East View Housing Management Limited - 25 Alexandra Road is a care home providing social and residential care for up to three adults with learning disabilities. On the day of our inspection there were three people living in the home. People had varied needs including learning disabilities and challenges to their mental health. The provider operates a number of care homes locally and is also a national provider of care. At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

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.

At our last inspection we found some improvement was needed in relation to the monitoring and completion of maintenance within the home. At this inspection improvements had been made in this area, all maintenance had been recorded and addressed promptly. New audits had been introduced to monitor the effectiveness of the systems that had been introduced to address this area. Despite these improvements we identified minor areas of record keeping that needed to improve to document more clearly the running of the home. Whilst staff received training in fire safety, there was no system to test that staff knew how to respond in the event of a fire.

There were good recruitment procedures and enough staff to meet people’s individual needs and wishes. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were well managed and people were able to stay safe without having their freedoms restricted. People’s independence was well promoted. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were supported well with induction, training, supervision and appraisal. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People had enough to eat and drink and had been involved in menu planning and where they chose the preparation of their food. Everyone was supported to maintain good physical and mental health. Appropriate referrals were made to health care professionals when needed.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with people. People told us they were happy with the support they received and with their day to day activities. They told us they knew who to talk to if they had any concerns or worries. There was a friendly and relaxed atmosphere in the home.

There was good leadership in the home and the registered manager had an open door policy which staff valued. The organisation had effective systems to monitor and review the quality of the care provided.

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?

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 needs assessments. Care records were reviewed when needed, we saw that they were complete and reflected people’s current circumstances. One person told us, “I enjoy doing all the things I do, the staff are good. I am very happy here”.

Other 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?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. 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. One person who used the service told us, “The staff are great, I get any help I need”.

Is the service caring?

People were treated with respect and staff were courteous. Staff encouraged and engaged with people. They explained to people what they were doing and offered them a wide variety of activities. People told us that the staff were supportive. We saw that staff knew how to communicate effectively with people and we saw how this managed people’s expectations and helped them plan for activities and events.

Is the service responsive?

People had regular review meetings with keyworkers to make sure that changes in their needs were identified and action taken. Records confirmed that people’s preferences, interests and diverse needs had been recorded and that care and support had been provided that met their wishes. People had access to activities that were important to them. For example, some people had work placements, or went to college and day centres. People were supported to attend religious services and social events such as clubs and music events.

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 saw that staff and people who used the service were given opportunities to express their views. We found the acting manager had good knowledge and oversight of the running of the home.

We made a short notice announced visit to this house because people were out during the day and sometimes in the evening too. We wanted to ensure we met staff and the people who lived in the house during our inspection.

We were able to meet all of the people who 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 the people they lived with and where they lived. Staff were seen interacting well with the people in the house and showed a good understanding of their individual characters and support needs.

People told us about the things they did during the week which they enjoyed. They all had a busy activity programme and also enjoyed an active social life.

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.

Three people lived at the house but were not in when we visited. We met one person at the end of our visit upon their return from activities. We saw that they had a relaxed and friendly relationship with staff and heard them asking for a take away for their evening meal.

We met two service users when we visited who were on their way out to activities.

One person told us that they were happy living at number 25 and the care they received.

Another person said that they liked living at the house but would like a friend to sleepover sometimes which would be difficult because the bed was not big enough.

This inspection took place on 07 and 13 May 2015. 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 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.

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.

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 subject to a DoLS, 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 their care and support. 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.