We carried out this unannounced inspection of Champions Place on 6 December 2018. Champions Place is registered to provide accommodation with personal care for up to 14 people with a physical or learning disability. At the time of our visit 11 people lived at the service.

This service was set up and registered prior to Building the Right Support and Registering the Right Support and it is not the type or size of service we would be registering if the application to register was made to CQC today. This is because it does not conform to the guidance as it is very difficult for large services for people with autism to meet the standards.

There was a registered manager in post. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run. The registered manager assisted us with our inspection.

We last inspected Champions Place in May 2018 when we rated the service Inadequate. This was because we found restrictive, institutionalised practices taking place and a lack of respect being shown to people. There were insufficient staff to care for people and a failure to recognise incidents of abuse. Poor medicines management practices were taking place and there was a lack of information about potential risks to people. People’s care plans did not demonstrate person-centred care planning and the management oversight of the service was not robust. In addition, we found the registered manager was not meeting the requirements of registration as they had failed to notify us of significant incidents.

Following this inspection, we placed the service into Special Measures and we asked the registered provider to send us an action plan to demonstrate how they planned to address the shortfalls. We carried out this inspection to check that they had taken the appropriate steps to follow their action plan. We found significant improvements in the service overall and it was clear from people’s behaviours that they were more relaxed and happy living at Champions Place.

Processes in relation to medicines management had improved, however we identified some shortfalls that required further work. Although improvement was seen in following the principles of the Mental Capacity Act 2005, further work was needed to ensure that legal guidelines were being adhered to.

People were cared for by staff who showed a kind, caring, attentive and respectful approach towards them. People were encouraged in their independence, making their own decisions and supported to maintain relationships that were important to them.

People were being cared for by a sufficient number of staff who had been recruited through an appropriate process. People were protected from the potential risk of harm or abuse as staff were aware of their responsibilities in this respect and there was guidance in place for staff. In the event people had an accident or incident, this was recorded and appropriate action taken in response.

People lived in an environment that was checked for its safety and was clean and suitable for people’s needs. People’s needs were assessed and reviewed and where they required the input of a healthcare professional, this was provided for them.

Staff were competent in their role and worked well together as a team. They had access to training and supervision.

People could choose their favourite foods and they were encouraged to be more independent during mealtimes. Where people had specific dietary requirements, these were recognised and appropriate action taken.

Person-centred care planning had improved. There was a new care plan format in place which was a work in progress and information around people’s end of life wishes needed to be included.

People had the opportunity to access more activities in line with

This inspection took place on 7 and 8 February 2017. The first day was unannounced and the second day was announced.

Champions Place is a residential care home that provides accommodation and support for a maximum of 14 adults with a learning disability. People who live at the home have mild to moderate learning disabilities, Down’s Syndrome or autism. At the time of this inspection there were nine people living at the home whose age ranged from 35 to 86.

People had varied communication needs and abilities. Some people were able to hold conversations, others could express themselves verbally using one or two words; others used body language and gestures to communicate their needs. Everyone who lived at the home required support from staff for all aspects of their life including emotional and physical support.

During our inspection the registered manager was present. 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 and associated Regulations about how the service is run.

Quality assurance audits and checks were completed but had not ensured quality standards were maintained and legislation complied with. Aspects of the provider’s quality assurance policy were not being followed. You can see what action we told the provider to take at the back of the full version of the report.

There were infection control policies and procedures in place but these had not ensured all aspects of the service promoted effective infection control. You can see what action we told the provider to take at the back of the full version of the report.

People’s legal rights to consent were not upheld. Mental capacity assessments and DoLS applications had not been made when required. You can see what action we told the provider to take at the back of the full version of the report.

People’s rights to privacy and dignity were not always promoted as a shower used by one person was located in a store room. Everyone’s medicines were stored the same person’s bedroom and they were unable to consent to this. You can see what action we told the provider to take at the back of the full version of the report.

Formal processes for actively involving people in making decisions about their care and treatment were either not in place or used inconsistently. Information was not routinely provided to people in formats they could understand. You can see what action we told the provider to take at the back of the full version of the report.

Care records gave descriptions of people’s needs and the support staff should give to meet these. However, recommendations from a professional were not acted upon for one person when their needs changed. You can see what action we told the provider to take at the back of the full version of the report.

Staff were available for people when they needed support in the home and when they wanted to participate in activities outside of the home. However, a formal dependency assessment was not used to decide staffing levels. We have made a recommendation about this in the main body of our report. Robust recruitment procedures were followed to ensure staff were safe to work with people.

A monitored dosage system (MDS) was used to help ensure people received the correct amount of medicine at the right time. Some information about medicines was located in different parts of the home and meant that staff might not be able to access this quickly if needed. We have made a recommendation about this in the main body of our report.

People were supported to access healthcare services and to maintain good health. People had enough to eat and drink throughout the day to help them stay healthy.

There was a stable staff group employed at the home and this helped build positive relationships with people. People appeared v

We carried out an unannounced comprehensive inspection of this service on 12 and 17 November 2014 when we found breaches of legal requirements. Following this inspection the provider wrote to us to say what they would do in order to meet legal requirements in ensuring people were kept safe and treated by staff in a respectful and dignified way.

We undertook this unannounced focussed inspection on 4 March 2015 to check the provider had followed their plan and to confirm they were meeting the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Champions Place on our website at www.cqc.org.uk.

People were protected from the potential risk of using equipment or accessing areas of the home which may cause them harm. The registered manager had carried out risk assessments for people in relation to the kitchen area which contained a hot water urn. These were contained in people’s care plans for staff to follow.

The registered manager had purchased a different type of sling for the hoist used by staff, which meant people’s dignity was upheld. The provider had taken appropriate action to ensure people’s privacy was protected when they used the bathroom or shower, and staff equipment stored in one person’s bedroom had been removed.

Staff were heard to speak to people in an appropriate manner during our visit and the registered manager told us (and staff confirmed) they had received recent dignity training.

The provider had taken all necessary actions to ensure they had addressed the breaches in regulation and we found them to be compliant in all areas.

This inspection was carried out to review the quality and standard of care provided at Champions Place and to follow-up on the findings from our previous inspection of 15 March 2013 to assess if action had been taken with regards to the concerns we highlighted.

People who used the service spoke positively about the care they received. We spoke with five of the eleven people who lived at Champions Place. Comments included “I am well looked after”, “The girls (staff) are lovely” and “I wouldn’t like to live anywhere else”.

We also spoke with Care Managers who are Social Care Professionals responsible for placing and supporting people in social care settings. One Care Manager said "I could only best describe the care as very good. They (the service) meet the needs of my client” and “I have no concerns about this service".

Where people's health or care needs had changed, the service had responded by re-assessing their needs to ensure the caredelivered was effective.

We found the home was in a good state of repair and the patio to the rear of the property had been improved.

Windows on the first floor had been fitted with restrictors which meant windows could not be fully opened therefore safeguarding people from the risks of falling.

We found that recruitment processes were in place and staff files contained the relevant information as required by the Health and Social Care Act.

People who used the service told us that they "very much enjoyed living at Champions Place". We saw that people were encouraged to be as independent as their own abilities allowed them. Staff were seen to interact well with people. One person said "the staff are so lovely". We found that people who used the service were clean, well groomed and well dressed. The home was clean and tidy.

There were systems in place for staff to seek consent from people before care or treatment was carried out. Where people lacked the capacity to make decisions, we found that the manager took steps to organise best interest meetings to ensure that appropriate decisions were made for individuals.

The service had their own internal adult safeguarding policy and staff also had access to the Surrey Multi-Agency Adult Protection document. Staff had a good understanding of adult protection and could identify the various types of abuse. Staff knew how to escalate their concerns to the appropriate authorities.

We found that whilst the inside of the home was in a good state of repair, the patio to the rear of the property was in a poor condition and presented a trip hazard to people. We also found that windows on the first floor did not have restrictors which meant windows could be fully opened. We have asked the provider to make improvements.

We found that recruitment processes were in place but staff files had missing information. We have asked the provider to make improvements.

Five people who use the service were able to tell us about their views of the service. Each person said they liked living at the home, were happy and spoke very positively about living there.

Champions Place is a residential home which provides care and accommodation for up to 19 older adults with mild to moderate learning difficulties, Down syndrome or Autism. The service provides personal care and support both within and outside of the home to enable people to live as independent a life as possible. The home, which is set over three floors, is located in extensive grounds. There is a dining and lounge area on the ground floor, together with an activities room and a level garden to the rear of the building. On the day of our inspection12 people were living in the home.

This inspection took place on 12 and 17 November 2014 and was unannounced.

The home is run by a registered manager, who was present on the day of the 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 and associated Regulations about how the service is run.

Although people told us they felt safe and staff had written information about risks to people and how to manage these, we found the registered manager needed to consider additional risks to people in relation to the kitchen and how to ensure people were safe when accessing it.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. The provider carried out appropriate checks on staff to help ensure they employed suitable people to work in the home.

Care was provided to people by a sufficient number of staff who were trained and supported to keep people safe. People did not have to wait to be assisted. One relative told us, “There are always staff around.”

Medicines were managed effectively and staff ensured people received the medicines they required in the correct dosage at the right time.

Staff were provided with the correct knowledge to provide effective care. For example, staff had undertaken training in dementia associated with people with Down syndrome.

The registered manager and staff explained their understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They currently had no one living at the service who was restricted in any way.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We heard how relatives could join their family member for lunch if they wished. People felt the food was good and were seen to enjoy their lunch and dinner.

We read in people’s care plans staff ensured people had access to healthcare professionals when needed. For example, the doctor or optician.

People appeared happy and relaxed and were enjoying each other’s company. It was evident staff knew people well and had developed caring relationships with people. However, we observed a couple of occasions where staff did not act in a respectful way towards people. People were not always provided with the dignity and privacy they should expect.

Care plans were individualised and contained information to guide staff on how someone wished to be cared for. Care plans were reviewed regularly and relatives were happy for staff to make decisions in the best interest of their family member. For example, one relative told us, “I am happy to let staff do what they think is best as they are with her 24 hours a day.”

People had personalised care responsive to their needs. For example, one person was moved to another bedroom to enable them to remain as independent as possible. Another person, had equipment to enable them to move around the home in a safe way.

Complaint procedures were accessible to people and people where reminded on how to make a complaint. Relatives told us they had never needed to make a complaint but knew they could speak to the registered manager if they needed to.

We saw examples of activities undertaken by people displayed around the home. We heard of the ways in which staff supported and enabled people to maintain their independence and keep up their individual hobbies and interests to reduce the risk of social isolation.

People were helped to complete regular satisfaction questionnaires to express their views on the care and support they received.

The registered manager told us how they were involved in the day to day running of the home. This was supported by our observations and staff comments. One staff member told us, “The (registered) manager is always around.”

Staff were encouraged to develop professionally and progress in order to improve their skills and working practice. Staff meetings were held on a regular basis and staff told us they felt they could speak openly at these meetings.

The provider had quality assurance systems in place to audit the home. This included regular audits on health and safety and care plans. The home had recently had a medicines audit by the local pharmacy. The registered manager met CQC registration requirements by sending in notifications when appropriate.

During the inspection we found a breach of Regulation 17 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 the report in relation to the breaches in regulation.