This inspection was carried out on 27 and 28 July 2016 and was announced. We gave short notice of this inspection due to the needs of people living at the service.

This service provides care and accommodation for up to six people with learning disabilities and autism. Six people lived at the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 the last inspection undertaken on the 31 March and 01 April 2015, we asked the provider to make improvements in relation to a number of areas. Some aspects of staff recruitment processes required improvements to ensure all valid checks had been completed on staff. Records of incidents of behaviours that challenged required more detailed information to support risk assessments and to reduce the risk of future occurrences. Some areas of the home required refurbishing. Further training was required to help staff provide support to meet people’s individual needs and how to apply the Mental Health Act and Deprivation of Liberty Safeguarding in their work roles. Food and drink supplies required further monitoring to ensure they were suitably replenished and to provide people with required choices. Communication by staff required improvements to ensure that people’s individual needs were met. Individual activity planners needed to be updated and presented in the ways identified in people’s care plans. Improvements were needed to ensure people’s goals and wishes were effectively progressed and to explore new activities which met people’s preferences. A quality monitoring system was in place but required improvement to enable the service to identify shortfalls we found at the last inspection.

The provider sent us an action plan stating they would have addressed all of these concerns by 01 October 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.

Staff 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. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references and personal identification.

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.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. Staff training in the Mental Capacity Act 2005 (MCA) and DoLS was effective. People’s mental capacity was appropriately assessed about particular decisions. When necessary, appropriate meetings were held to make decisions in people’s best interests, as per the requirements of the MCA.

Staff received regular one to one supervision sessions and all essential training for their role. The staff supported people to have meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

Information was provided using accessible language and contained pic

At inspection we met five of the six people living there. We also met five of the six staff on duty in addition to the manager and spoke with four in depth.

People living in the house had complex needs and communication difficulties. As a consequence they were unable to fully participate in the inspection process or tell us about their experiences, but we observed what they did and interactions with staff.

We looked at some care records and risk information, this was comprehensive and kept updated. Staff said they felt well informed about people’s needs.

Records indicated that the service was mindful of people's specific dietary needs and where nutritional risks were identified.

We looked at how medication was managed. We found that staff had been appropriately trained and that systems to minimise risk to people were kept under review.

We noted the environment and furnishings were of good quality but experienced high levels of wear and tear. There were sometimes delays in works being carried out but these did not impact on the well being of people living there.

We looked at notifications of incidents. We found that staff had a good understanding and showed confidence in regard to their role and responsibilities around these.

From our observations and discussions with four of the six staff on duty, we were satisfied that staff felt that staffing levels were sufficient for the dependency of the people living in the house.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We looked at records, observed care and spoke to staff.

When we visited we saw three people who were coming and going from the house and to and from activities.

When we visited we met four of the people who lived in the home. Only one person we spoke with was willing to engage in the inspection process, and told us that they were happy.

The inspection took place on 31 March and 1 April 2015 and was an unannounced inspection. The previous inspection on 4 September 2013 found that there no breaches in the legal requirements.

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.

The service is registered to provide accommodation and personal care to six people who have learning disabilities, including autism and limited verbal communication. People living at the home were male and female younger people. There were no vacancies at the time of the inspection. The home is a detached chalet bungalow, which stands back a little from a busy road. There is limited off road parking on the unmade drive. Each person has their own bedroom, most have ensuite facilities. There is a communal bathroom, kitchen, a lounge and a lounge/diner area. There is an accessible garden with a paved seating area at the back of the house.

This service had a registered manager in post. A registered manager is a person who is 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 the time of inspection we were able to meet with all of the people living in the home and speak with some of them. People told us that they liked living in the home, they were happy and the staff were kind.

Whilst our inspection showed that whilst the service offered people a homely environment and their basic care needs were being supported, there were shortfalls in a number of areas that required Improvement.

Records of incidents of behaviours that challenged did not always provide sufficient information to support risk assessment reviews or promote learning, understanding and evaluation of strategies to reduce the risk of future occurrences.

Some areas of the home required improvement. Growth of mould and mildew in some shower areas had not been addressed. Some of the dining chairs were stained and torn and the dining table tops were damaged and worn.

Some aspects of staff recruitment process had not been completed as needed.

People were offered choices of food they could not have. Some supplies of food and drinks had run low or run out and had not been replenished, this meant there was little choice of food at the home.

The provider had identified areas of training that would help staff provide support to the people they cared for. However, this training had received little priority and in some instances had not been delivered. This affected how staff were able to communicate with some people, their understanding of people’s conditions and how to apply aspects of the Mental Health Act and Deprivation of Liberty Safeguards in their works roles.

Communication by staff did not always ensure that people experienced a good level of care; we saw that some people’s expectations were not well managed and staff were not always aware of people’s priorities or the meaning of some of their mannerisms.

Individual activity planners were not up to date or always presented in the ways identified in people’s care plans. The home was not always responsive to people’s needs because their goals and wishes were not effectively progressed to encourage development of learning and exploring new activities and challenges.

A quality monitoring system was in place but was not effective enough to enable the service to highlight the kind of issues raised within this inspection. Some of the issues that had been highlighted, particularly in relation to the condition of some areas of the home and furnishings, had not been resolved.

There were also the following areas that did work well.

People felt safe in the service and out with staff. The service had safeguarding procedures in place and most staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns.

People had personalised records detailing their care and support, including well developed support plans for their emotional and behavioural needs. People were supported to access routine and specialist health care appointments and staff showed concern when people were unwell and took appropriate action.

We checked the arrangements for the management of medicines. They were stored appropriately and people received the right amount of the right medicine at the right time. Staff had received training to administer medicines and were assessed as being competent to do so.

The manager had an understanding of the mental capacity Act 2005, and Deprivation of Liberty safeguards, they understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Which now correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.