The inspection took place on the 31 August 2017 and 4 September 2017 and was announced.

Church Lane is a care home service that provides support to people living with autism and or a learning disability, the service is registered to accommodate up to two people.

The service has a registered manager. 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.

We last carried out a comprehensive inspection of this service on 19 April 2016 and breaches of the Health and Social Care Act 2008 were found. After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment and good governance.

At this inspection we checked that they had followed their plan and confirmed that they now met legal requirements.

Accidents and incidents were recorded and there was a clear investigation process. This meant that themes and trends were highlighted and steps could be taken to reduce the likelihood and risk of further events.

Risk assessments were in place to direct staff in managing specific health conditions that affected the health and welfare of those at the service such as skin integrity, dietary needs and the management of constipation. There were also robust assessments and management plans in regards to environmental risks and those associated with day to day activities.

The registered provider had made changes to the management structure to improve on staff support, career progression and retention. Staff were positive about the changes and felt they were well supported and listened to.

Systems were in place to monitor the quality and safety of service by both the registered manager and the registered provider and these were effective in highlighting and resolving issues.

Information about people’s care needs was stored securely to ensure that people’s confidentiality was maintained.

Staff had an understanding of how to incorporate the basic principles of the Mental Capacity Act 2005 into their day-to-day practice. Each care plan and risk assessment included an assessment of the person’s ability to make a decision around that aspect of their support. Where a person was not able to make an informed decision, it was evidenced that staff were acting in the person’s best interest. Staff had undertaken training about the Deprivation of Liberty Safeguards (DoLS). DoLS had been appropriately applied for the people who needed them which meant that people’s liberties and rights were protected.

There was a record of comments and complaints made about the service. Any actions taken were recorded and this included an apology where necessary.

Staff had a good understanding of people’s care needs. Staff had an in-depth knowledge about the strengths and personalities of those they supported. Care records contained clear and detailed information about the person that enabled staff to understand their preferences and support needs.

People were supported to engage in activities, such as going for walk in the morning, swimming or watching their favourite television programs. The registered manager had started to explore new community based opportunities for those who lived at the service.

Medication records (MAR) were in place and kept up-to-date. The MARs showed that people were supported to take their medication as prescribed.

People’s relatives told us that they felt the service was safe. Staff had received training about safeguarding people from harm and were aware of how to report any concerns. Staff treated people with kindness and patience. We observed that people’s privacy was maintained, for example, during personal care interventions.

The rotas indicated tha

The first day of the inspection was announced and took place on the 19 April 2016. A second day of inspection took place on the 21 April 2016 and was unannounced.

Church Lane is a service that provides support to people living with autism and or a learning disability, the service is registered to accommodate up to two people.

The service has a registered manager. 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.

We found that whilst some aspects of the care and support were satisfactory, there were areas which required improvement and did not meet the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Not all accidents and incidents were recorded in the accident book and so issues not always investigated. This meant that themes and trends may not be highlighted and the likelihood of further events and risk reduced. Risk assessments were not in place to direct staff in managing specific health conditions that affected the health and welfare of those at the service such as skin integrity and the management of constipation. These were breaches of Regulation 12 of the Health and Social Care Act 2008.

The registered provider had made changes to the management structure in an attempt to improve on staff support, career progression and retention. Feedback about the effectiveness of the new structure from relatives and staff was mixed.

Quality assurance systems were in place to monitor the quality and safety of service by both the registered manager and the registered provider but these were not fully effective in highlighting and resolving issues.

Information around people’s care needs was not stored securely to ensure that people’s confidentiality was being maintained.

These were breaches of Regulation 17 of the Health and Social Care Act 2008.

Staff spoken with had an understanding around how to incorporate the basic principles of the Mental Capacity Act 2005 into their day-to-day practice. However, this was not evident in their recording and they did not carry out an assessment of a person’s mental capacity to make a decision. This meant that they did not evidence where they were acting in person’s best interest. We made a recommendation that the service review their decision making records to ensure they comply with the Mental Capacity Act 2005 and its code of practice.

Staff had undertaken training around the deprivation of liberty safeguards (DoLS). DoLS had been appropriately to the local authority for the people who needed them which meant that people’s liberties and rights were being protected

Although matters had been investigated, the comments and complaints records held at the service and by the registered provider did not reflect these. Therefore there was not an accurate record in regards to complaints made about the service. We made a recommendation that the registered provider ensure that their records are kept up to date in line with their own complaints policy .

Staff had a good understanding around people’s care needs and demonstrated knowledge of the strengths of those that they supported. Care records contained information about the person that should enable staff to understand their preferences and support needs. However, not all of a person’s support needs were clearly indicated.

People were supported to engage in activities, such as going for walk in the morning, swimming or watching their favourite television programs. Relatives were not always confident that people had the opportunity to engage in activities as recorded in their care plan or that new opportunities were explored

Medication records (MAR) were in place and kept up-to-date. The MARs

The inspection team included two inspectors and a specialist advisor. The team gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? An inspector gathered information from representatives of people using the service by telephoning them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with representatives of people who used the service and staff and from looking at records.

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

Is the service safe?

Representatives told us they felt people who used the service were safe and their rights and dignity were respected.

People's care records were accurate to ensure that they received appropriate care. Staff knew about risk management plans and gave us examples of how they had followed them. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents.

The accommodation was suitable and well-maintained.

Recruitment practice was safe and thorough.

Is the service effective?

There were systems in place for seeking and obtaining valid consent to care and people's human rights were respected.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service caring?

The relatives spoken with said that they were happy with the service and that a good standard of care was provided. They said they had attended meetings to agree the care provided and were kept well informed. They said they had a good working relationship with the staff. One relative said:- "I'm pleased with the level of care, it's fantastic." The other said:- "My relative is more independent since being there and their speech has improved".

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

There was investment in staff training and staff were clear about their roles and responsibilities.

There was a complaints procedure in place.

Is the service well-led?

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Staff had a good understanding of the ethos of the service and said they felt well supported.

We gathered information about people's views of the service provided by speaking with their relatives and by making observations and looking at records. We were not able to speak with the people who used the service because we were unfamiliar with their communication needs.

Our observations indicated that the people who used the service were relaxed and content with the staff that supported them. The staff were observed to have a very caring and patient approach and knew the needs of the people they supported.

We spoke to two relatives who were happy with the service and said that a good standard of care was provided. Some comments made were :-

"The service is a blessing. The staff know what they are doing. They are caring and supportive."

"I'm very happy with the care and support provided."

We spoke to two members of staff who told us they enjoyed working at the home and considered that the people who lived there got a good service.

We spoke to a health professional who said that the person they supported had their needs very well met.

We found that people were assessed before they began to use the service and they had care plans that identified their needs. People were appropriately supported with their nutritional needs. The home was clean with adequate systems in place to promote infection control. Medication was managed safely and the quality assurance systems that were in place ensured people received safe, appropriate care, treatment and support.

At the time of our visit there was one person living at the home who expressed a wish not to meet with us. We gathered information about their views by speaking with a relative and by looking at records of care reviews.

Our observations indicated that the staff interacted with the person who used the service in a manner that promoted their dignity and respected their wishes.

A relative spoken with said they were very happy with the service provided. They described the staff as friendly, caring and attentive. They said that they were kept informed about their relatives' well-being and were invited to attend reviews of care plans were they could express their views. They said:-

“A very good service is provided. I’m very happy. The staff keep me well informed.”

Records showed how the person who used the service had settled in well to their new home and feedback forms indicated that they were satisfied with the activities provided, staff support, meals, decoration and bedrooms.

We asked the commissioner of the service and social worker for their views. However, no information was provided to us at the time of writing this report.

We requested information from Cheshire West and Chester Local Involvement Network (*LINks). At the time of writing this report no information was received from this agency.

* LINKs are networks of individuals and organisations that have an interest in improving health and social care services. They are independent of the council, NHS and other service providers. LINks aim to involve local people in the planning and delivery of services.