People were not always able to verbalise their views, we therefore observed and listened to the interaction between people and the staff who were supporting them.

People were supported by staff who knew them well, however, people did not have access to communication aids that would promote their knowledge and independence. At the time of the inspection people did not have routine and structure to their day. People had sensory impairments or were living with autism, which meant it was important for them to have structure to their day and information which informed them of the what day it was and what the events of the day were going to be.

Staff although kind in their approach to people were focused on task related activities such as cooking, cleaning and supporting people with eating their meals where this was required and personal care tasks.

People’s privacy, dignity and independence were respected and promoted by staff. Although kind in their approach to people, staff were focused on task related activities such as cooking, cleaning and supporting people with eating their meals where this was required and personal care tasks. Staff responded promptly to people’s requests for assistance and regularly checked whether people were happy and comfortable.

People received help with their medicines from staff who were trained to safely support them and who made sure they had their medicine when they needed it. When errors occurred, staff were supported to reflect and learn from their mistake.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people effectively. Training certificates in staff files confirmed the training staff had undertaken, which included safeguarding of vulnerable adults, manual handling, infection control and the Mental Capacity Act 2005 (MCA).

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) was being met. Where people had restriction on their choices, best interest decision making processes were in place. People were consulted on decision in regards restriction on their movements with the support of advocates, relatives or health professionals.

People's risk of abuse was reduced as the provider had a suitable recruitment processes in place. Although there were sufficient staff to meet people’s care needs, staff felt they were unable to support people in their preferred activities as much as they would like. The registered manager informed us additional funding was being sought.

People were protected by the prevention and control of infection by staff who had received the appropriate training. The service had a comprehensive range of health and safety policies and procedures to keep people safe and each person had an emergency evacuation plan in place.

To ensure the environment for people was kept safe specialist contractors were commissioned to carry out fire, gas, water and electrical safety checks.

Care staff prepared and cooked meals. Staff told us they asked people what they wished to eat and then prepared their dinners. We observed the lunch time meal, people were not involved in supporting staff to prepare their meals or setting the tables.

The service had a complaints policy and procedure which was available for people and visitors to view in the home. Although the provider had an easy read version of their complaints procedure, this was not visible for people to see around the home. People had access to external health professionals. Where people's health needs had changed, staff worked closely with other health professionals to ensure they received support to meet their needs

Quality assurance systems were in place to monitor the quality of the service and audits took place. However, these audits were not always effective in identifying some of the issues found during our inspection.

The inspection took place on 17 June and was announced. Dorset Learning Disability Service 4 Romulus Close is a service which provides care and support to four people with learning disabilities. It is situated in a residential cul-de-sac in Dorchester.

The service 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.

When we last inspected the service in December 2013, we had concerns that people were not protected from the risk of inappropriate care because peoples care plans had not been changed to identify peoples risks and because accurate review records were not maintained. We asked the provider to take action about these concerns and they sent us a plan detailing that they would have addressed them all by August 2014. At this inspection we found that improvements had been made.

There were enough staff at the service to keep people safe, but the home had vacancies and was sometimes running on minimum staff numbers. People were supported with a range of activities and were not impacted by the staffing levels, however it meant that unplanned activities might not have been possible on some occasions.

People were protected from avoidable harm by staff who knew them well and understood the risks they faced. Risk assessments were comprehensive and focussed on supporting people to be as independent as possible whilst supporting their behaviours and managing their individual risks. Staff were recruited following appropriate pre-employment checks and received appropriate training for their role.

People were supported to live in a safe environment because fire safety, building and equipment checks were carried out regularly and any issues were recorded and actioned.

People received their medicines as prescribed and we saw that they were stored safely and recording was accurate and regularly audited.

Staff had daily contact with the registered manager and were encouraged to speak with them whenever they needed to. More formal supervisions for staff were being scheduled but were overdue and the registered manager was aware and managing this.

People were supported to make decisions or to be involved in best interests decisions where they were unable to make decisions for themselves. Staff understood the relevant legislation around this and records were robust.

Staff understood how to offer people choice and we saw that people were involved in choices about all aspects of their support in ways they were able to understand.

People were supported by staff in a way which was kind and respectful. Rapport between people and staff was good and there was a relaxed atmosphere at the home. Staff ensured that they were mindful about how to maintain peoples privacy and dignity.

Relatives were regularly contacted to discuss any issues and were involved in reviews of their relatives care. Records were person centred and detailed, they gave histories of the people living at the home and focussed on what people liked and what their interests were.

Relatives and health professionals who visited the service felt welcomed and that staff were caring and supporting peoples needs well. They also felt that the home was well managed and had regular contact with the staff and registered manager.

There had been some corporate changes made which were not all viewed positively. Staff told us about the impacts both on people who lived at the service, and also on staff. The registered manager was aware of these and in the process of feeding them back at management level.

There was an open culture at the service and staff were clear about their roles and responsibilities. The registered manager encouraged staff to tell them about ideas and

We visited the service initially on the day of 12 December 2013. We returned to the service on the evening of 13 December 2013, to view environmental risk assessments the registered manager had completed.

During our visit we spoke with one person who lives in the service. We also spoke to the relatives of two people who live in the service. We were unable to speak with other people who live in the service due to their complex needs.

People's relatives told us that they felt positive about the quality of care people received; and with their families relationships with the staff. We observed residents interacting with the staff in a relaxed way.

People’s relatives told us that they were asked for their consent when making choices and decisions about their daily lives; and that people's choices and decisions were respected by the staff. A person’s relative told us, “The care is very good."

The home had procedures in place to ensure that people received their medicines as prescribed. Medicines were handled in a secure way.

We found that there were sufficient numbers of staff, with the right competencies.

People benefitted from safe care. However, the service was not consistently monitoring the management of risks to people’s welfare and safety.

We found that people's personal records were not appropriately maintained.

We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had limited speech and difficulties with communication related to their disability. We observed people in their day to day environment and spoke to some of their relatives. We gathered evidence from the care records and talking to staff.

We observed people being treated with respect and kindness by staff and that people appeared happy and relaxed. We saw that people were encouraged to participate in activities outside their home in the local community and to socialise with others. People were assisted with transportation in an adapted vehicle for sole use by the people who lived there.

The care record showed that assessments had been carried out and this information was kept in the home to assist staff in planning and delivering care.We found that staff worked as a team to deliver the service and were well supported by training and supervision. The involvement of relatives was supported and encouraged where possible.

Safeguarding procedures were in place and appropriate actions were put in place to address the concerns. There was evidence that learning from incidents took place and appropriate changes were implemented.