About the service: Cragside is a care home that provides accommodation and personal care for up to five adults. The home has five individual flats. At the time of inspection, three people were living at the home.

People’s experience of using this service:

• People were safe. Staff had completed training in safeguarding and were aware of their responsibilities in keeping people safe from harm. Risks to people’s safety and well-being were assessed and reviewed. The home was clean and free from odour.

• There were robust procedures in place to reduce the risk of employing staff who may be unsuitable to work with vulnerable adults. There were enough staff employed to meet peoples assessed needs.

• The management of people’s medicines was safe.

• Peoples care, and support needs were delivered in line with current good practice guidance. New staff received induction and there was a programme of on-going support for existing staff through training and supervision.

• People received individualised support to prepare and cook meals. People were encouraged to eat a healthy diet.

• People had access healthcare to a range of external health care professionals.

• The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

• 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. People were able to participate in their hobbies and interests.

• Staff were caring and kind. People were treated with respect and staff were aware of people’s right to privacy. Staff enabled people to express their views and involved them in decisions about their care.

• Care records were person centred, reflecting people’s individuality, likes and dislikes. Daily records were completed but lacked detail. Some documents in peoples care records were not dated and we identified a nutritional risk assessment which had not been reviewed since October 2018. We have made a recommendation regarding end of life care planning for people.

• People felt listened to and staff were supported. There were effective systems in place to gather feedback from people, relatives and staff. Audits were completed on a regular basis to assess and monitor the quality of the service people received.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 19 April 2018).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 13 and 19 December 2017 and was unannounced. At the last inspection on 27 June and 4 July 2017 we asked the provider to take action to make improvements around person centred care, safe care and treatment and good governance. We issued a warning notice in relation to good governance.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. At this inspection we checked to see whether improvements had been made and found improvements had been made, however the registered provider was still not meeting all the regulatory requirements.

Cragside is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cragside is registered to provide accommodation for up to nine people who require nursing or personal care. It specialises in providing support for people with learning disabilities, autism, highly complex needs and challenging behaviour. The accommodation is provided in a Victorian property over three floors with five self-contained flats each with a lounge, fully-fitted kitchen, bedroom and bathroom or shower room. One flat is used for respite care. At the time of our inspection four people were living in the flats and one person was using the respite care flat.

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.

A registered manager was in place. 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 reviewed the systems for the management of medicines and found that systems had improved and issues from our last inspection had been addressed. Competency checks on the administration of medicines were up to date. People received their medicines safely, although some minor issues still needed to be addressed. The registered manager did this immediately.

Building maintenance, cleaning and environmental risk management had improved, although water temperature checks had not all been completed.

Emergency procedures were in place and people knew what to do in the event of a fire. Some information needed to be updated in the fire safety grab file. Risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Detailed individual behaviour support plans gave staff the direction they needed to provide safe care. Incidents and accidents were analysed to prevent future risks to people.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse and safe recruitment and selection processes were in place.

The required number of staff was provided to meet people’s assessed needs. People and staff found regular use of agency staff sometimes reduced consistency, which was important for people who used the service, however regular agency staff were used where possible and recruitment for permanent staff was ongoing.

Staff told us they felt supported, however we found they were not always supported with regular management supervision. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home.

People were

The inspection took place on 27 June and 4 July 2017 and was unannounced. At the last inspection on 23 March 2016 we asked the provider to take action to make improvements around person centred care, safe care and treatment and good governance. We checked to see whether improvements had been made and found the service was still not meeting its regulatory requirements.

Cragside is registered to provide accommodation for up to nine people who require nursing or personal care. It specialises in providing support for people with learning disabilities, autism, highly complex needs and challenging behaviour. The accommodation is provided in a Victorian property over three floors with five self-contained flats each with a lounge, fully-fitted kitchen, bedroom and bathroom or shower room.

There were two managers registered at the service. 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 management of medicines had not been consistently safe and audits had not picked up the issues to drive the necessary improvements. Risk assessments in relation to the management of people’s behaviours which challenged were detailed and provided a plan for staff to follow. However, not all risks to people’s health and safety had been assessed thoroughly.

Staff demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents. Records showed recruitment checks were carried out to ensure suitable staff were recruited to work with people at the service.

Staff training was not up to date and not all staff had received regular supervision and appraisal to ensure they developed in their role. Competency checks on the administration of medicines were not up to date.

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 Not all staff had received training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards, and although the staff we spoke with could describe the principles of the Act and how they would support people who had been assessed as lacking capacity, they were not clear about their responsibilities in relation to assessing people’s fluctuating capacity on a daily basis.

We found all the care staff we spoke with during our inspection to be caring in their approach to the people who lived at Cragside and we observed they treated people with dignity and respect and they clearly knew the people they supported. We saw evidence staff were working with people to maximise their independence in personal and domestic activities of living and accessing the community. We did observe not all staff had been compassionate in their interactions with people at the service.

Some care plans contained high quality and detailed information to enable staff to deliver person centred care. This included a record of people’s preferences and views. They also had a one page summary at the front giving care staff an at a glance summary of people’s support requirements. Not all information had been updated following a change in a person’s needs.

People were involved in planning activities that were meaningful to them and the service was working on their activity programme to ensure they provided activities which people enjoyed and improved their mental wellbeing and independence.

The service was not well-led. The registered manager was not in day to day control at the service to be able to effectively monitor and drive improvements. Systems and processes were not effectively monitoring the quality and driving up improvements. The

This was an announced inspection which took place on 23 March 2016. The service was last inspected 28 January 2014 and we found the provider met the all regulations we looked at.

Cragside is a care home for up to nine people with complex needs. The home is bright and spacious with bedroom accommodation on the first floor. The secure gardens provide a private leisure area and a large modern sunroom provides additional daytime space for activities. The home is located just outside Huddersfield, close to local amenities including, shops, cafes, bank, post office and a garden centre. Cragside is on a regular bus route.

There was a registered manager in place. 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.

On the day of our inspection there were three people using the service. Not all of the people spoken with during the inspection were able, due to complex care needs, to tell us about their experience of living at the home. We spoke with one person using the service and they told us they were happy with the support they received.

Effective systems were not in place to ensure people’s safety and manage risks to people using the service. Accidents and incidents were monitored however, there was no evidence to show that learning had taken place following serious incidents. Risk assessments were not in place for one person.

Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough. Appropriate checks were carried out to make sure staff were suitable and safe to work with vulnerable people.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in medicines management.

Maintenance issues were not addressed in a timely manner.

People were cared for by sufficient numbers of suitably trained staff. We saw staff received the training and support required to meet people’s needs.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions where they had the capacity to do so and where people did not have the capacity, decisions had to be in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Suitable arrangements were in place and people were supported and provided with a choice of suitable healthy food and drink ensuring their nutritional and hydration needs were met.

Staff had good relationships with the people using the service. Staff knew how to support people to raise concerns and complaints. The complaints procedure was also available in a pictorial format. We saw the provider had not received any complaints in the last 12 months however, we found that were concerns were raised these were not responded to appropriately.

Staff were kind and considerate with people, listening to them and involving them in decisions. Arrangements were in place to provide advocacy services for people who needed someone to speak up on their behalf.

There was no planned activity programme in place to ensure the people's social needs were consistently met. People were at risk of receiving care that did not meet their needs as guidance within care records was not utilised.

We received mixed feedback from staff regarding the support they received from the organisation.

The service had not sought feedback from people using the service and/or their representatives.

We found three breaches during our inspect

All of the people who lived at the home had complex care needs and difficulty with verbal communication. We used a number of different methods to help us to understand their experiences, including talking with staff, looking at records and observing the care being delivered.

We spoke with three members of staff. One member of staff told us “it’s brilliant here” another told us “the people who live here are treated well”.

We looked at four care plans and saw that they were comprehensive and reflected the needs of the individual. In the care plans we looked at we saw that risk assessments and plans were in place and had been reviewed and updated on a regular basis. We saw that families were involved with the care and support of the people who used the service.

The home had an up to date safeguarding policy and all the staff had received training in safeguarding. The staff we spoke told us they would know what to do if they had any concerns about the treatment of the people who used the service.

The staff we spoke with told is they felt people were treated with dignity and respect and we saw that interaction between staff and people who used the service was warm and respectful.

Although the home could accommodate up to nine people there were only four people currently living at the home and there were plans in place to re-locate two people out of the area. The manager told us that they weren't sure what would be happening with the home once the two people had left.

On the day of the inspection there were four people living at Cragside. People living at Cragside have complex needs which meant they were unable to talk to us. We used different methods to help us understand the experiences of people using the service. During our visit we spoke with the Registered Manager, the Locality Manager and two members of staff.

Throughout our observations we saw people relaxed in their surroundings and engaged in different activities. We observed interactions between people and staff that were positive, people frequently laughed or smiled. Staff gently reassured and supported people if they became unsettled or anxious.

We saw people's individual needs were assessed thoroughly and care and support was developed from an assessment of their needs. People appeared well-dressed and well cared-for.

There were sufficient numbers of staff with the right knowledge, experience, skills and qualifications to support people at all times. Staff had received appropriate training for their role and understood the importance of reporting suspected abuse.

The two staff members we spoke with told us they felt well-supported. One of them told us “It’s one of the best team’s I’ve ever worked in”.

We were unable to communicate with some of the people living at Cragside because of the complexity of their needs however, through our observations we saw that people seemed confident in their surroundings and in their interactions with staff.

We were unable to get peoples’ views verbally due to the nature of their disabilities. We therefore spent time observing care practice and peoples’ responses and interactions. What we found is included in the relevant sections of this report.