This inspection took place on 25 and 26 April 2018 and was unannounced.

The last comprehensive inspection was on 4 April 2017 when breaches of legal requirements were found in regards to safe care and treatment, staffing and good governance. After the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook a focused inspection on 1 August 2017 and found the provider had met the breaches in regulations in regards to safe care and staffing. However, they remained in breach of the regulations under well led. After the inspection the provider wrote to us to say what they were going to do to meet the legal requirements, they told us these would be met by 21 August 2017.

During this inspection we found breaches in safe care and treatment, person centred care, staffing and a continued breach in good governance.You can see the action we asked the provider to take on the back of our full-length report.

David House 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.

David House provides accommodation and support for up to eight adults with learning disabilities, some of whom also have mental health needs and/or are living with dementia. At the time of our inspection four people were using the service.

We met with the manager at this inspection who had made an application to become a registered manager with the CQC. 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 not always protected from the risk of harm due to environmental concerns. One communal window was not restricted meaning people could fall from height. We found a fire door was not linked to an alarm system to alert staff if people left the service. A light was not working in one corridor meaning people could not see where they were walking. Some important checks to ensure people’s safety had not been completed, this included checks for hot water, fire safety and checks to reduce the risk of Legionnaires’ disease.

Not all risk had been identified for people and some risk assessments had not been reviewed. This meant staff did not always have the guidance they needed to support people and manage their risk according to their individual needs.

There were enough staff to keep people safe during our inspection. However, we found past examples where there had been insufficient cover to keep people safe and staff had worked excessive hours putting people at risk of unsafe care.

Staff had received supervision but the providers mandatory training requirements had not been completed so there was a risk staff may not have the knowledge and skills to meet people’s needs. Some recruitment procedures were poor regarding criminal checks so the provider could not be sure staff met the criteria to keep people safe.

The service was poor at identifying and managing risk relating to infection control because monitoring systems were insufficient and out of date.

Medicine audits were carried out by the manager but not everyone had a medicine profile in place with a photograph so staff could be sure they were giving medicine to the right person. Records were not always clear if medicine should be given 'as required' or as a prescribed medicine.

People had limited opportunities to access the community and in-house activities were limited. The service did not always support people to take part in social activities relevant to their individual interests and hobbies. People were not always involved in the development of their care plan and how they wanted

We carried out an unannounced comprehensive inspection of this service on 4 April 2017. At which breaches of legal requirements were found in regards to safe care and treatment, staffing and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. They stated they would take the necessary action to address the breaches by 9 June 2017.

We undertook this focused inspection on 1 August 2017 to check they had followed their plan and to confirm they now met legal requirements. 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 ‘David House’ on our website at www.cqc.org.uk.

David House provides accommodation and personal care to up to nine adults with a learning disability. At the time of our inspection three people were using the service.

Since our comprehensive inspection a new manager had been appointed. They were registered with us on 8 June 2017. 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 registered manager had introduced new processes to review the quality of some areas of service delivery including ensuring a safe and suitable environment was provided. The registered manager had plans to implement systems to audit medicines management and ensure oversight of service delivery through the completion of provider quality audits. However, these were not in place at the time of our inspection. The provider remained in breach of regulation relating to good governance. You can see what action we have asked the provider to take at the back of this report.

Staffing levels had been reviewed and there were now sufficient numbers of staff to meet people’s needs. Staff had received refresher training and had the knowledge and skills to meet people’s needs.

Work had been completed to ensure a safe and secure environment, including installing window restrictors and alarms on external doors. Medicines management processes had been reviewed and people received their medicines as prescribed.

The provider was now meeting the breach of regulation we identified at our previous inspection in regards to safe care and treatment, and staffing.

We undertook an unannounced inspection on 4 April 2017. This was the first inspection of this service under this provider. The provider registered this service with the Care Quality Commission on 9 March 2017. The service was previously registered under a different provider as ‘Cottisbraine House’. You can read our inspection reports for ‘Cottisbraine House’ by selecting the 'all reports' link for ‘Cottisbraine House’ on our website at www.cqc.org.uk.

David House provides accommodation and support for up to eight adults with learning disabilities, some of whom also have mental health needs and/or are living with dementia. At the time of our inspection five people were using the service.

A registered manager was 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 2008 and associated Regulations about how the service is run.

We found there were insufficient staff on duty to meet people’s needs and keep them safe in the event of an emergency, especially at night. There was a risk that staff did not have up to date knowledge and skills to meet people’s needs as they were not up to date with their training requirements and many staff had not completed the required refresher training courses.

People were not always protected from the risk of harm due to environmental concerns. Windows were not restricted meaning there was a risk people could fall from height, and external doors to the garden were not secure or linked to an alarm system to alert staff if people left the service.

Safe medicines management was not consistently followed and we identified errors in the recording of medicines administered and stocks of medicines at the service.

With the recent change in provider of the service, this had impacted on the leadership and management of the service. We found there was a lack of communication between the provider and registered manager regarding decisions relating to service delivery. There were processes in place to review the quality of service provision, however, these were not always comprehensive and sufficient action was not always taken to mitigate risks to people’s safety.

The provider was in breach of the legal requirements relating to safe care and treatment, good governance and staffing. You can see what action we have asked the provider to take at the back of this report.

Staff had assessed individual risks to people’s harm and plans were in place to manage and mitigate those risks. Staff were aware of their responsibility to safeguard people from harm and escalated any concerns to the registered manager and the local authority safeguarding team when necessary.

Staff supported people in line with the Mental Capacity Act 2005 and in line with the authorisations approved through the deprivation of liberty safeguards. Staff assisted people with their nutritional and health needs, liaising with other healthcare professionals as and when required.

There were kind and considerate interactions between staff and people using the service. Staff were friendly and polite when speaking with people. They were aware of people’s communication methods and offered them choices throughout the day. Staff respected people’s privacy and maintained their dignity.

Care records provided clear and detailed information about people’s needs, outlining the level of support they required with different tasks and their preferred daily routines. There were some but not many scheduled activities at the service and limited opportunities for people to access the community. We recommend that the provider reviews national guidance to support social inclusion for people, in the community.

The registered manager adhered to the requirements of their registration with the Care Quality Commission and submitted