This inspection took place on 21 November 2016 and was unannounced. At our previous inspection in June 2016 we found the provider was in breach of several Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as care being delivered was not safe, effective, caring, responsive or well led. We had rated the service as Inadequate and placed it into special measures. At this inspection we found that improvements had been made in all areas and the provider was no longer in breach of any Regulations and therefore will be taken out of special measures.

34-36 Porthill Bank provides accommodation and personal care for up to six people with a learning disability. At the time of this inspection four people were using the service.

There was a new manager in post who was in the process of registering with us. 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 were safeguarded from the risk of abuse as the manager and staff knew what to do if they suspected someone had been abused. Incidents of alleged abuse were being referred to the local safeguarding authority for investigation.

There were sufficient suitably trained staff to safely meet the needs of people who used the service. They had been recruited using safe recruitment procedures to ensure they were of good character and fit to work with people.

Risks of harm to people were assessed and minimised through effective use of risk assessments. Staff knew people's risk and how to keep them safe.

The principles of the Mental Capacity Act 2005 were being followed as people were consenting to or being supported to consent their care.

People were supported to maintain a healthy diet and staff sought medical advice if people's health care needs changed. The manager and staff worked alongside other health care professionals to ensure people's physical and mental health care needs were met.

Staff were supervised, supported and received training to be effective in their roles.

People were treated with dignity and respect and their right to privacy was upheld. People were able to spend time alone whist maintaining their safety.

People were receiving care that met their individual needs and preferences. People were supported to be involved in the community and participate in hobbies and activities of their choice.

There was a complaints procedure and people's relatives knew how and who to report their concerns to and they had confidence they would be acted upon.

The systems in place to monitor and improve the service were effective. There was a plan for continuous improvement.

This inspection took place on the 27 June 2016 and was unannounced. At our previous inspection in 2013 we had no concerns in the areas we inspected. At this inspection we had concerns that the service was not safe, effective, caring, responsive and well led. We fed back our concerns to the provider and reported them to the local authority. We have judged this service as Inadequate and placed it into 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months.

34-36 Porthill bank provides accommodation and personal care to up to six people with a learning disability, autism and associated challenging behaviours. At the time of the inspection six people were using the service.

There was no registered manager. The manager had recently left prior to registering with us. 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 who used the service were not safeguarded from abuse as incidents of abuse had not been reported to the local authority for investigation. Some incidents of abuse had not been recognised and no action had been taken to minimise the risk of further incidents.

There were insufficient suitably experienced staff to safely meet the needs of people. Care staff were being required to provide one to one care to people and complete management duties.

The provider had recruitment procedures in place although we were unable to clarify if appropriate references had been gained prior to employment.

Risks were not reviewed and assessed to ensure that risk of harm to people were minimised following incidents of harm.

People did not always receive health care support in a timely manner. When people complained of being unwell support was not always gained.

People were supported to maintain a healthy diet.

Staff did not feel supported to fulfil their role effectively and had received no formal supervision or competency checks.

The provider did not consistently follow the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care, treatment and support.

People were not always treated with dignity and respect. Care staff lacked clear leadership and a culture of poor staff practise had developed.

Staff did not always have the information they needed to be able to meet people's individual needs. People did not always receive care that personalised and met their individual preferences.

Compl

There were six people using the service and we spoke with five of them. All spoke positively and enthusiastically about the service. One person said, "Yes I like living here, I choose the places I want to go to". Another person said, "I like the staff they are good and we have some good times" and "I have settled well here, I have no complaints". A relative told us, "X loves the place and adores the staff, it is a fantastic place".

We found that people were involved in all aspects of planning and reviewing their care and treatment plans. People made choices about how they spent their time and how they were supported by staff to achieve their goals and promote their independence.

We saw that people's care records contained detailed information about their needs and they had access to a range of health and social care professionals. Care and treatment was planned in a way that ensured each person's safety and wellbeing. People were supported to achieve independence.

We found that suitable arrangements were in place to protect people from abuse or harm.

There was a system in place to ensure that people were protected against the risks associated with medicines. We found that people were receiving medicines safely and as prescribed.

We found that correct recruitment checks had been carried out before staff commenced work. This ensures that people were protected from potential harm.

We spoke with three people who used the service and we spoke with their families. We spoke with three staff and the registered manager and her deputy about how the service was delivered and the quality of service provision. The people who used the service needed differing degrees of assistance with their personal care. Some people who used the service had challenging behaviour.

We observed the routines and daily activities were flexible and staff responded to people's needs. Some people were supported on an individual basis to ensure they were safe and had access to activities in the home and the community.

People received care and support that met their individual needs. People had care records which had been written in a style that people understood, and people told us they had decided how they wanted to be supported.

We checked the cleanliness of the home and spoke to staff and relatives about cleaning routines and infection control.

We checked records to help us see if people had the care they needed, and records to show that the home was kept clean and safe.

We saw that there was a complaints procedure and people were supported to use it.

The young adults in the home seemed comfortable and confident in expressing their individual views and choices. The service recently introduced ‘Listen to me’ workbooks for each person when they are assisted by staff to express their thoughts on a range of issues important to them. We looked at these workbooks with two of the people using the service. Also recently introduced was an ‘Essential Lifestyle Plan’, pictorial and involving users in daily planning and recording. People were aware of the purpose and importance of their involvement in this process and showed pride of ownership and knowledge of the documents we looked at.

People using the service told us about their interests and activities, including attending college and their regular ‘parties’ when they invited their friends and relatives. One person excitedly told us about a recent holiday in Prestatyn, supported by staff and talked about her regular visits by her mother and how important they were to her.

Two young people told us about their established relationship and how they enjoy spending time together and the different interests they pursued. They were keen to let us know that they were “boyfriend and girlfriend”.

An integral part of the new workbooks for everyone including Lifestyle Plan and Listen to Me, include decisions about consent to care and treatment. Involvement of other professionals including learning disability specialists and physical health care personnel are recorded. There is evidence that the involvement of specialists and purpose of their involvement are discussed with the individual. These documents record the discussions about care and actual or implied consent to care and treatment.

All people using the service have individual care planning information outlining their comprehensive needs. We explored care plans with two people who had awareness of the detail and reasons for keeping personal information. They were able to talk to us about the introduction of the new work books recording their individual needs and daily activity programmes and the way they were involved in them. There were five page daily entries in pictorial form recording:’ What we like to do. Activities completed, What else happened? Social contacts and events’. People are fully involved in making these daily choices, the outcomes and events arising from them.

People using the service spoke to us about external professionals being involved with them and were able to tell us the purpose of their involvement

In the afternoon of this inspection visit a resident arrived home from college, becoming very animated and threatening in his behaviour outside the house. Staff went outside, calmly re-assuring him and finally persuading him to come into the house They listened and gave supportive moves and comments, resulting in the person becoming calmer after some time and eventually no threat to anyone else.

This was a good example of diversionary tactics being used to reassure and de-escalate the situation avoiding potential physical threats to other people without the need for physical restraint.