We carried out an unannounced inspection at 2 Cowley Way on 15 November 2016. At the last inspection we found there was a breach in the regulations and we could not be assured that there were enough staff available to support people safely. The provider sent us an action plan that showed how they would make improvements to meet the regulations. At this inspection we found that the required improvements had been made.

The service is registered to provide accommodation and personal care for up to eight people. People who used the service had a learning disability. At the time of our inspection there were eight people who used the service.

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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was unavailable at the time of our inspection, but we were able to speak with the deputy manager.

People were kept safe because staff understood how to recognise possible signs of abuse and the actions they needed to take if people were at risk of harm. People’s risks were assessed in a way that kept them safe whilst promoting their independence.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available to meet people’s needs in a timely manner. The registered manager made changes to staffing levels when people’s needs changed or to accommodate support with accessing the community.

Staff were trained to carry out their role and the provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests where they are unable to do this

for themselves. People’s capacity had been assessed and staff knew how to support people in a way that was in their best interests. We found that where people were able they consented to their care and treatment.

People were supported with their individual nutritional needs and were able to access other health services with support from staff.

People told us and we saw staff were kind and compassionate. Staff treated people with respect, gave choices and listened to what people wanted.

People’s preferences in care were recorded throughout the care plans and we saw that people were supported to be involved in hobbies and interests that were important to them.

The provider had a complaints procedure that was available to people in a format that they understood.

Staff told us that the registered manager was approachable and led the team well. Staff were enthusiastic about their role and what their support meant for people.

People, relatives and staff were encouraged to provide feedback on the service provided. The registered manager had systems in place to assess and monitor the quality of the service provided.

This inspection took place on the 7 October 2015 and was unannounced.

2 Cowley Way provides accommodation and personal care for up to eight people with a learning disability. There were eight people using the service at the time of the inspection.

The registered manager was absent from the service. The deputy manager had been appointed as the acting manager and was in the process of taking over as the manager of the service on a full time basis. 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.

There were insufficient suitably trained staff to keep people safe. Staffing levels had not been assessed based on the needs of people who used the service.

People were protected from abuse as the provider and staff followed the correct procedures when they suspected abuse had taken place. Staff had received training in safeguarding and knew what constituted abuse.

Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to safely store medicines.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) is part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the guidelines of the MCA to ensure that people were not being unlawfully restricted of their liberty and decisions were made in people’s best interests.

People and their representatives were involved in decisions relating to their care, treatment and support.

People were supported to have a healthy diet dependent on their assessed individual needs.

People had access to a range of health professionals and staff supported people to attend health appointments when necessary.

People were treated with kindness and compassion and their privacy was respected.

People had opportunities to be involved in the community and to participate in hobbies and interests of their choice; however these were limited to weekdays as there were insufficient staff to support people at the weekends.

Staff felt supported to fulfil their role effectively through regular support and supervision and training applicable to their role.

The provider had systems in place to monitor the quality of the service and an on-going improvement plan was in place. However the provider had not identified through their monitoring systems that there were insufficient staff to safely meet the needs of people who used the service.

We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

This inspection was carried out by a CQC inspector. We spoke with five people who used the service, two relatives, three members of staff and the registered manager. We also reviewed records relating to the management of the home, which included three care records, daily activity logs, incident reports, staff training records, medication records and minutes of staff and service user meetings. We used the information to answer the five questions we always ask:

Is the service safe?

There was a system in place to make sure that the manager and staff learned from events such as accidents, incidents, complaints, concerns and investigations. We saw that lessons had been learned in some of these areas. This reduced the risks to people and helped the service to continually improve. The provider closely monitored the operation and safety of the service.

A safe system of medication was in place. Medication had been appropriately stored, recorded and administered. Staff received training and regular competency tests by the manager to ensure that medication was given correctly and safely.

We saw detailed care records outlining people's needs and the actions needed to ensure they were safe. Some people could become distressed and agitated, presenting a potential threat to themselves or others. Behaviour management plans were in place to manage these situations. Diversionary actions had been successful in avoiding an escalation of behaviours.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. The service had procedures in place and the manager knew how to apply for this authorisation. A recent application had been made in relation to DoLS. The service were awaiting a decision from the best interests team of the local authority. No one at the time of our inspection was subject to DoLS.

Is the service effective?

People's health and care needs were assessed with them. They had been involved in care planning and establishing care and treatment plans. Goals had been set with people and reviewed quarterly. Monthly reviews had monitored progress and the actions needed to ensure people's goals and objectives had been met.

People told us that they were happy with the care they received and felt that their needs were being met. This confirmed what we had seen in care records. There was a relaxed and positive atmosphere. We observed good engagement and relationships between staff and all people using the service. A relative told us, "X was really ill last year and needed surgery. The staff were marvellous. They brought X through it. I can't praise them enough."

Is the service caring?

We found that people and staff treated each other with mutual respect. Staff gave us examples of how they ensured privacy and dignity for people. We saw in a person's care record that doors and curtains could be used to provide privacy and dignity.

People were listened to. We saw people approach staff in a relaxed way. Responses were positive and supportive. We saw people sitting with staff and having individual conversations. Some people sat in the office and chatted to staff, they did not need a reason to do this.

People who used the service completed an annual questionnaire. They recorded high scores for questions that included: Do you like the way staff treat you? Do staff listen when you have something to say? Do staff treat you like an equal?

Is the service responsive?

People undertook activities and had contacts with relatives and friends that were important to them. Staff supported them to maintain contact with people. People were encouraged to use public transport, taxis or the provider's transport to visit relatives and friends. A relative told us, "Every week X comes to visit me for the day. I then visit (them). The contact is important to us both."

People's health care needs had been monitored closely. When changes occurred external health care professionals had been contacted. We saw their advice and treatment plans in the records we examined. For example we saw daily exercises for a person that had been recommended by a physiotherapist. Staff had given daily encouragement to the person to exercise.

Is the service well-led?

People told us that the manager and staff were approachable and helpful. Staff told us they could approach managers at any time including out of hours contacts with on-call managers.

Systems were in place to monitor the quality of the service. Information from incidents and accidents had been analysed and used to identify changes and improvements to minimise the risk of them happening again. Action was taken to improve the quality of service, correct any shortfalls and act on concerns raised.

Regular staff meetings had been held. Staff told us they had been able to raise any concerns. They confirmed that regular supervision and appraisals were part of the support they received. We noted a commitment and pride in their work from the manager and staff we spoke with.

We spent time watching how care and support was provided and how staff communicated with people. Everyone received the same caring response from care staff and were included in the activities and conversations taking place. One person told us how they come to live in the home and told us, “It is a much better and happier place than where I was before.” Another person told us, “We all get on great. We are friends.”

A relative who visited the home regularly told us that they had no concerns about people’s safety or welfare. They told us that people were supported to enjoy life as much as possible. They said, “I know he is happy and looked after.”

Every person had an individual plan of care, based on their learning disability and other health needs. During our inspection, everybody received unhurried care and support, at the time they needed it.

The home had a stable staff team, which ensured people were familiar with the staff supporting them. All the staff we spoke with were positive about working at the home. The training of staff ensured staff had the skills and knowledge to support people effectively and keep them safe. We found that adequate background checks had been completed as part of the recruitment of staff.

We found that important records about the care and support provided to people were complete and up to date.

We saw that eight people lived at the house. Four had rooms on the first floor and four on the ground floor. Each floor had its own bedrooms, lounge and kitchen. People could move freely between the floors and meet with each other. Staff on each floor also moved between the units assisting in each area.

We spoke with most of the people who lived there; two people showed us their rooms and spoke privately with us.

When we arrived at 10.30am people were involved in a range of personal activities. Playing on a games machine, cleaning the house, or just sitting listening to music. There was a relaxed homely atmosphere.

Details of the registered manager for this location do not appear in this report as the administrative process was still to be finalised. Miss Becky Whelan was in the process of registering but her details were not yet recorded on our system.

We carried out this review to check on the care and welfare of people using this service as we had not visited for sometime. We needed to assess whether the service was meeting the essential standards of quality and safety.

Eight people live in this detached house. Four on each of the two floors of the building, providing a small group experience, each part operating independently although both people using the service and staff do move between the two floors. There is plenty of living space that is comfortable and well-equipped.

People were able to to tell us about living at Cowley Way, we spoke with all eight people. They told us their plans for the day that included visiting a nearby social group where they had lunch. We saw a schedule of activities for the week and talked to people about this.

When we arrived at 8.30 am people were busy rising, having breakfast and some having showers. Some people were able to make drinks and assist with preparing breakfast, others were not and were supported by staff. There were two staff on duty and it was a busy time, but people were following their usual routines. During the morning three other staff arrived at different times, clearly well planned as some people were going to the social event another had an hospital appointment and some people remained at home.

We spoke with a visitor who told us that their relative had been at Cowley Way for 10 years. The relative said "Three of us visit regularly at different times but (our relative) is always well cared for, staff are really good they tell us if they are concerned about anything and we have no complaints about the home at all".

The visitor gave us an example saying their relative was not able to communicate verbally, but more than able to in other ways and had indicated that they were in pain. The relative said that this had been pursued, the family informed, an X-ray arranged that had indicated possible muscular origin and pain relief had been prescribed.

Three people showed us their bedrooms and said they liked their rooms and we were able to see they were personalised reflecting the individuality and interests of each person.

During our visit we identified some concerns relating to medication and healthcare management.