9 Roseland Avenue is a small care home, registered to provide accommodation and personal care (not nursing) for up to six people with learning disabilities. The house is a two-storey building with its own secure garden.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that 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.

At the last inspection on 29 June and 5 July 2017 we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because audits did not always identify shortfalls. Where shortfalls were identified, action was not taken to ensure fundamental standards were met. The provider wrote to us telling us of the actions they were taking to make improvements. At this inspection we found improvements had been made.

People were kept safe from the risk of harm and abuse. Staff were knowledgeable about the types of abuse and how to report it. Risks were identified and assessed and assessments reviewed regularly. There were sufficient numbers of staff deployed to meet people’s needs. Medicines were administered, stored and managed safely.

Staff were appropriately trained. Care plans were person centred and contained personalised information to support people’s needs. Staff worked together with health and social care professionals to deliver timely health care and promote well-being.

Staff and people had developed respectful and caring relationships. The person-centred ethos of care was shared throughout the staff group. There were quality assurance and audit processes in place, including requests for feedback from people and their relatives about the service.

Care was planned to reflect people’s preferences and abilities. 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.

Further information is in the detailed findings below.

9 Roseland Avenue registered to provide accommodation and nursing or personal care (no nursing) for up to six people with learning disabilities. At the time of our inspection three people lived at the home.

Last inspection was carried out 21 January 2016. We identified two breaches of Regulation 12 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 associated with the safe & well led domain. We made two requirement notices regarding financial arrangements and notifications to us. The provider sent us an action plan as requested. The manager registered with us in May 2016.

At this inspection we identified audits were not always identifying shortfalls, which were not actioned. Where shortfalls were identified action was not taken to ensure fundamental standards were met. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulation 17. We have made a recommendation about the management of some medicines.

This inspection took place on 29 June and 4 July 2017 and was announced. The provider was given short notice because people living in the home can become unsettled by the presence of an unannounced visitor. This gave the provider an opportunity to plan our visit with the people using the service. The inspection was carried out by one inspector and an expert by experience. We found improvements had been made to people’s financial arrangements and we have received notifications as required.

A registered manager was employed by the service, they were on annual leave during this inspection, however the nominated individual and another manager registered at another location owned by the provider were present throughout the inspection. 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.

People were supported to maintain good health and had access to healthcare services, however one person had delayed access to dental health.

There was a stable management team who took appropriate action to make sure they provided a safe and reliable service for people.

People received care and support from staff they knew well and had built trusting relationships with them.

People were treated with respect and dignity and were encouraged to make choices.

Staff felt supported and received training they required to carry out their jobs.

The service’s robust recruitment procedure and staff training helped to minimise the risks of abuse to people.

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

This inspection took place on the 21 January 2016 and was announced. We had last inspected the service in July 2013 and found no breaches of regulations.

9 Roseland Avenue is a care home which provides accommodation and personal care for up to six people with learning disabilities. At the time of our inspection three people were living at the home.

There was a registered manager of the service, however they had not been in day to day management of the service recently. They had recently submitted an application to de-register with us. Another manager had been appointed and assisted us during this inspection. The manager told us they had applied for their Disclosure and Barring Service (DBS). This is a criminal records check to make sure people were suitable to work with vulnerable adults.. The manager said they would apply to register as soon as that was returned. 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 Health and Social Care Act 2008 requires services to tell us about important events relating to the care they provide by sending us a notification. We saw three incidents had been reported and investigated, however we had not been notified of these. The manager said this was an oversight and they would ensure we would be notified in the future.

People were not always protected against the risks of potential financial abuse.

Overall, downstairs in the home was clean and felt safe. The carpet on the stairs and landing appeared stained. The temperature fluctuated throughout the home during the day. The manager told us there was a problem with the heating being inconsistent, which had been reported.

Despite being given notice of our inspection, there were not sufficient staff on duty to ensure people were supported effectively.

People were not always involved in making choices and decisions about their care. For example we observed staff being attentive to people by making drinks and snacks for people, rather than encouraging and supporting people to do it for themselves.

One person was able to tell us they felt safe and “the staff look after me well”. When asked about what they would do if they were not happy; they replied they “would talk to staff.” We observed people appeared relaxed and comfortable in the presence of staff.

Safe recruitment practices were followed before new staff were employed to work with people.

We looked around the communial areas of the home and one person showed us their bedroom. They described how they had chosen the soft furnishings for their room.

People had regular contact with health and social care professionals and had maintained links with the local community.

The principles of the Mental Capacity Act (MCA) were being followed.

Staff demonstrated respect and knowledge about the people they were suporting in the way they spoke about and interacted with them. People were supported by staff who had received regular training and supervision

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our visit we met two of the people living at the home. Although one of the people was unable to verbally communicate with us we observed how the staff on duty interacted with the person.

One person told us they “liked" living at the home and that staff treated them well.

We saw staff offered people choices throughout the day, such as a choice of drinks and food, what they would prefer to watch on the television and if they would like to go out for a walk.

Records demonstrated that staff worked in conjunction with other health care professionals with regard to people’s care and welfare. Decisions relating to people’s care and treatment were made within a multi-disciplinary team.

As part of our inspection we toured the building and found it to be safe and suitable for the needs of the people living there. One person explained they had moved bedrooms due to changes in their physical health. Records showed staff had explained the reasons for the move to the person and they had agreed it would be in their best interests.

The home had systems in place to ensure any concerns or complaints were dealt with in a timely manner and in line with company policy.

We visited 9 Roseland Avenue on 9 May 2012. We met and talked to people using the service and staff on duty.

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

We spoke to the relatives of two people who told us they thought their family members were happy living at the home.

We saw that assessments were made to establish whether people had the capacity to make decisions relating to their health care needs. A relative described how they had been invited to attend a ‘best interests’ meeting to discuss a surgical procedure for their family member. Another relative told us they were involved in any decisions relating to health and wellbeing.

We saw people looked relaxed and comfortable in their environment. Staff involved people in their conversations.

We observed that people were clean and well dressed. People could make choices about what they ate, clothes they wore and where they wished to spend their time.

We noted various activities took place both within and outside the home. People could choose to join in or not.