Edward House is a care home, which is registered to provide care (without nursing) for up to 12 people living with autistic spectrum conditions and learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is a detached building which is situated on the outskirts of Gloucester, easily accessible to local amenities and with links to public transport. Each person using the service had their own bedrooms and access to communal areas.

The care service has been developed and designed in line with the values which 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- CQC Registering the Right Support policy.

The service had a registered manager, as required. A registered manager is a person who has registered with the Care Quality Commission (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. The registered manager was present during the course of our inspection.

At our previous inspection on 9 and 10 October 2017, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, and good governance. The overall rating for the service was 'Requires Improvement.' As a result of this inspection, we imposed conditions on the provider's registration. The provider was required to submit monthly reports to us, setting out how they were monitoring the quality and safety of care provided.

At this inspection, we found the provider was no longer in breach of these Regulations and the rating had improved to Good.

Why the service is now rated Good:

The provider had made changes to the management structure at the home and a new registered manager was in post. Staff welcomed the new structure and spoke of its benefits. Relatives, staff and healthcare professionals gave consistently positive feedback about the running of the service and the improvements introduced by the registered manager.

People's independence was encouraged. Where people had relied on staff for daily living skills, they had now developed and were able to actively do more for themselves.

A range of communication aids were used so that people were able to express their views and be involved in decisions about their day-to-day care.

The registered manager and the staff team saw people's potential and continually found ways to help people to progress and develop. People had a renewed interest in their individual hobbies and interests.

People received their medicines safely and in line with the prescriber's guidance. De-escalation methods were exhausted in the first instance before using medicines to stabilise people's mood, and there had been a reduction in the use of antipsychotic medicines.

People were part of their local community. People were supported to maintain relationships with those important to them, and to develop new relationships also.

People's rights were protected, in line with the Human Rights Act and the Mental Capacity Act. 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.

Staff received ongoing training and development in their roles. Bespoke training was arranged to enable them to meet people's individual care and support needs.

Complaints, concerns and feedback were captured and respond

Edward House is a residential care home and provides accommodation and personal care for up to 12 people who have learning and physical disabilities. At the time of our inspection there were 12 people living at the home.

When we previously inspected the service on 4 and 5 April 2017 we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service 'Inadequate' overall and the service was placed in special measures. To support the provider to make the necessary improvements we issued a Warning Notice and imposed two conditions on their registration. The provider was required to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these and any actions taken or to be taken as a result.

At this inspection we found the provider had action taken to address most of the concerns we had identified. Sufficient improvement had been made for the provider to meet the requirements of six of the eight previously breached regulations. More time is required for the provider to complete their action plan and test out the robustness of the improvements and systems in place to ensure it will be able to continue to provide an improved service. The provider would need to sustain the improvements made before people could always be confident that they would receive a high standard of quality individualised care that always met their needs and ensured their safety. Following this inspection the service was rated ‘Requires Improvement’ overall. It has not been rated as 'Inadequate' for any of the five key questions and has therefore been taken out of special measures.

Some further improvement was needed before the provider met the requirements relating to Safe care and treatment and Good governance. This included ensuring all staff would be familiar with people’s risk management strategies and action would always be taken promptly to keep people safe when accidents and incidents occurred. Regular audits were now being completed; however improvements were needed to monitor the effective operation of the service’s safety incident procedures. People’s satisfaction with their care had not been routinely sought for a period of time. People had not always been given a regular opportunity to discuss any concerns or provide feedback about their care experience so that improvements could be made when needed.

There was no registered manager in post. The registered manager had not been working at the home since January 2017 and de-registered with CQC in April 2017. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had employed an ‘acting manager’ who had been working at the home for six weeks at the time of our inspection. They were starting the process of registering as the manager with CQC. Relatives were concerned that a consistent manager had not been in place in the home for some time and was beginning to lack confidence in the provider’s ability to establish a strong management team. There were mixed feedback from relatives about the care and support people received.

Following our previous inspection staff had been provided with training on how to recognise abuse and how to report allegations and incidents of abuse. Staff confirmed they had attended safeguarding training. It was clear that people were accessing health professionals as each appointment was now recorded in an individual health file that had been implemented. Complaints were documented; however relatives told us they didn’t always feel listened to when raising issues

This inspection was unannounced and took place on 4 and 5 April 2017. The last comprehensive inspection of the service was on 24 and 25 September 2015 and there were no breaches of regulations at that time. Edward House is a residential care home and provides accommodation and personal care for up to 12 people with learning and physical disabilities. At the time of our inspection there were 12 people living at the home.

There was no registered manager in post. The registered manager had not been working in the home since January 2017 when an internal quality audit by the provider had identified some concerns. The registered manager had de-registered with CQC on 11 March 2017. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had employed an ‘acting manager’ from another service who had been working at Edward House for two months.

The service was the subject of on-going monitoring by the local authority. This was because when they visited in 2016, they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was still in progress during our inspection.

We received information prior to this inspection from a health and social care professional telling us that people were at risk. This was because staff were not adequately trained and people were being placed at risk due to high numbers of agency staff being employed. The local authority had completed a visit to the service on 22 March 2017 and found concerns relating to people’s safety. Our inspection highlighted shortfalls where some regulations were not met. We also identified further areas where improvement was required.

People did not receive a service that was safe. The provider did not have effective systems to assess, review and manage risks to ensure the safety of people.

Sufficient numbers of staff were available to keep people safe; however a high number of agency staff were being employed. This reduced staff consistency and this in turn negatively impacted on people’s care. Some people were not being supported to reach their full potential.

The service did not provide effective care and support. Staff had not received suitable training enabling them to effectively support the people living at Edward House such as people living with autism or with behaviours that may challenge. Many of the staff team had not attended mandatory training courses such as adult safeguarding, face to face first aid, MCA and DoLS and infection control.

There were some positive comments from relatives and health professionals about the care provided and the staff members who cared for their loved one.

The service was not responsive to people’s needs. Support plans and risk assessments were out of date and lacked detail required to provide consistent, high quality care and support. People did not always have sufficient activities to support them to socialise and lead a fulfilling life. Complaints were not documented or dealt with appropriately.

The provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around recording of information and assessing risks.

Staff we spoke with said they felt anxious about the service provided and that the morale was low. We observed staff trying to support people in a caring and patient way during the inspection; however staff did not appear to know the people they were caring for well. Staff were not respecting people’s choices on two occasions.

The service was not well led. The registered manager had left the service along with many staff members. The registered manager a

We used a number of different methods to help us understand the experiences of people using the service. Because people using the service had complex needs which meant they were not always able to tell us their experiences. We observed staff interacting with people and spoke with staff about people's needs and examined their care records. Eleven people were using the service at the time of our inspection and of these nine people required one to one support from staff due to their complex needs. We examined the care of three people in detail and we found all had comprehensive care and support plans in place. These were all individual to each person and contained text and pictures. Staff we spoke with demonstrated a very good knowledge of these three people's care and support needs. Each person had a weekly activities plan in place and several people were attending these during our inspection.

The service had a system in place to make sure people who were not able provide consent for aspects of their care treatment were protected and the home acted in their best interests.

An effective system was in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We were not able to speak with people using the service because of their complex needs. We gathered evidence of their experiences of the service by observing care, reading care records and speaking to staff about people’s individual needs. We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were able to demonstrate very good knowledge of people's needs and they explained how they had input into their care records.

The manager had been at the service for about five months and was in the process of reviewing and updating people's care records. He told us of his plans to improve the service for people who lived at Edward House.

We observed staff treating people with respect and offering them choices.

People were able to go on outings and undertake activities with the support of staff; as people were out in the community during our visit.

A safe system was in place for management of people's monies.

Staff told us it was a good place to work as they had access to training to maintain and learn new skills. They felt supported by their staff team and the manager.

This inspection took place on 24 and 25 September 2015 and was unannounced. Edward House provides accommodation and personal care for up to 12 adults with a learning disability or autism spectrum condition in four individual flats and eight bedrooms with shared facilities. Twelve people were living at the home when we visited and they had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and people required the support of one or more staff when away from the home.

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 and associated Regulations about how the service is run.

People were supported by a caring staff team who knew them well and treated them as individuals. Staff worked hard to understand what was important to people and to meet their needs despite the difficulties some people had communicating. Staff were patient and respectful of people’s unique preferences.

Staff supported people to take part in activities they knew matched the person’s individual preferences and interests. People were encouraged to make choices and to do things for themselves as far as possible. In order to achieve this, a balance was struck between keeping people safe and supporting them to take risks and develop their independence. Some people had complex needs and these were met by staff in collaboration with health and social care professionals.

Staff felt well supported and had the training they needed to provide personalised support to each person. Staff met with their line manager to discuss their development needs and action was taken when concerns were raised. Staff understood what they needed to do if they had concerns about the way a person was being treated. Staff were prepared to challenge and address poor care to keep people safe and happy.

The registered manager received support and supervision from the provider. They conducted quality audits that were then checked by the provider. Learning took place following any incidents to prevent them happening again. Complaints were acted on but not recorded to allow future review and learning.