Derby House provides personal care and accommodation for up to eight females with a learning disability. At the time of our inspection there were five ladies living at Derby House.

There was a no registered manager in post however a new manager had started at the service and had submitted their application to the CQC to become registered. 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 new manager assisted us with our inspection on the day.

We last inspected Derby House in December 2015 where we found breaches of regulation in relation to a lack of safe person-centre care, a lack of respect and dignity shown towards people and a lack of robust quality assurance. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns. We carried out this inspection to see if the provider had taken action in line with their action plan.

There was a sufficient number of staff to enable people to go out of the home supported by the level of staffing they should expect. Staffing levels within the home were appropriate.

Risks to people had been identified and action taken to reduce these risks. Accidents and incidents were recorded and action taken to prevent reoccurrence. Staff followed good medicines management processes.

People were cared for by staff who showed kindness and care and people’s individualities were recognised by staff. People were supported to maintain relationships with their family members. Activities for people were varied and work was continuing on ensuring that people had access to a range of meaningful, individualised activities.

People’s dietary requirements had been identified by staff and people were encouraged to be independent by making their own snacks. Where people’s health needs changed they were supported to access the appropriate health care professionals.

Quality assurance monitoring took place and the new manager had made positive changes to the home. Relative’s and staff felt the new manager was an asset to Derby House. People were involved in the running of the home and feedback from relatives was sought. Complaint information was available.

Support plans in relation to people had been reviewed and were more person-centred with a sufficient level of information in them for staff. Staff knew people’s needs and had received training appropriate to these. Staff had access to one to one support from their line manager and received regular supervisions to help ensure they were carrying out their roles in an appropriate manner.

Staff had a good understanding of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff were also aware of their responsibilities in relation to abuse. The provider followed good recruitment processes and had an emergency contingency plan in place to help ensure people cared would not be interrupted in the event of an emergency.

Derby House provides personal care and accommodation for up to eight females with a learning disability. This includes autism or behavioural difficulties.

There was no registered manager in post. The new manager had submitted his application to CQC to become registered. 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 new manager assisted us with our inspection on the day.

Where people had identified risks, such as a risk of choking, staff did not always follow the guidance that was in place. For example, by sitting next to people whilst they were eating. Accidents and incidents were recorded and monitored but staff did not adhere to steps put in place to mitigate the reoccurrence of such incidents. For example, in relation to people choking.

There were enough staff working to meet people’s needs but deployment of staff was not always appropriate to ensure people had regular access to the community. Activities were arranged for people but we found there was a lack of oversight by management to ensure people received the level of activity they may be funded for.

People’s dietary requirements had been identified by staff and although people were involved in developing the menu we did not see people being offered a choice of the food they ate.

Actions from quality assurance monitoring were not always completed to help improve the care and treatment people received. We found staff behaviour was not always open or transparent. The provider only acted on concerns once they had been identified by us during our inspection.

Although we saw some good examples of care, we found staff did not always show people respect, speak to them in an appropriate manner or provide them with care personalised for their needs. Care records in relation to people were detailed and comprehensive but did not always focus on the person as an individual.

Staff were provided with regular training to assist them with carrying out their role and staff had the opportunity to meet with their line manager to check they were following best practice and to discuss any aspect of their work.

Staff had a good understanding of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, which meant staff had followed the correct procedures in relation to any restrictions that were in place.

Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse. In the event of an emergency or the home had to be evacuated people’s care and support would not be interrupted.

Good medicine management procedures were followed by staff and guidance was in place for staff to indicate when people may require medicines for pain. People were supported to access external health care professionals when required in order to help them maintain a good level of health.

Staff were involved in all aspects of the home and attended regular staff meetings. Staff felt supported by the manager. There was complaint information available for people should they have any concerns about the care they were receiving. Relatives were asked for their feedback in relation to the home and were made to feel welcome when they visited.

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.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with the four people who use the service, the registered manager, two care staff and four relatives of people who used the service. We also reviewed records relating to the management of the home which included, three care plans, daily care records, daily care records, training and maintenance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

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 found that where people did not have capacity to consent, the provider acted in accordance with legal requirements.

People’s relatives told us they had no complaints and they felt they were listened to when they raised any concerns or minor issues.

People’s relatives also told us the home kept them informed about their relative’s well-being and felt their relative was safe.

People's relatives also told us they thought the building and their relative’s bedrooms were suitable and clean.

We saw that the Trust had an emergency procedures file, which covered such things as fire evacuation, electricity power cuts, gas failure, heating failure, and adverse weather conditions.

We saw that doors and areas that were required to be kept locked to protect people were secure, for example electrical cupboards and the Control of Substances Hazardous to Health (COSHH) Cupboard were locked and medication was secured.

Is the service effective?

We saw that staff had regular training in the core areas relating to their work to ensure they were effective in their practice.

We noted that the people who used the service were registered with a local General Practitioner. Records of GP visits, dental care, and visits from the chiropodist, optician and other healthcare professionals were recorded in care plane. This also meant that people's health care needs were being monitored and maintained.

People who used the service told us that the food was good and they got enough to eat.

Is the service caring?

We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner.

People’s individual person centred care plans also covered what matters to the person.

People’s relative's also told us the staff were caring, their relative was well cared for and the home kept them informed about their relative’s wellbeing and their care.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but supported the individual to be as independent as possible.

People who use the service, their representatives were not always asked for their views about their care and treatment. People told us that the quality meetings that the relatives used to attend had not happened for some time. One person told us that they and their daughter wanted to go to meetings.

Is the service well led?

We noted that the complaints system The complaints system was monitored to identify any trends and to improve quality. Information about risks was gathered, analysed and reviewed. was monitored to identify any trends and to improve quality.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare, but did not have an effective system to regularly assess and monitor the quality of service that people receive.

Derby House used to provide a service to people with inpatient status and under the Care Programme approach (CPA) and although it had only transferred to the social care sector as a social care home with nursing a matter of weeks before the inspection, it had already made many of the changes needed in practice for the different purpose of the home and associated different working practices and approach.

Our visit was early in the morning and unannounced and we found the building fresh and clean and people were treated with respect and dignity.

People who used the service told us about activities they were planning for that day like going swimming or to the day centre and showed us on the touch screen activities timetable which was well used and seen as good practice.

People who used the service were free to move around the building and staff put them first and gave them priority over other staff with attention, time and choice of areas to be in, even when it made working difficult for those staff.

We saw that although staff did offer choices and seek consent before offering care and information was included in formats and languages people would understand better so the persons consent would be better informed, but where people did not have capacity the provider did not always act in accordance with legal requirements.

We found care and treatment was not always planned in a way that ensured people’s safety and welfare.

We noted people who use 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.

We saw that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.