be confident they would be listened to and their concerns taken seriously.

People received a good quality service, which was well managed. There were processes in place to monitor the quality of the service people received, ensuring that the provider could easily recognise and act on any shortfalls in the quality of the service.

This was an unannounced inspection, which took place on 12 May 2015.

The home is made up of two linked terrace houses located in the Erdington area of Birmingham and provides care and support for up to five adults who have a learning disability. One of the house is divided into two flats, with ground floor facilities, that could be adapted for people with restricted mobility, should the need arise. At the time of inspection there were five people living there.

There was no registered manager 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.

Procedures were in place to reduce the risk of harm to people and staff were trained and knew how to help to keep people safe. Risks to people’s care was assessed and managed and there were processes in place to ensure people received their medicines as prescribed.

Sufficient numbers of staff that were suitably recruited were available to meet the needs of people and to help in ensuring people received safe care.

Staff knew the individual needs of people; however, some staff needed appraisal and updated training.

People were able to choose what they ate and drank, with support from staff to help them to maintain a healthy diet. People had access to a range of health care professionals to support their care and the provider had processes in place to ensure regular health checks were undertaken as necessary.

Staff were caring towards people and respected people’s privacy, dignity and independence. People’s needs were assessed and planned so that they received a service that focused on their individual needs and abilities. People were able to raise concerns with staff and managers and felt confident they would be addressed.

Processes were in place to monitor the quality of the service. There had been changes in the staff team, which had unsettled the service, so administrative processes were not as robust as they should be and needed improving.

This inspection was carried out by one inspector. At the time of the inspection there were four people living at the home. Due to their health conditions and complex needs, not all people were able to verbally share their views about the service that they received; so we spent time observing their care in order to understand their experiences. We met with four people who used the service and observed their experiences of care to support our inspection. We spoke with the registered manager, five care staff, two relatives and one health care professional.

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in an environment that was clean and hygienic and met their needs.

At the time of the inspection, there were no Deprivation of Liberty Safeguards procedure in place. Staff had received training, so they knew how to safeguard people at risk of abuse and we saw best interest decisions had been made to protect people from harm and advice given from local safeguarding teams.

One relative also told us that they thought their relative was very safe living at the home.

The provider had emergency procedures in place to keep people safe from harm, these included adequate fire evacuation procedures and missing person’s protocols. There was also quality assurance audits completed to make sure that the building was in good order and safe for people to live in.

Is the service effective?

Some people who were able and all of their relatives, told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well, which meant that people received an effective service. Staff had received adequate training to meet the needs of the people living at the home.

When we spoke to one relative, they told us that the service was very good and had helped to improve their relative’s behaviour since they came to live there. This also showed evidence of an effective service.

Is the service caring?

We asked two relatives if they had any concerns about the care provided by the home and they told us that were happy with the care provided.

Observations during the visit showed staff being compassionate and caring to the people they were supporting. We found good interactions taking place and staff responding in a thoughtful and kind manner.

Is the service responsive?

We could see from care records, that when a person’s needs changed appropriate actions were taken to ensure that needs were met, including for example; arranging for people to see a GP. Activities were organised around what people liked to do, for example; going shopping when they wanted to and we saw evidence of staff quickly responding to requests from one person who wanted to go to the shops to buy toiletries.

When we spoke to the health care professional, they said that they thought the service was responsive to the needs of people living there.

Is the service well-led?

We found a good staff team in place; staff had very good knowledge of the home and what care the service provided to people living there. A quality assurance process was in place to ensure that the quality of the service was maintained and further improved.

Two relatives told us that they were kept regularly updated by the staff team if any changes occurred. One relative told us, “They always seem to have things in hand and know what’s going on with my relative.”

There were four people who lived there on the day of our inspection. We met all four people. Due to their communication needs, people were not able to verbally tell us their views of the service provided at the home. Therefore, we observed how staff supported people and spoke with eight members of staff, the registered manager and the service improvement manager.

Staff had the information they needed to know how to support people to meet their individual needs. We observed that staff knew how to support people in the way they preferred and to meet their individual needs. We saw that people’s healthcare needs had been monitored and met.

We saw that people who lived there were given their medicines as they had been prescribed by their doctor to ensure their healthcare needs were met.

All staff spoken with told us and we saw that staff had the support they needed to safely support people who lived there to ensure their wellbeing.

People and their relatives were asked for their views about the service and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.

We saw that records were accurate and stored safely so that people were protected from the risks of unsafe or inappropriate care.

On the day of our inspection there were four people receiving care and support, there were two people living in each of the homes, our inspection covered both the homes. All of the people had limited or no verbal communication skills and difficulty expressing their wishes clearly. We therefore spent some time observing what life was like for people who lived at each home.

We spoke with three members of staff and the registered manager. We pathway tracked the care of two people, this involved looking at their care records, speaking with them where possible and their relatives to help us understand people's needs. We also spoke with staff and observed care to see how people's needs were being met.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse so that people were protected from the risk of harm.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Staffing levels were adequate to meet people's care needs in a safe and timely manner. We saw staff supporting people according to their level of assessed need.

Systems were in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We found that the four people living at 19-21 Wheelwright Road looked happy and relaxed in the home. Each person had varied complex communication needs. It was therefore difficult to find out what they thought about the service through conversation. We read about how each person spent his or her day. The information available told us that people had a varied day and were encouraged to take part in daily activities of their choosing both in and outside the home.

Our observations of the people living in the home and the interaction we saw between them and care staff showed that people were comfortable living in the home. People were seen to engage easily with care staff and move freely and easily around the home.

At the time of our visit there were no family members visiting the home therefore, we did not get the opportunity to speak to relatives. The manager told us that relatives and other family members visit the home regularly and take an active part in their relatives care. People living in the home also visit their relatives at their homes.