We carried out an announced inspection of the service on 1 December 2016. Christie Development Centre is registered to provide accommodation for up to ten people who require nursing or personal care, some of whom may be living with a learning disability. At the time of the inspection there were ten people living at the home.

On the day of our inspection there was a registered manager in place. 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.

During our previous inspection on the 23 and 24 April 2015 we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the failure of the registered manager to be able to provide records requested during the inspection. These records were the mental capacity assessments carried out for people who were unable to make their own decisions about complex issues regarding their care and support needs.

During this inspection we found improvements had been made. The registered manager now ensured the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. The registered manager was aware of the requirements to apply for and implement Deprivation of Liberty Safeguards where required.

People were encouraged to lead a healthy and balanced lifestyle and where able, were supported to buy and cook their own food. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

People were supported by staff who received an induction, were well trained and received regular assessments of their work. People felt staff understood how to support them effectively.

The risks to people’s safety were reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Risk assessments had been completed in areas where people’s safety could be at risk. People had the freedom to live their lives as they wanted to. Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe.

Accidents and incidents were investigated. Assessments of the risks associated with the environment which people lived were carried out and people had personal emergency evacuation plans (PEEPs) in place. Safe procedures for the management of people’s medicines were in place, although a review of the processes for the administration of some ‘as needed’ medicines was required.

People were supported by staff who were kind and caring and treated them with respect and dignity, whilst maintaining their privacy. Independence was encouraged and people’s care and support needs were provided in a way that encouraged independent thought. People were encouraged to contribute to decisions about their care. People were provided with the information they needed if they wished to speak with an independent advocate, to support them with decisions about their care and support needs. People’s friends and relatives were able to visit whenever they wanted to.

People’s support records were person centred and were regularly reviewed to ensure they met people’s current needs and preferences. People were encouraged and supported to achieve their goals and ambitions. People were encouraged to take part in activities that were important to them. People were provided with the information they needed, in a format they could understand, if they wished to make a complaint.

People, relatives, staff and professionals spoke positively about the registered manager; they found him approachable and supportive. The provider ensured systems

We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not all able to tell us their experiences.

We spoke with three people who used the service, observed care delivery and checked care plans. We spoke with the acting manager, three care staff and the therapeutic support manager. The home owner (provider) supplied information on quality assurance systems related to the standards we inspected.

The acting manager had been in post since December 2013. The registered manager was in the process of applying to cancel her registration.

Three people who used the service told us they were happy and felt safe at Christie Development Centre. Comments included, “I go out for walks, go to the shops and the GP. Staff help me to clean my room." Another person who used the service told us, "I like it here, the staff help me.”

We found that people who used the service were safe because their individual needs were assessed regularly and a care plan was in place to ensure staff knew how to support their needs. This ensured they experienced effective, safe and appropriate care that met their needs and protected their rights.

Staff told us that they felt competent to administer medicines. We found that the provider had systems in place to handle medicines safely, securely and appropriately. There was appropriate training for the staff who administered medicines to ensure that medicines were prescribed and given to people safely.

A person who used the service told us, "I feel safe here, it’s nice, I love it." We found that the acting manager and provider had responded appropriately when it was suspected that abuse had occurred.

Systems were in place to ensure that people who used the service were protected against the risk of unlawful or excessive control or restraint because the provider supported a person centred approach to the management of behaviours that challenged. Staff were trained to use de-escalation over restraint wherever possible.

We visited the Christie Development Centre on 5 November 2012 and found that some people who lived there had difficulty understanding spoken or written language at times. We spoke with two people who used the service who told us they were happy there. We observed three people accessing the local community and being supported by staff. We spoke with three staff and the manager of the service. We looked at records and support plans for three people.

We saw the records of feedback received from relatives and advocates who had completed a survey for the provider in May 2012. We looked at six feedback records. These contained the following comments, “The staff recognise non verbal signs and my relative is very happy here.” “I am very pleased with how well staff have done getting to know my relatives needs.” “Staff treat my relative with respect.” “The quality of care is excellent, my relative is involved, makes choices and is very happy.”

We found that improvements had been made to the quality assurance systems, which ensured they were effective in assessing and monitoring the quality of the service and incorporated user involvement. This provided assurances to the provider that people were in receipt of appropriate care and support.

We visited the Christie Development Centre on 26 August 2011 and found that some people who lived there had difficulty understanding spoken or written language at times. Two people were able to tell us they liked living at the home and they also liked their rooms. We spent time in the company of people who use the service observing their experience of care and evaluating the quality of support they received. We also spoke with other groups who have regular contact with the service to ask for their comments and observations. We checked some of the provider’s records, and looked at records of two people who were living at the service when we visited.

We carried out an unannounced inspection on 23 and 24 April 2015. Christie Development Centre provides accommodation and support for up to ten people; some of whom are living with a learning disability or have mental health needs.

This inspection was unannounced.

There were two managers in place at the time of the inspection. Although neither of them were registered we had received applications for both of them. The home required two managers as the service is managed in two separate parts of the building.

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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom unlawfully. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The managers were aware of the principles of DoLS and how these were implemented to maintain the person’s safety.

People’s support plans did not always contain the appropriate paperwork that showed that when decisions had been made for people they had been done so in line with the legal requirements of the MCA.

People felt safe. The risk to people experiencing abuse at the home was reduced because the staff had received training on safeguarding of adults, could identify the different types of abuse and knew who to report concerns to. However information for people on who to report concerns to externally was not available. Plans were in place that assessed people’s ability to be as independent as they could be and risk assessments were in place that enabled staff to ensure people’s freedom was not unnecessarily restricted whilst maintaining people’s safety. There were enough staff to meet people’s needs. People’s medicines were managed in a safe way.

People were supported by staff who were well trained for their role and received regular assessment of their work in order for them to provide effective care for people. People spoke highly of the food. When people required referrals or appointments with external professionals these were done in a timely manner.

Staff treated people with respect and supported people in a dignified and caring way. When people became distressed, staff responded to them in a timely manner. When people needed an independent advocate to act on their behalf this was provided. However the information was not easily accessible for people and could reduce their ability to use this service. People contributed to their care and felt their wishes were welcomed. People’s privacy and dignity was maintained at all times. There were no restrictions on people’s friends or relatives visiting them.

People’s care was planned and provided in the way they wanted it to be with input from relatives or external professionals if needed. People were supported to take part in the activities and hobbies that interested them. People felt able to raise any concerns or complaints with the staff and the manager and they were confident that they would be dealt with appropriately.

There was a friendly and positive atmosphere in the home. Staff and people interacted well and people spoke highly of the managers. Auditing systems identified issues within the home and recommendations made by the manager were reviewed to ensure they had been carried out. Staff were aware of the values of the homes and how to incorporate these values into their work.

You can see what action we told the provider to take at the back of the full version of the report.