The inspection of Claremont took place on 28 February 2017 and was unannounced. At the last inspection on 15 and 18 December 2015 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated ‘Requires Improvement’ because there were four breaches of the regulations. These were in relation to inadequately maintained premises, untrained staff, non-notification of incidents and ineffective quality assurance records.

Claremont House is in a residential area of the town of Goole in East Yorkshire. The property is on three floors and has all single accommodation, some with en-suite bathrooms. The service provides care and support to adults with a learning disability. At the time of our inspection the service was providing support to four people. It offers rehabilitation, learning with living skills and activities that are educational, occupational and recreational. There is on street parking and access to the town via public transport.

The registered provider is required to have a registered manager and on the day of the inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

At this inspection we found that the registered provider had made sufficient improvement to the service to meet the requirements of the regulations. We found the overall rating for this service to be ‘Good’. The rating is based on an aggregation of the ratings awarded for all 5 key questions.

The registered provider had made sufficient improvements to the property to ensure people that used the service had their own suitable toilet and bath/shower and the staff had a separate toilet and bathroom available to them. The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. The premises were suitable for providing care to people with a learning disability or autistic spectrum disorder.

The registered provider had made sufficient improvements with monitoring and providing staff training up-dates, so that all staff were now better trained with regard to refresher courses in safeguarding adults, medicine management and other courses relevant to their roles. We saw that people were cared for and supported by qualified and competent staff that were regularly supervised and received an appraisal regarding their personal performance.

The registered provider had made sufficient improvements in notifying the Commission of significant events as required by regulations. Notifications were sent to the Commission and so the service fulfilled its responsibility to ensure any required notifications were made.

The registered provider had made sufficient improvements to ensure audits were effectively carried out and people were consulted about their views of the service provision. There was an effective system in place for checking the quality of the service using audits, satisfaction surveys and meetings.

People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury or harm.

Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the staff that were on duty. Recruitment policies, procedures and practices were ca

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, speaking with visitors, speaking with the staff who supported them and from looking at records.

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

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. All staff had received training in this area and the staff we spoke with confirmed that they understood when an application should be made, and how to submit one. This meant that people were safeguarded as required.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes. People told us that they were consulted about their care. Comments included, “I can choose when I get up and what I want to do. I help cook and clean. If I had any worries I would talk to the staff."

The home had systems in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints, concerns and whistleblowing. This helped to reduce the risks to people and helped the service to continually improve.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

Is the service effective?

The home had appropriate arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. This meant that staff were able to deliver care in a way that supported people.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative commented, “I am generally happy with the way my relative is cared for but sometimes I think they need encouragement to do more."

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes. We did observe people going out and getting involved in social opportunities. However a relative said that more support would be beneficial with personal care tasks and motivating people to go out more and be involved in household tasks such as keeping their room clean.

Is the service responsive?

We saw that the home had responded to areas of improvement identified within their audits and people were confident that the home would respond to any concerns if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive. Meetings were held so that people could air their views.

A relative told us that the manager was very approachable.

People that used the service gave both written and verbal consent to their care and treatment on a daily basis. They were generally satisfied with the care they received and looked forward to achieving greater independence so they could perhaps live in their own home in the community. They said “I make up my own mind”, “It’s alright here”, “I wish I could go out on my own”, and “I like my room here and I like some of the staff”.

People were well cared for and enjoyed a variety of activities in the community and in the home. They also engaged in educational and occupational pastimes.

People received their medication safely and were encouraged to be independent with arranging to collect it. People were cared for by staff in sufficient numbers and there was a system in place to monitor the quality of the service provided at Claremont House.

People told us they had input to their care plans and were able to talk to staff about what they wanted to do on a daily basis. They said there were social activities organised, both in the community and in the home, which they enjoyed.

Visitors to the service told us “People are being well looked after and we have no concerns about the service”.

People told us that staff explained all procedures and treatment to them and respected their decisions about care.

People we spoke with told us that they felt safe within the service. People said they were aware of their rights and choices and were confident in the systems set up by the service to enable them to voice any concerns.

The inspection of Claremont took place on 15 and 18 December 2015 and was unannounced. At the last inspection on14 May 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Claremont is a residential care home that provides accommodation and support to a maximum of four people who have a learning disability. People that may exhibit behaviour that reflects their complex needs are also supported there. The service is in a residential area of the town of Goole in East Yorkshire. The property is on three floors and has all single accommodation, some with en-suite bathrooms. The service offers people rehabilitation, learning with living skills and activities that are educational, occupational and recreational. There is on street parking and access in and out of the town via public transport.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a 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 2008 and associated Regulations about how the service is run.

We found that not all of the people that used the service were cared for in an environment that was suitable to meet their needs. This was because one person had inadequately maintained bathroom facilities and the staff had no separate toilet facility outside of people’s personal bedrooms to use.

This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the registered provider to take at the end of the full version of this report.

People were not always cared for and supported by staff that were appropriately trained and skilled to carry out their roles. This was because although staff had completed some of the training necessary to ensure they were skilled in their roles, they had not all completed all of the training. The evidence we were presented with did not corroborate, in some cases, with what staff told us.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the registered provider to take at the end of the full version of this report.

We found that the registered manager had not always notified us of safeguarding referrals that had been made to the local authority safeguarding adults team and investigated by them. They had failed to notify us of other significant events.

This was a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. You can see the action we have told the registered provider to take at the end of the full version of this report.

We found that people did not benefit from a well-led service because quality assurance systems were not as effective as they should have been. Audits on staff training systems were not effective and there were no methods of consulting people about their views. We were not certain of the accuracy of information we had been given at the inspection in respect of staff training, staff files and some records.

This was a breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the end of the full version of this report.

People experienced a service where the culture was unsettled and staff morale was low. Staff told us they thought morale was low and that they didn’t feel motivated. The registered manager had a lot of responsibility managing three service locations and told us this was difficult to keep on top of. We were told by staff and the registered manager that support in most matters from the registered provider was sometimes absent.

We found that people that used the service were protected from the risk of harm and abuse because the registered provider had systems in place to monitor the risk of safeguarding issues arising. The registered provider had systems in place to refer any suspected or actual safeguarding concern to the local authority safeguarding team. However they were not making relevant notifications to the CQC as is required in regulation. Staff that worked in the service were trained in safeguarding adults’ awareness and knew the types and signs and symptoms of abuse.

We saw that people lived in a safely maintained property because the registered provider had valid certificates of safety for utilities, equipment and facilities in the property. Although the premises were safe they were not entirely suitable to meet people’s needs. We saw there were sufficient numbers of staff employed in the service that had been vetted as suitable to care for vulnerable people.

People’s medication was safely managed because there were systems in place to order, handle, store, administer, record and dispose of all medication that came into the service. People told us their medicines were well managed.

We saw that when necessary people were protected by the correct use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation that were in place to ensure people’s rights were upheld and safeguarded.

We found that people were fully involved in their care because they were included in making choices and decisions about their daily lives. People experienced good communication between themselves and staff and people were supported by staff in communicating with the general community and professionals with an interest in their care.

We saw that people were supported to eat adequate amounts of nutritional food and to drink adequate amounts of fluid to maintain their wellbeing. People’s health care needs were assessed, monitored and recorded and any issues regarding health were referred to the appropriate health care professionals or service.

We found that people were cared for by staff that had a young approach and outlook in their own daily lives and so this was reflected in the care that staff gave to people that used the service. We found that people were given individual support by staff that was in line with their individual care needs as recorded in their care and support plans. People had person-centred care plans that staff followed to ensure people’s needs were met. We saw, and this was confirmed by what people told us, that their privacy and dignity was upheld and staff encouraged them to remain as independent as possible.

We saw that people made their own decisions about the activities and pastimes they engaged in and there were systems in place to enable people to complain about the service if they wished or needed to.