Courthill House provides accommodation and personal care for up to ten people who have a learning disability, such as autism or epilepsy. People's accommodation is arranged over two floors with easy access via a lift. There were eight people living at Courthill House on the day of our inspection.

There was a registered 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 and associated Regulations about how the service is run. The registered manager helped us during our inspection.

We last inspected Courthill House in January 2016 when we identified concerns in relation to deployment of staff, risk assessments, nutrition, person-centred care, records and staff not always treating people in a respectful way. We found at this inspection things had improved and although we highlighted some minor things to the registered manager she dealt with these immediately, so we were satisfied that we had no similar concerns.

People lived in a homely environment. People’s rooms were cosy and personalised. People were encouraged to be independent and supported to do things for themselves. Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in activities which were meaningful to them. People were given choice on what they wished to do during the day, not only within the home but if they wished to go out. People’s care records were detailed and included sufficient information for staff to know how to care for someone.

Medicines were managed in a safe way and recording of medicines demonstrated people had received the medicines they required. Risks to people had been identified and guidance was in place to help reduce the risk of harm to individuals. Accidents and incidents were recorded and action taken to help prevent reoccurrence. Appropriate checks were carried out to help ensure only suitable staff worked in the home.

Staff met with their line manager on a one to one basis and staff said they felt supported. We found the registered manager had good management oversight of the home and there was a good culture within the team.

There were a sufficient number of staff on duty to enable people to either stay indoors or go out to their individual activities. It was evident staff knew people well, understood people’s individuality and needs and respected people when they wished to have time alone. Staff were caring to people.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

Staff received a good range of training which included training specific to the needs of people living at Courthill House. Staff met together regularly as a team to discuss all aspects of the home and they were aware of their responsibilities to safeguard people from abuse.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned.

Regular fire checks and fire drills were carried out to help ensure staff would know what to do in the event of an emergency. The registered manager had increased night staff to cover this possibility and if necessary people would be moved to another of the provider’s homes if Courthill House had to be closed.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. Peo

Court Hill House provides personal care and accommodation for up to 10 adults with a learning disability. At the time of the inspection there were eight people living in the home.

This inspection took place on 6 January 2016 and was unannounced.

There was a registered manager in post, although he was absent from the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The area manager was acting as the manager and had begun the application process to become the registered manager. As the registered manager was not present during our inspection and we were assisted by the shift leader and the Trust service manager.

Although we found staff treated people in a kind and caring manner at times we observed occasions when staff did not treat people with the respect they deserved. We heard staff use outdated language and display outdated practices in relation to the information they recorded.

Staff carried out checks to make sure that any risks of harm to people were identified however we found these assessments lacked information and guidance for staff. Staff deployment around the home meant people did not always have regular interaction from staff.

People were not provided with a nutritious or varied diet and staff did not always monitor people to check they remained at a healthy weight.

People had access to the community although at times this was limited due to lack of drivers. Activities were not always recorded to show what people had participated in. Care records for people did not contain information for staff on people’s preferences, likes or dislikes.

Where there were restrictions in place, staff had followed legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event. People’s care would not be interrupted in the event of an emergency and people needed to be evacuated from the home as staff had guidance to follow.

Staff were provided with induction and training to help them carry out their role in a competent way. Staff had the opportunity to meet with the line manager on a regular basis to discuss aspects of their work.

Appropriate checks were carried out to help ensure only suitable staff worked in the home. Accidents and incidents were recorded and staff took appropriate action to reduce the risk of further accidents. Staff followed safe medicines management practices and people received their medicines when they required them.

People were supported to access external health services and professional involvement was sought by staff when appropriate. Guidance was in place for staff to identify when people may be in pain.

We saw some good examples of caring practice by staff and where possible people were encouraged to do things for themselves.

A complaints procedure was available for any concerns and relatives and people were encouraged to feedback their views and ideas into the running of the home.

The provider and staff carried out a number of checks to make sure people received a good quality of care.

During the inspection we found 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 the report.

The inspection was conducted by one inspector to help us 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 using the service, their relatives, the staff supporting 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?

Relatives told us they felt their relative was safe at Court Hill House.

One person’s relative told us they visited often and unannounced and have never seen anything to give them concern about how their relative was treated or their and safety.

Relatives also told us they thought the building and people’s bedrooms were suitable.

We saw people had a risk profile to identify potential risks. Where identified there were individual assessments to protect people.

We saw that the service minimised the risk and the likelihood of abuse by making sure all the policies and procedures to promote safeguarding were in place.

We spoke to staff who were aware of safeguarding procedures, and saw records that confirmed they had all received recent training in this area so they knew how to protect people.

The manager confirmed that there had not been any significant concerns that had resulted in a formal investigation by the local safeguarding authority. This matched our records.

The provider continued to notify CQC of any relevant issues relating to the safety and welfare of people who used the service and took the appropriate action if necessary. This safeguarded to people who used the service and ensured multi agency involvement and communication.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. To ensure people’s rights are protected, applications have been submitted to ensure some people did not go out of the service alone. Relevant staff had been trained to understand when an application should be made, and how to submit one and the proper policies and procedures were in place, to ensure applications were submitted for consideration where needed.

Is the service effective?

Relatives told us people were well cared for at the home. One relative said they could not be happier with the set up.

Another relative said it was good that the home had staff that had worked there for many years as it was better for people to see familiar staff faces they and staff could get to know people better.

People’s health and care needs were assessed with them, and people who used the service told us that they were involved in their care plans.

Relatives told us the staff were caring, kept them informed and that people was safe at Courthill House.

We saw people involved in activities around the home, and preparing for and returning from activities in the community that reflected their choices and needs, as recorded in their Care plans.

Is the service caring?

Relatives told us the staff were caring, people was well cared for well and the home kept them informed about their relatives well being and their care.

We saw that people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s care plan.

We noted that people were offered a trial period so that they could decide if they liked the home and staff before they committed to stay.

One relative said ‘’His carer takes a special pride in ensuring that he has all he needs. The most impressive thing is that the staff are wholly dedicated to the well being of the residents.’’

Is the service responsive?

Relatives told us the home was responsive and kept them informed and updated about people’s well being and their care and any changes or concerns.

People who used the service told us they had no complaints and felt listened to.

We noted a new internet based quality assurance system was being set up. This allowed continual input and assessment as opposed to periodical quality reviews.

Is the service well-led?

People living in the home and their relatives told us they thought the home was well led. They had no complaints and they felt they were listened to when they raised any concerns or minor issues.

We saw that the home was subject to external audits which included, finances and the home’s policies and procedures.

We noted that all complaints people made were monitored. This was done to identify any overall trends that showed where practice changes were needed to improve quality for everybody.

We found that some people’s care records were not accurate and some contradicted information in other records.

People greeted us in their own individual ways and some showed us activities they had been involved in that day such as buying jewellery.

We saw people involved in activities around the home, and preparing for and returning from activities in the community that reflected their choices and needs, as recorded in their plans of care.

We found where people did not have the capacity to consent, the provider acted within legal requirements.

We saw that the service provided safe, appropriate care, through carrying out initial assessments, planning care based on collating all the required information, and making decisions based on people’s choice and risk assessments.

People were protected from unsafe or unsuitable equipment.

We saw there were enough qualified, skilled and experienced staff to meet people's needs.

We found that people were not always protected against the risks of unsafe or inappropriate care and treatment because the provider had not kept care planning records securely and confidentially, and had not ensured that contingency plans required to provide continuation of appropriate and safe care in the event of emergencies could be promptly located when needed.

All the people we spoke to appeared happy and relaxed, and confident to choose where to be and what to be involved in around the home.

People told us that they like the food.

One person told us that the staff were nice and they liked their rooms.

Another person showed us an activity they enjoyed.

The comments section of the visitor’s book contained positive feedback about the care of people’s relatives, the staff, and the welcome they received.

A relative of a person who used the service told us that the building was a good design and well laid out, that food was good and the staff knew their relative’s likes and dislikes. They had no complaints, but felt they could make one if they did. They felt their relative was as safe as they could be there.

We found the home to be well maintained hygienic and clean.

We saw that staff received appropriate professional development and support.

We saw that comments and complaints that people made were responded to appropriately.

One person said they wanted to go out, and we saw staff arrange this. We saw people involved in activities around the home. We saw that staff were attentive to people, and responded to people with a good understanding of their communication styles or body language. We also saw that staff gave adequate time for people to communicate with their individual communication styles and methods.