68 West Park Road provides residential care and support for up to fourteen people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were twelve people living in the home. At the last inspection in March 2015, the service was rated Good. At this inspection we judged that the service provided remained Good.

Staff knew the procedures they should follow to ensure people did not suffer harm or abuse. People were supported by enough staff to ensure their complex needs and lifestyle could be supported safely. Procedures were followed to ensure staff were recruited safely. Staff had been trained to support people with their medicines and most checks on medicines were accurate.

People were supported by staff who had been trained to meet their specific needs. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received the support they needed to maintain their health and access health professionals. People had control over what they ate and drank with support to help them do so independently.

People had benefitted from phased introductions to staff which had enabled them to build positive relations with the staff who supported them. Staff demonstrated a thorough knowledge of people’s needs and desires and used this well to support them with their lifestyle.

People had been actively involved in developing social opportunities within the local community which had been tailored to their needs and preferences. People were supported to develop their independence and skills to support their goal of moving on to independent living. Each person had been involved in identifying and developing plans which reflected their personal goals and aspirations.

We received positive feedback that the home was well run. The provider had ensured the on going quality of the service by developing their facilities and opportunities for people. The provider worked with a number of other organisations to support people transitioning into or out of the home. This provided assurance that the service remained good, and that the service was meeting people's needs.

At our last inspection in July 2014 the provider was not meeting all of the regulations that we assessed. The breaches of regulations related mostly to record keeping. This inspection found that although some work was on-going sufficient improvements had been made.

A manager was registered with us as is required by law. 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.

Staff followed the provider’s procedures to ensure the risk of harm to people was reduced and that people received care and support in a safe way. We found that where people received support from staff with taking prescribed medicines, this was done in a way that minimised any risk to them.

People and their relatives told us that staff were available to meet their [or their family members] individual needs. We found that staff were trained and competent to support the people who lived there effectively and safely. Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager had referred people to the local authority where they felt a DoLS issue needed to be assessed.

People’s health and welfare needs were assessed and met by a range of external health and social care professionals. We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered.

People were supported to consume the food and drinks that they preferred in sufficient quantities to prevent malnutrition and dehydration.

We found that staff were kind and caring and gave people the time and attention they needed. Staff knew the importance of promoting people’s privacy and dignity.

Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks and attend to their own personal hygiene needs.

People were encouraged and supported to partake in a range of recreational activities which they chose and enjoyed. Staff supported people to keep in contact with their family as this was important to them.

Systems were in place for people and their relatives to raise their concerns or complaints.

People we spoke with told us that the quality of service was good. This was confirmed by the relatives we spoke with. The management of the service was stable, with processes in place to monitor the quality of the service.

We carried out an inspection on the 16 September 2013 and found that the provider was not meeting the regulations for assessing and monitoring the quality of service provision and records. The provider wrote to us and told us what actions they were going to take to improve. On our inspection of the 15 July 2014 we looked to see what actions had been taken.

From our previous inspection some action had been taken to improve the service to people. However, there are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were 11 people living at the home on the day of the inspection. We were not able to speak with people as they were unable to verbally express their views so we observed where we could how people were supported and how staff interacted with them. During our inspection we spoke with three members of staff who supported people, two relatives and the manager who had been employed since our last inspection and was supporting the inspection process. We looked at three people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the provider had a system in place to ensure newly recruited staff were suitable to work with vulnerable adults. The provider also had in place a risk assessment process to ensure that staff continued to be suitable. This meant that people could be confident that staff were being appropriately checked.

Relatives told us they felt people were safe living in the home. One relative said, "He is definitely safe". Staff we spoke with were able to explain how they would keep people safe and who they would report concern to. This meant that people had the appropriate knowledge to ensure people were safe from harm.

We found that where risk assessments were needed to ensure the safety of people they were in place.

We found that an application under the Deprivation of Liberty Safeguards (DoLS) was in place to ensure the person affected was being supported in their best interest. There was a reviewing process in place as part of ensuring the person who liberty was being deprived was still appropriate. Training records showed that not all staff had received the appropriate training in the (DoLS) or the Mental Capacity Act (MCA). The staff we spoke with were aware of the application in place for the person who was being restricted and were able to explain this. However one member of staff was unable to explain in any way what DoLS or MCA was and its impact on people. The manager confirmed that some staff were still awaiting training.

We found from our previous inspection that people's finances were not being audited regularly. Evidence we saw at this inspection showed that the balance total on one persons account was in correct and staff were not always signing when they accessed people's monies. This meant there had been no improvement since our last inspection.

We discussed with the provider two safeguarding alert that was being investigated. The manager confirmed both investigation had been concluded and were found to be unsubstantiated.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.

Is the service effective?

We looked at three people's care records and found that pre-admission assessments were not in place to identify their support needs. We saw that support plans were in place and the provider was using specific support plans to identify how people with diabetes should be supported by staff. Staff we spoke with were able to describe the needs of people. This meant that people could be assured that staff would know how what their support needs were.

Care records showed that the need to see a health professional like a dentist or optician was highlighted in people's health action plans. However there was no evidence to show that people were having access to dentist, opticians and chiropodists where needed. We saw blank appointment forms that had not been completed. The manager told us that people were able to see their doctor or other health professionals when needed, these appointments were just not being recorded as they should have been. This meant that documents were not being completed sufficiently or accurately to reflect the support people were receiving.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

Relatives we spoke with told us that staff supported people appropriately and that they were caring. People were unable to share their views with us directly due to their complex support needs but we observed staff interacting with people. People were comfortable and happy around staff. This meant that people were happy and secure in how staff supported them.

We spoke to staff who had a good understanding of the people who they cared for and they were able to explain their support needs. We saw staff support people on an individualised basis. On the day of our inspection we went on a tour of the home and visited people being supported on a one to one basis in their flats by staff. The people we saw were happy and even where some people were being supported by two staff, due to their complex health needs, our observations were that people were happy and relaxed and interacting with staff. This meant that people needs were being met appropriately.

People were supported to go shopping and on trips. This was highlighted in their support plan. One person who had been out to the shops came back and gave the impression they were happy to have gone out and gestured they wanted to go back out. This meant that people were able to go out when they wanted with support from staff.

Is the service responsive?

The manager had recently been employed and was very responsive to the concerns we highlighted. The manager discussed with us the actions that had already been taken and the actions to be taken as part of improving the service. The manager recognised that there were still improvements to be made.

We found that since our last inspection there was evidence that 'relative's meetings' were now taking place on a regular basis. This meant that relatives had the opportunity to share any concerns they had with the manager.

Is the service well-led?

In this report there is the name of the registered manager Mrs Yvonne Whitehouse who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still identified as the registered manager on our register at the time.

The service was managed by a registered manager who was supportive throughout the inspection. Evidence we saw showed that where the manager needed to act in people's best interest this was being done. This meant that people could be confident that where needed their interest would be an important part of the support they received.

We found that there were systems in place to support the learning from events like accidents, incidents and complaints. The relatives we spoke with told us they would speak with the manager if they had a complaint. We saw that the complaints process was displayed and this meant this information was available for visitors to view.

We found from our previous inspection that medication audits were not being carried out to ensure medicines were being administered safely. We saw no evidence of these audits being carried out at this inspection, which meant the provider had failed to make the necessary improvements.

On the day of our inspection there were nine people living at the home, we spoke with four people. Some people were unable to verbally share with us their views about their care due to their individual needs. We used different ways to evidence their experiences such as observing care, looking at their records and speaking with staff. Following our inspection we conducted telephone interviews with three relatives.

At the time of inspection the registered manager had left their post. We spoke with the service manager who was responsible for the running of the service, the deputy manager and four members of staff.

Care was person centred, planned and delivered to ensure people's safety and welfare. One person told us, “We get a choice in what we do, I like to go shopping and swimming".

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

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "The staff are nice and help me when I need it".

Systems were in place for the on-going monitoring of the quality of service. However, a lack of analysis meant that the provider may not identify themes and trends in order to learn and improve from the findings

A lack of detail and inconsistencies in record keeping meant that people were not protected from the risks of unsafe or inappropriate care.

On the day of our inspection there were seven people living at the home. Some 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 the home. We spoke with three members of staff and the registered manager. We pathway tracked three people to see how their care needs where being met.

People told us that they were afforded dignity and respect and their independence was promoted. One person that we spoke with told us, "Staff always knock on my door".

Care was person centred so that people received care in the way that they preferred. However the lack of relevant and consistent information meant that care was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

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 were cared for by staff who were supported to deliver safe care and treatment.

Comments and complaints people made were responded to appropriately. One person that we spoke with said, "I am happy with everything".

We met with a number of people living at the home and saw that they looked clean and well. They were appropriately dressed as to reflect their age and gender. None of the people living at West Park Road showed any concerns or reservations when it came to communicating with us or the staff on duty at the home. We saw positive interactions between people and staff members.

A number of the people living at the home were out in the community with staff at the time of our visit, and another told us that they were getting ready to go shopping with staff. They said they were looking forward to this.

People that we talked with told us that they were happy living at West Park Road one saying “Alright – happy here”. We have heard from social services that one person remains satisfied with their placement at the home.

We looked at people’s individual care plans and where possible checked out with people, if these plans were accurate. We also spoke to a number of staff about their understanding of how people wanted to be supported, as detailed in their plans.

Based on these discussions and observations during the time we visited, we found these plans to reflect people’s preferences and support needs. One person told us that staff had talked through their plan with them although they could not remember it all. They did say their support was provided in a way that agreed with their likes and dislikes.

Some people told us about what they like to do and said they have choices available to them. One person told us tasks they did within the home that helped them be more independent such as preparing lunch. One person told us that if they need anything they only need to ask staff and they will get it. They also said that they get on well with staff.

We heard from people and the provider earlier in the year that there had been a number of alleged or actual incidents that had compromised people's safety or well being. These incidents have been the subject of on going investigation by the local authority with co-operation by the provider.

Staff told us at the time of our previous visit that they had whistle blown on bad practice by other staff to protect people living at the home. We spoke to staff on our visit, who also stated they would do the same.

Involvement from other statutory agencies since the time of our last review has indicated that people are now safer at the home. There have been some further safeguarding alerts since the time of our last visit. These have been reported to us and social services more promptly. The service is more responsive in ensuring issues are addressed than was the case earlier this year.

People we spoke to told us that they feel safe at the home. We saw that one person was anxious and made reference to not liking a member of staff. Based on records we saw, this is common occurrence for that person as stated in their behaviour management plan. We saw that the staff member present did not assume this was just a routine part of their behaviour patterns, and we saw that they explored with the person as to whether they wished to take this matter further.

We also saw the staff have encouraged people to be aware of how to raise concerns through producing more user friendly complaints procedures. These were signed by people where they were able to do so.

At the time of our last review of the home, we had concerns that medicines had not always been handled safely, securely or appropriately. This concern was partly based on what the provider told us. The management of the home informed us that they would continue to audit and monitor medication on a weekly basis. They have since forwarded copies of action plans so we have been aware of their progress towards compliance. They have told us that management of medication is much safer.

At the time of our last review staff told us that their morale and confidence in previous management was low.

They have told us when we spoke to them that morale is much improved and they feel that the support they provide for people is far more effective and consistent.

We met with five out of the nine people that live at West Park Road. Other people we heard were out with staff, this due to involvement with planned activities or health appointments. All the people who use services that we met looked clean and well dressed, reflecting their age and gender. None of the people living at West Park showed any concerns or reservations when it came to communicating with the inspector or the staff on duty at the home. Two of the people we met communicate by signing. We observed that some staff are using appropriate communication techniques such as signing; this meaning it is possible for people to communicate their views.

One person living at the home showed us their bedroom and told us what activities they enjoy. They showed us their favourite X box games and the range of audio and visual equipment they had for their own personal use. They told us how the bedrooms décor reflected their personal likes and interests.

We saw people living at the home have involvement in domestic routines such as doing their own washing, and have access to appropriate equipment to allow this.

Only one person that we spoke to had any dissatisfaction, these centring on a wish to live independently in the community, although they had changed their mind about this later in the day. They also expressed dissatisfaction about staff restricting access to their cigarettes.

We saw that an individual at the home was able to say what they thought about things that were important to them, so as to plan changes that were agreeable to them.

We saw that there is ample space in the building so that people living there have ready access to their own space when they want this.

The provider has made us aware that there have been a number of alleged or actual incidents that have compromised people’s safety or well being. The local authority has also confirmed that there are a number of allegations that are to be investigated and we have heard that people at the home have spoken about abusive practices to professional visitors. Staff told us they have whistle blown on bad practice by their peers to protect people living at the home.

Professionals who have visited the home recently have told us that people living at the home are safe.

People we spoke to told us that staff give them their medication as needed.

Staff told us that they are positive about changes which they hope will improve the service to the benefit of people living there.