East View Housing (19 Alexandra road) is a residential care service for three people with learning disabilities. It is situated over three floors with a communal lounge, kitchen and dining area. Bedrooms are located on the second and third floor with a communal bathroom and toilet.

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)

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Although regular quality audits were completed by the registered manager and senior support worker, a number of shortfalls were found within record keeping which suggested current auditing processes needed to be developed. Staff had a thorough knowledge of people and their support needs, which meant where shortfalls were identified, there was limited impact to people. However, support needs were not consistently identified within care documentation. This was an area that the registered manager had already identified as requiring some improvements.

People were safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People had a range of individualised risk assessments to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. There were sufficient numbers of suitable staff to ensure peoples safety.

Staff received regular training, supervisions and attended meetings to ensure they were well supported and had the knowledge and skills to support people. 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’s nutritional needs were met and they were given choice and control over what they wanted to eat and drink.

People and relative’s felt that staff were kind and caring. It was evident that staff knew people well and strong relationships had been built. People’s privacy, dignity and independence was promoted at all times and they were encouraged to engage with a variety of social activities of their choice in house and in the community.

Staff knew the people they cared for and what was important to them. Staff appreciated people's life histories and understood how these could influence the way people wanted to be cared for. Each person also had a key-worker; this was a named member of staff who had a central role in their lives and would oversee their support needs and care plans. Care plans were person centred and emphasised involvement from people, their relatives and health professionals.

People and their relative’s felt that they were listened to and were confident complaints were dealt with effectively. People, their relatives and staff were complimentary about the management team and how the service was run.

Further information is in the detailed findings below.

Our inspection team was made up of one inspector. We set out to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service and staff told us, our observations during the inspection and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the service told us that they felt safe and trusted the staff who supported them. One person told us “I’m happy to live here, I have no concerns at all”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that care plans were sufficiently detailed to allow staff to deliver safe and effective care that reflected the support required in people’s assessed needs. However, we found that some key worker reports had not been completed and records such as routine monitoring of weight had also lapsed. People told us that staff sometimes spoke with them about their support plans.

Records showed that systems were in place to make sure that staff learnt from events such as accidents and incidents, complaints and concerns. Records kept by the service ensured that risks were identified and reviewed. This helped reduce risks to people and enabled the service to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care settings. This is when restrictions may have to be made to help keep people safe. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Staff files contained all of the information needed by the Health and Social Care Act as well as details of the training they had received. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support the people who lived there.

Is the service effective?

Staff we spoke with understood people’s evident care and support needs well. People told us that they were happy with the care they received, they had no concerns and felt their needs had been met. One person said “All of the staff are great”. People understood that they had given their consent to receive the care and support provided and knew that they could change their minds about the decisions that they had made.

Is the service caring?

People were treated with respect and staff were courteous. Staff were aware of people’s interests, they encouraged people and offered them a wide variety of activities. People told us that the staff were supportive and we saw that interaction between staff and people was polite and often with humour. Staff communicated effectively with people. We saw that this helped to reduce people’s anxieties when planning activities and events.

Is the service responsive?

People’s needs had been assessed before they moved to the service. People we spoke with told us they were happy with the support provided and that it met their preferences, interests and goals. People had access to activities that were important to them. For example, some people had work placements, or went to college and day centres. We found that people had been supported to maintain friendships.

Is the service well-led?

The name of a previous registered manager appears in this report, who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because it had not been removed as the registered manager of this location at the time of our inspection.

Staff had a good understanding of their roles in the service and felt supported by the acting manager. There were quality assurance processes in place to maintain standards in the service. We found the acting manager had good knowledge of the running of the home.

The house was unstaffed during the day when people were out at activities. Sometimes people were out at evening activities too. To ensure we met staff and the people that lived in the house, we made a short notice announced inspection of the service.

During our visit we met all of the people that lived in the house. We also met two staff who worked across this and two other houses operated by the provider in the same street. People were able to tell us about their experiences and told us they liked where they lived. We found that staff demonstrated an in-depth understanding of people's individual care and support needs.

All the people in the house had a weekly activity programme. We saw them coming and going to activities during our inspection. They told us about the things they liked to do during the day and at evenings and weekends.

We saw that interactions between staff and people living in the house were relaxed and mutually respectful.

We saw that appropriate systems were in place for the safe management of medicines, and for the receipt of and response to complaints.

We found that people lived in a safe, well maintained and homely environment.

We had some concern that a robust recruitment and induction process for new staff was not clearly evidenced and that records were not always kept updated.

There were three people who lived in the house. At our visit we met with one person. They told us that it was their day off from doing activities. They said they enjoyed living at the house.

On the day we visited all the service users living in the house had left to attend external activities and were unavailable to speak with.

This inspection took place on 07 and 12 May 2015. This was due to the need to talk to people when they returned from activities outside the home and to staff who were working at the service on different days. To ensure we met staff and the people that lived in the house, we gave short notice of our inspection to the service.

This location is registered to provide accommodation and personal care for a maximum of three people with learning disabilities. Three people lived at the service at the time of our inspection.

People who lived in the house were younger adults below the age of sixty five years old. People had different communication needs. Some people were able to communicate verbally, and other people used gestures and body language. We talked directly with people and used observations to better understand people's needs.

Our inspection on 21 May 2014 found that the provider was in breach of regulation 20 of the Health and Social Care Act 2008 (HSCA) which relates to records. This was because some records were not always well maintained. For example, weight checks had not been recorded in line with people’s needs and monthly key worker reviews had not been consistently completed. A keyworker is a member of care staff with key responsibility to support an individual, to meet their support and care needs.The provider sent us an action plan to show how they intended to improve the records they kept by October 2014. They intended to review all risk assessments and care plans and introduce a monthly keyworker report system. They intended to introduce a new quality monitoring process to monitor and analyse care plans and key worker report records to ensure they were up-to-date and met people’s needs.

During this inspection we found that improvements to record keeping had been made and fully embedded into common practice by the provider.

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.

People and staff were encouraged to comment on the service provided and their feedback was used to identify service improvements. There were audit processes in place to monitor the quality of the service. Maintenance systems were not always sufficiently robust to ensure low priority repairs and maintenance tasks were completed in a timely manner.

We recommend that the service explores relevant guidance from reputable websites about quality monitoring and action planning to improve the maintenance audit system and ensures effective communication of this with staff

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Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Risk assessments took account of people’s right to make their own decisions.

Accidents and incidents were recorded and monitored to identify how the risks of re-occurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed and were continually reviewed.

Staff were competent to meet people’s needs. Staff received on-going training and supervision to monitor their performance and professional development. Staff were supported to undertake a professional qualification in social care to develop their skills and competence.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no one living at the home was currently subject to a DoLS, we found that the registered manager understood when an application should be made and how to submit one.

The service provided meals and supported people to make meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People were satisfied about how their care and treatment was delivered. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were involved in their day to day care and support. People’s care plans were reviewed with their participation and relatives were invited to attend the reviews and contribute.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. People were involved in planning activities of their choice.

People received care that responded to their individual care and support needs. People felt confident they could make a complaint and that the registered manager would address concerns.

There was an open culture that put people at the centre of everything that took place. Staff held a clear set of values based on respect for people, ensuring people had freedom of choice and support to be as independent as possible.