This unannounced inspection took place on 6 November 2018. It was prompted by the outcome of a safeguarding investigation which had been carried out by the local authority and the allegation had been substantiated.

At our previous inspection in March 2018 we found that the provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had served two warning notices and asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we found that the quality and safety of the service had deteriorated and there were serious areas of concerns and ongoing breaches of regulations. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Derwent House is a residential care home registered to provide accommodation and personal care for up to 14 people with a learning disability. The house is next door to another of the provider's services and has one shared bedroom and shared toilet and bathroom facilities. At the time of the inspection 13 people were living there. We inspected this service within the principles of Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion and promote people with learning disabilities and autism using the service living as ordinary a life as any citizen. We found that the model of care at Derwent House was not supportive of these principles and that people did not have choice and control over their day to day lives.

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 2008 and associated Regulations about how the service is run.

The provider had not taken action to ensure that people were safeguarded from abuse. They had failed to respond and learn lessons from an incident that had resulted in psychological abuse of some people who used the service. There were still insufficient safely recruited staff to meet people's assessed needs. The provider could not be sure that staff were trained and safe to fulfil their roles.

The service did not always

This unannounced inspection took place on 8 March 2018. At our previous inspection in October 2016 we found that the principles of the Mental Capacity Act 2005 (MCA) were not consistently followed and the provider was not notifying us of significant events. We had found two breaches of the Health and Social Care Act Regulations (Regulated Activities) Regulations 2014. Since the last inspection the provider had notified us of a death however we had not been notified of other significant events. We found further concerns and four more breaches of Regulations. You can see what action we have asked the provider to take at the back of this report.

Derwent House is a 'care home' registered to care for up to 14 people. At the time of the inspection 13 people were using the service. 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.

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.' Registering the Right Support CQC policy'.

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 2008 and associated Regulations about how the service is run.

The provider had failed to improve and meet the regulations following our previous inspection and the new registered manager was not supported by the provider to understand their responsibilities in relation to their registration with us.

There were insufficient quality assurance systems in place for the provider to monitor and improve the quality of service for people.

There were insufficient numbers of staff to meet the assessed needs of people. People were not always safeguarded from abuse as safeguarding procedures were not always followed.

The principles of the MCA were not always followed to ensure people were not being unlawfully restricted.

Risks of harm to people were assessed and minimised through the effective use of risk assessments. People's medicines were stored and administered safely. Safe recruitment procedures were followed when recruiting new staff. Control measures were in place to reduce the risk of infection.

People's needs were assessed and staff knew people's individual needs and plans of care. Staff worked with other agencies to ensure people received holistic care and when people were unwell or their needs changed health care support was gained.

People were supported to maintain a healthy nutritional diet of their choice. Staff received support, supervision and training to be able to fulfil their roles effectively. The environment was designed and adapted to meet the needs of people who used the service.

People who used the service were treated with dignity and respect and they were involved in the planning of their care and the running of their home. People's right to privacy was upheld and they received care that was personalised and met their individual needs and reflected their preferences.

People were supported to engage in hobbies and activities of their choice and people and their relatives were able to raise concerns and they were acted upon. People would be supported at the end of their life according to their wishes.

People and the staff liked and respected the registered manager.

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This inspection took place on 24 October 2016 and was unannounced.

Derwent House is a care home for people with learning disabilities or autism spectrum disorder. A maximum of 14 people can use the service. At the time of our visit, 13 people lived in the home.

The home had a registered manager. 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.

Staff understood the importance of gaining people's consent and knew the principles of the Mental Capacity Act. However, one person who lived at the home did not have capacity to make decisions and was having their liberty restricted without a Deprivation of Liberty Safeguard (DoLS) in place. This was rectified after the inspection.

The registered manager had not sent two statutory notifications to the CQC to inform us of an incident and a death at the home. Statutory notifications are sent to the CQC to help us monitor the care people receive and to ensure they are safe.

The providers and the registered manager were well respected and provided good care to people who lived in the home. However there were no formal systems in place to check that delegated responsibilities were carried out, and to ensure the home and other homes in the provider group would continue to meet the regulations.

The deputy manager gave staff good day-to-day support and was well liked by people who lived at the home. People and staff felt management were approachable and supportive.

Staff understood the risks related to people's physical health and well-being, and followed people’s individual risk assessments to ensure they minimised any identified risks. Staff understood the local authority's safeguarding policies and procedures and knew when to report concerns about abuse.

There were enough suitably trained staff to support people's needs. Staff recruitment procedures reduced the risk of the provider employing unsuitable staff.

Staff were kind and supportive of people's needs. People enjoyed living at Derwent House and led lives which reflected their interests and preferences.

People received healthcare when needed, and their medicines as prescribed.

At our last inspection on 16 September 2013, we made three compliance actions in relation to the support people received from staff, how medicines were managed and how the provider carried out checks to monitor the quality of the service. We inspected this service to review how the provider had made improvements to demonstrate they were providing safe care.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate outcomes for people using the service had improved.

During our inspection we spoke with six people who used the service, four members of care staff and the registered manager. People told us they were happy with their care. One person told us, “If I have a problem, the staff look after me”. Another person said, “I feel safe here and the staff are very well mannered”.

People told us they could make choices about their care and that the choices they made were respected by the staff.

We saw that staff interacted positively with the people who used the service, and people received support from staff in a caring manner.

We saw that people were not protected from the risks associated with medicines, because appropriate systems were not in place to ensure that medicines were stored and administered as prescribed.

We found that the provider did not have effective systems in place to consistently assess and monitor the quality of the service provided. People were at risk of receiving inappropriate care because of this.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with four people using this service, one relative and three members of staff. People using the service told us that they liked living in the home. One person said, “I have been here a long time and I like it”. Relatives that we spoke with told us that they were happy with the care provided. One relative said, “The home is excellent, very welcoming and the staff are approachable. They always make themselves available if I need to talk to them and I have every confidence that people get a good quality life”.

During our inspection we saw that people were supported to make decisions and were involved in the planning of their care. We saw that people were treated with care and respect.

We saw that people were supported to access the community and that appropriate risk management plans were in place to promote independence.

We saw that staff had the required knowledge and skills to provide the level of care that people required. We also saw that people using the service were protected from harm, abuse and neglect. Arrangements for the management of people’s finances had been improved.

During our inspection we identified that adequate systems were not in place to assess and monitor the quality of the service.