24 Tower Road West is a care home. People in care homes receive accommodation and nursing or personal care as a 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.

24 Tower Road West provides accommodation and personal care for up to five people who have learning disabilities and some associated physical and/or sensory disabilities. There were five people using the service at the time of inspection. The building was situated over two floors, with people's bedrooms located on both. Some people had their own bathrooms attached to their bedrooms and there were communal facilities for those that did not. There was a kitchen, dining-room and a large lounge for people to relax in. One person had their own self-contained flat with their own lounge, bathroom and kitchenette. People also had access to outside space. There was a large decking area with table and chairs which we saw people accessing during the inspection and garden space beyond that.

At our last inspection in November 2014, the service was rated 'Requires Improvement' with five breaches to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found significant improvements had been made and the provider is now meeting the regulations.

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.

Since their previous inspection, significant improvements had been made to the quality and quantity of audits. However, we still found some inconsistencies within people’s care documentation which suggested quality assurance systems required some improvements. We have made a recommendation regarding this.

People were supported to be safe with person centred risk assessments. Safety checks were completed regularly by the management team and external professionals on equipment and the building. There were suitable numbers of staff to meet the needs of people and absences were covered by other staff who knew people well. People received their medicines safely from suitably trained and competent staff. Staff had a good understanding of how to protect people from potential harm and any incidents were responded to in a timely way, with actions taken to minimalize reoccurrence.

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 practise.

Staff had the skills and knowledge to support people and meet all their needs. They received a thorough induction and training that ensured they were up to date with current good practise. Staff also told us they had regular supervision and appraisals to support them in their roles.

People's nutritional needs were met and they were encouraged to be as independent as possible with preparing food. People had regular support from a variety of health and social care professionals to promote their mental health and well-being.

People, their relatives and professionals spoke positively about the caring nature of staff. People's dignity, independence and privacy was promoted and encouraged. Staff knew people, their preferences and support needs well.

Care plans were detailed and person centred with an emphasis on people’s prefere

There were four people living at the house when we inspected. We were told that the provider was seeking referrals to fill the fifth space. We met three of the people living there. A fourth person was at day care.

The people we met were happy with where they lived. They enjoyed the activities they did during the day and in the evenings. They made decisions whether they wanted to attend structured day care activities or not. They had opportunities to discuss with the manager and key work staff any concerns they might have regarding their support and care. They were consulted about how their care was delivered and decisions about their future.

People had access to routine and specialist healthcare support. Any nutritional risks or dietary concerns were assessed and measures implemented to minimise risks of harm from poor nutrition.

A system was in place for the management of medicines but this was under review to improve safety.

We found that the house provided a comfortable homely environment for people to live in. It was clean and well maintained. Furnishings were of good quality. Health and safety and property checks were undertaken to ensure people lived in a safe environment.

People’s concerns were listened to and actions taken to resolve them. Where necessary the service sought the involvement of other stakeholders.

At our previous inspection minor shortfalls in respect of infection control and safeguarding were identified. We asked the provider for an action plan of how they had addressed these, and this was provided within the agreed timescale.

At this visit we viewed all communal areas, including toilet and bathing facilities where particular infection control issues were highlighted previously. We found the cleanliness of these much improved. We met four people who lived in the home/service but their feedback did not relate to the outcomes assessed. We spoke with staff who confirmed that following our previous inspection, cleaning schedules had been reviewed and staff awareness of infection control had been raised at team meeting discussions. We saw evidence that the manager was introducing new monitoring systems and that an infection control audit had recently been conducted.

Staff told us that safeguarding had been discussed with staff at recent team meetings, and this was evidenced in meeting minutes viewed. The manager reported that safeguarding featured as a regular agenda item and this was evidenced in an agenda plan viewed for the next meeting. The manager reported that staff safeguarding training frequencies had been increased to annually. When we spoke with staff they confirmed that safeguarding training was happening.

Three people we met at the house said they were happy there. They said they spoke with staff about their support or any concerns they had. They said they felt involved. People were encouraged to maximise their independence. For example some had door keys and were able to go out independently.

Care plans viewed were comprehensive and informed staff how to support each person. People told us they participated in a range of daytime and evening activities that they liked.

Staff demonstrated an awareness of safeguarding vulnerable adults and had received training. Systems were in place for the reporting of accidents and incidents. However, we noted several incidents where it was unclear if they had been reported or acted upon, and we were concerned that people could be placed at risk from under reporting.

People were provided with a comfortable homely and generally well maintained home, they were encouraged to be involved in household tasks. We noted shortfalls in the infection control practice in the house that placed people at risk of harm from cross infection.

Staff records demonstrated that there was a satisfactory recruitment system in place. Staff told us that they received good support through supervision and staff meetings and were provided with a programme of training.

We saw that a range of audits were in place to monitor aspects of service quality, and that the views of people living there and their representatives were sought to inform this.

This inspection took place on 28 November and 1December and was unannounced. The home was last inspected in November 2013 and no concerns were identified.

24 Tower Road West provides personal care and support for people with various forms of learning disability. The home can accommodate up to six people. Five people were living at the home when we inspected.

The home is one of a number of locations operated by East View Housing Management Limited, who provide support locally for people with learning disabilities.

Accommodation is provided over three floors with communal lounge and dining areas. The top floor of the property is a set up as a self-contained annex, providing accommodation for people wanting to live more independently.

There was a registered manager in place. 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.

Our inspection showed that whilst the service offered people a comfortable environment and their basic care needs were being supported, there were shortfalls in a number of areas that required improvement.

Although care plans provided staff with clear guidance about how to support people with behaviour that challenged, action taken and evaluation to learn from these incidents did not always happen.

Personal emergency evacuation plans were not in place for each person living at the home and one person had missed an appointment with their GP because staff had not supported them to attend.

Some procedures to record the safe administration of medicine were not always carried out and information was missing from staff recruitment files.

The provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005 because Deprivation of Liberty Safeguard applications had not been made when they were needed.

Staff were not supported through a system of regular supervision that positively promoted their development, because this process had lapsed.

The service was not always responsive to people’s needs because their goals and wishes were not always effectively progressed or followed up.

The management of the service did not always ensure that key tasks were carried out to ensure the safety and promote the quality of the service that the home provided.

There were also positive aspects of care at the service. People were very complimentary about the caring nature of the staff and were happy living there. They told us staff were kind and compassionate and respectful of their privacy and dignity.

Staff interactions demonstrated they had built rapports with people who responded to this positively. Activities were varied; people could choose how to spend their day. They took part in activities in the home and the community and told us they enjoyed them.

The service encouraged people to express their views and be involved in developing the home. The provider undertook quality assurance reviews to measure the standard of the service and actively sought to improve it where they could.

There were breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.