We inspected Community Living and Support Services (CLaSS) on 14 November 2018. The inspection was unannounced. CLaSS is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates five people who have a learning disability or Autism spectrum disorder.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

On the day of our inspection five people were using the service.

At our last inspection on 3 November 2015 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall but there had been a deterioration in safe which was rated as ‘requires improvement’. There was no evidence or information from our inspection and ongoing monitoring which demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service was rated as ‘requires improvement’ for ‘safe’ at this inspection. The processes in place for the administration of medicines were not always in line with good practice. Medicine administration records were not completed in line with the prescribers’ instructions. Protocols for medicines which were given as and when required did not offer clear advice on when these should be given. Risks associated with people’s needs had been assessed and measures were in place to reduce risks. There were sufficient staff to meet people’s needs and safe recruitment procedures for staff were in place. Accidents and incidents were monitored to identify any trends and measures were put in place to reduce the likelihood of these happening again.

People continued to receive an effective service. Staff received the training and support they required including specialist training to meet people’s individual needs. People were supported with their nutritional needs. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to support people when they were distressed and made sure emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and their support was planned with them and or their relative where required. Staff knew and understood people’s needs well. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaints procedure available if this was needed.

People continued to receive a well-led service. The monitoring of service provision was effective because most shortfalls had been identified and resolved. There was an open and transparent and person-centred culture with adequate leadership. People were asked to share their feedback about the service.

Further information is in the detailed findings below.

We inspected this home on 3 November 2015. This was an unannounced Inspection. The home was registered to provide personal care and accommodation for up to five people who may have a learning disability or mental health support needs. At the time of our inspection five people were living at the home.

The service was previously inspected in July 2014 and at that time we found the service was not compliant with two of the regulations we looked at. The issues identified that the provider did not have suitable arrangements in place for assessing and monitoring the quality of service provision and did not always keep records and information up to date in relation to the care and support provided. The provider took action and at this inspection we found improvements had been made.

There was a registered manager at the home but they were unavailable on the day of the inspection. We spoke with the registered manager following our inspection to discuss the outcome. 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 people using this service were safe. People told us they were encouraged to raise any concerns they had and this was confirmed by relatives. We found that staff knew how to recognise when people might be at risk of harm and were aware of the registered provider’s procedures for reporting any concerns.

We received positive comments from people using the service and their relatives about the staffing arrangements in the home. We saw that staff knew people well and could describe consistently their personal preferences and preferred routines. Staff treated people with respect and communication between staff and people using the service was respectful and inclusive.

People were supported by staff who had received training and who had been supported to obtain qualifications. This ensured that the care provided was safe and followed best practice guidelines. Robust recruitment checks were in place to ensure new staff were suitable to work with people using the service.

People told us they received their medicines safely. Staff responsible for administering medicines had received relevant training.

People told us that they were involved in the planning and reviewing of their care. People’s needs had been assessed and person-centred care plans were being developed to inform staff how to support people in the way they preferred. Measures had been put into place to ensure risks were managed appropriately.

People told us they had access to a variety of food and drink which they enjoyed. People were supported to eat and drink sufficient amounts to help them to maintain good health. People told us they were supported to have access to a wide range of health care professionals.

Staff we spoke with were knowledgeable of the requirements and their responsibilities in line with the Mental Capacity Act 2005. Some necessary applications to apply for Deprivation of Liberty Safeguards (DoLS) to protect the rights of people had been submitted to the local supervisory body for authorisation.

People told us, or indicated that they were happy living at the home. People told us they continued to pursue individual interests and hobbies that they enjoyed and they were happy with the range of activities available to them.

People using the service and their relatives knew how to raise any complaints. The complaints procedure was displayed in different formats to support people’s preferred way of communicating.

There were systems in place to monitor and improve the quality of the service provided; these were effective in ensuring the home was consistently well led and compliant with the regulations.

The inspection team was made up of one inspector. There were 5 people using the service during our inspection. We spoke to four of the people who lived at the home and the commissioners of the service.

We set out 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, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us or indicated that they felt safe in the home. Comments included: "I feel safe here" and "I like it here."

We spoke with two of the people working in the home on the day of the inspection and they had an understanding of their roles in keeping people who lived in the home safe. Staff records showed that staff had received appropriate safeguarding training and we saw that there were videos available to refresh this training.

There were no people with restrictions placed on them through the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). These safeguards apply where it is thought that it is in someone's best interests for decisions to be made on their behalf where they lacked the capacity to make a specific decision. Differing arrangements had been put in place to assist people with their financial management that took into account the person's capacity to understand and legal arrangements were in place for some people.

Risks to individual people's safety and welfare had been assessed in respect of people's health conditions however, immediate action had not been taken where other risks were identified. For example where physical risks were identified to the outdoor area no immediate action had been taken. We found that there were occasions when staff were not available in the home when the people who use the service were out of the home unaccompanied by staff and could have returned unplanned.

Is the service effective?

People we spoke with indicated that they were generally happy living at the home. We saw that people were assisted when they asked for support. We saw that people were assisted to manage their anxieties and talk about actions that may pose a risk.

We looked at parts of three people's care plans and found that service was updating these plans to make it easier to find information and ensure that people’s needs were met. However, we found that these were not being updated in a consistent way and this could make it more difficult to find information that is needed to ensure people remain safe or have their needs met appropriately.

Is the service caring?

People were supported by staff who spoke positively about them. We saw that care staff responded well when people asked for help or asked them questions. Comments from people who lived in the home included: "They (staff) are my friends....they help me" and "The staff are good... I don't mind the student nurses coming, they are good too."

We looked at two people's activities and found that people undertook a range of activities during the day that they wanted to do.

The four people we saw were dressed appropriately, comfortably and appeared well groomed and cared for. There was evidence that people's individuality was respected in decisions they had made about the style of their appearance.

Is the service responsive?

At our last inspection in February 2014 we had identified that the home was not meeting some regulations. Whilst we found that there had been improvements in all areas there had not been enough action taken to ensure that records were consistently recorded and cross referenced so that information could be quickly retrieved.

Changes had been needed to ensure that the views gained from people who lived in the home and other involved people were detailed enough to enable the service to continually improve. We found that this whilst plans were in place to improve involving and consulting with people these had yet to be fully implemented.

Is the service well led?

The home was managed by a registered manager who had worked at the home since it was registered with us. They knew the people who lived there very well. However information about risks and outcomes of health meetings was not always organised in a way that it can be easily found should they be unavailable.

When we visited we spoke with four of the five people living in the home, some of whom had their own self-contained accommodation. There were also communal areas for people to use. We also spoke to the relatives of two people who use the service. People told us that they were generally happy with the care they received. One person told us, “I like it here”. We also spoke to the manager, two care staff and a person who was on work experience at the service. We also looked at care records.

We found that the provider did not always have care plans in place to manage the specific health and support needs of some of the people who use the service.

We saw that the provider had not always made suitable arrangements to ensure that people were safeguarded against the risk of abuse.

People were protected against the risks associated with medicines because the provider had appropriate arrangements for managing medicines safely.

We found that care workers were skilled, qualified and competent to provide people with the care they required to meet their individual needs.

The systems in place to assess and monitor the quality of the service were not effective.

Most care records were up to date however they were not always signed and dated by staff. Some of the records relating to people who use the service failed to refer to people with dignity and respect. Staff rotas were not always clear and failed to indicate clearly the hours that staff were working.

People using the service told us the care and support provided at the home was good and they got on well with staff. They said staff were helpful and listened to them. One person said. “I like it here, staff are helpful." Another person said. "Staff help me look after myself.”

We observed effective communication and good relationships between the staff on duty and the people living in the home. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Risks to people’s health and well-being were identified and managed. People had regular opportunities to do things they enjoyed.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe and said they could talk to a member of staff if they had any concerns.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Protocols for dispensing medicines were not being followed and staff had dispensed some people’s medicines without recording this.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

There were five people using the service at the time of our visit. We spoke with four of these people and the staff that were supporting them.

People told us that that they were happy about how their care and support needs were being met. A person using the service told us “Staff help us if we need to see a doctor.”

People told us that they were happy with the staff team that were supporting them. They told us that staff supported them in a respectful manner and offered them choices of how and where they wanted to spend their time. A person using the service told us “Staff are kind, they are my friends.”

People told us that they had many opportunities to take part in recreational activities and were encouraged to be as independent as possible. A person using the service told us “I like to keep my room tidy and clean.”

People told us that they felt safe and that they would speak to the staff if they had any concerns. Comments included : “I have nothing to worry about here. It is all good” and “If I was unhappy I would talk to the manager.”