We inspected this service on 7 July 2017. This was an unannounced inspection. At our previous inspection in August 2016, we found that the service met the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service had 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 and associated Regulations about how the service is run.

A positive approach to risk was used that meant people were encouraged and enabled to try new, meaningful activities at the service and in the local community. We saw and people's representatives told us that this had resulted in significant improvements in people’s quality of life. Staff thought outside the box to enable people to experience these new activities and used a person centred approach to ensure these activities were tailored to each person's needs.

Innovative methods were trialled and used to enable people to be involved in the planning and review of their care. Staff gained regular feedback about people’s care experiences, which enabled them to ensure people’s care was centred around their individual preferences and needs.

Some people who used the service had difficulties communicating their needs and wishes. Staff used a variety of tools that enabled and empowered to share their thoughts and care experiences which gave people a voice.

Staff understood how to keep people safe and people were involved in the assessment and management of risks to their health, safety and wellbeing. People’s medicines were managed safely.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse. Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals when required.

People were treated with care, kindness and respect and staff promoted people’s independence and right to privacy.

Staff sought and listened to people’s views about the care and action was taken to make improvements to care. We saw that complaints were managed in accordance with the provider’s complaints procedure.

The management team regularly assessed and monitored the quality of care to ensure standards were met and maintained.

The registered manager understood the requirements of their registration with us and they and the provider kept up to date with changes in health and social care regulation.

We carried out an unannounced comprehensive inspection of this service on 13 June 2016. At that inspection, we identified that improvements were needed to ensure people consistently received care that was safe and effective.

We undertook this focused inspection on the 11 July 2016 to check that the required improvements had been made. 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 Collinson Court on our website at www.cqc.org.uk

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service had 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 and associated Regulations about how the service is run.

At this inspection we found that the provider had made the required improvements and people were now receiving safe and effective care.

Changes in people’s needs triggered a review of the risks posed to their health, safety and wellbeing, and people’s risk management plans were consistently followed to promote their safety and wellbeing.

People’s health needs were effectively monitored and advice from health care professionals was sought and followed to promote their health and wellbeing.

We inspected this service on 13 June 2016. This was an unannounced inspection. We previously inspected this service on 6 and 7 January 2016 where we identified multiple Regulatory breaches. At that time, we found the service was not safe, effective, caring, responsive or well-led. The service was placed into special measures as a result of an earlier inspection in June 2015 and it had remained in special measures until this inspection. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, the service will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

At this inspection we found that the improvements the provider and registered manager had made were enough for us to remove the service from being under special measures.

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service had 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 and associated Regulations about how the service is run.

People’s known risks were regularly assessed, planned for and reviewed and the staff understood how to manage these risks. However, improvements were needed to ensure changes in people’s risks triggered a review of how their needs should be met.

Improvements in the monitoring of people’s health and wellbeing had been made, but further improvements were required to ensure changes in people’s physical health were acted upon in a prompt manner.

Advice from health and social care professionals was sought when needed. However, improvements were needed to ensure professional advice was followed to improve people’s care.

People’s medicines were managed safely, which meant people received the medicines they were prescribed when they needed them.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff received regular training that provided them with the knowledge and skills to meet people’s needs effectively.

People could access suitable amounts of food and drink that met their individual preferences and dietary needs.

Staff showed they understood and applied the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This ensured decisions were made in people’s best interests if they were unable to make decisions for themselves.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to be treated with dignity and privacy.

People and their relatives were involved in the planning and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them.

People’s feedback was sought and used to improve the care. People were supported to share concerns about their care and complaints were managed in accordance with the provider’s complaints policy.

Significant improvements had been made in the way the service was managed. People and staff were supported by the registered manager and provider.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us.

We inspected this service on 6 and 7 January 2016. This was an unannounced inspection. Our last inspection took place on 25 and 26 June 2015 where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. As a result of our last inspection, this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service did not have 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 and associated Regulations about how the service is run. A new manager had been recently recruited by the provider and they told us they were applying to register with us.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. This meant people’s safety, health and wellbeing was not consistently promoted.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

Medicines were not managed safely and people were not protected from the risks associated with them.

Safety incidents were not always reported and lessons were not learnt after safety incidents, which meant the risk of further incidents was not reduced.

People’s health needs were not always consistently monitored and managed effectively to promote their health, safety and wellbeing.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs. Effective systems were not in place to check staff had understood training they had completed.

People were enabled to participate in activities of their choosing, but improvements were required to ensure people could participate in their chosen activities at a time that suited their individual needs.

Improvements had been made to the way people received their care and support. People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy.

Relatives were now involved in the planning and review of their relations’ care. Plans were in place to enable people to become more involved in this process.

Systems were now in place to ensure people’s liberty was only restricted when this had been legally authorised. Staff followed the requirements of people’s Deprivation of liberty Safeguards authorisations.

The provider was now informing us and the local authority of reportable incidents in a timely manner. Staff told us they were supported by the managers and provider to make improvements to the way they delivered care and support. Complaints were managed effectively.

During our inspection we spoke with three people who used the service and one person’s relative. We also spoke with four members of staff, the registered manager and the regional manager.

People told us they were happy with their or their relatives care. One person told us, “I’m happy here because I like going outside” and “I like the staff”. A relative told us, “It’s a homely place and the staff do the best that they can”.

We saw that people’s needs were met in a caring, compassionate and timely manner, by staff who had received appropriate training and support. People were kept safe because they had received an assessment to identify their needs and people's care was delivered in accordance with their support plans.

Staff involved people who used the service in making choices about food and drink, and we saw that staff were responsive to people’s choices and requests.

People were protected from the risks associated with medicines because effective systems were in place to manage medicines at the home.

The service was well led because the registered manager and provider regularly assessed and monitored quality at the home, so that improvements to people's care could be made.

We completed our unannounced inspection, in response to information we received identifying concerns that people’s needs were not being met because there were not enough staff available.

During our inspection staff told us that staffing numbers had been low at times, but the numbers had recently improved. One staff member said, “We have been struggling, but recently we have been able to borrow staff from another home and use agency staff”.

We saw that there were enough suitably skilled and experienced staff on shift to meet people’s needs.

The provider had completed an internal investigation into staffing levels and had taken appropriate action to ensure that shifts were covered and people’s needs were met.

We saw that agency staff who were temporarily working at the service received a suitable induction to provide them with the information required to enable them to meet people’s needs.

We spoke with the families of two people who used the service, two staff and with the registered manager and her deputy about the quality of service and how it was delivered. Some people who used the service had challenging behaviour and all had difficulty communicating.

On the day of our inspection the home was also being accredited by the National Autism Society (NAS) The NAS had two assessors present and we were able to speak to them about what they found.

We observed the routines and daily activities were flexible and staff responded to people's needs. All the people were supported on an individual basis were given choices and allowed time to consider their options.

People received care and support that met their individual needs. People had care records which had been written in a style that people understood. A relative told us, “They seem very happy”.

We saw that there were risk assessments and systems in place to protect people who used the service against abuse.

We checked records and spoke to staff and managers about the recruitment process for staff, and how staff were monitored and supported to ensure appropriate care was provided.

We saw that there was a complaints procedure and this was available in an easy read format which people could understand. We saw evidence that complaints were recorded, responded to and dealt with in an appropriate manner. A relative of a person who used the service said, “I’m more than happy with the service”.

We undertook this review as we had not visited for some time and we wanted to see what life was like for the people who lived in the home.

Everyone had a plan of care that identified their needs. This included information about any communication needs and any support people needed to manage their behaviour. People's daily preferred routines were identified.

People who lived at the home were supported to have their health and personal care needs met. People saw the GP when they were ill and had regular checks with health care specialists to monitor their health.

Staff knew about how people made their needs and wishes known. Individual plans were in place to support people communicate their needs. For example some people used pictures and symbols and one person used some makaton signs. Communication dictionaries helped staff to understand people's non verbal communication.

Staff were trained to understand and manage any difficult behaviour through the use of redirection and de escalation methods.

People were supported to make choices and to be as independent as possible. Some people helped around the home doing household tasks. People chose what they wanted to eat and the activities they wanted to do.

The home had systems in place to monitor and evaluate people's care. Plans of care were reviewed monthly through key worker meetings. A risk management system assessed and put in place plans to make sure people were kept safe.

We inspected this service on 25 and 26 June 2015. This was an unannounced inspection. Our last inspection took place on 18 October 2013 where we found that the provider was meeting the Regulations that we inspected them against.

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 12 people were using the service.

The service had a registered manager. However, they had been absent from the service since January 2015. 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. A temporary manager who was registered to manage another of the provider’s service was managing the service at the time of our inspection.

During this inspection we identified a number of Regulatory breaches. You can see the action we have taken at the bottom of this summary.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. People were also not always protected from potential abuse and medicines were not always administered safely. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.

Advice from health care professionals was not always followed which resulted in a number of safety incidents occurring. Lessons were not learnt after safety incidents, which meant the risk of further incidents was not reduced.

Staff did not always fulfil their responsibilities to keep people safe. This was because the staff were not effectively led and managed.

Staff did not recognise that they were at times physically restraining people in order to keep them safe. This meant that the required protocols to ensure such incidents were managed safely and effectively were not being followed.

We saw that most people had a high level of restrictions placed on them in an attempt to keep them safe. However, staff did not always identify, consider or review the restrictions they placed on people which meant people could not be assured that they were being lawfully restricted.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider. The provider did not always inform us of incidents that occurred at the service which meant we were not always aware of reportable incidents that had occurred.

There was limited evidence to show that people’s care was based on best practice for people with autism and behaviours that challenged.

There were gaps in the staffs’ knowledge and skills that meant some people’s specialist needs were not met effectively. Staff and relatives were not always aware of the changes in management which led to some uncertainty.

People were not always supported to make decisions about their care and people were not always treated with dignity and respect. Independence was not consistently promoted and people sometimes experienced inconsistent care. This meant there was a risk that people could become confused which could result in an increase in anxiety and display of behaviours that challenged.

Staff did not always understand people’s communication styles which meant there was a risk that people may not always be able to express their needs effectively.

People were enabled to access the community, but improvements were required to ensure the activities people participated in were meaningful and purposeful to them.

Most of the staff demonstrated that they valued the people who used the service and the manager and provider were aware of some of the shortfalls and were positive about improving people’s care. When complaints were received the provider managed these in accordance with their complaints procedure.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.