We carried out this inspection on 11 March 2017. When Ellsworth House was last inspected in October 2015 there was one breach of the legal requirements identified in relation to premises and equipment. At this inspection we found the service had made sufficient improvements and was no longer in breach of the legal requirements.

At the last inspection, the service was rated Good. At this inspection we found the service had met all relevant fundamental standards and remained rated as Good.

The service provides accommodation and personal care for up to eight people who have a learning disability. On the day of our inspection there were seven people living at the service.

The staff had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. The service had not been fully effective in identifying the issues in relation to best interest decisions.

The provider had quality monitoring systems in place which were used to bring about improvements to the service. There were processes in place for the safe storage and management of medicines.

The staff had received training regarding how to keep people safe and they were aware of the service safeguarding and whistle-blowing policy and procedures. Staffing was arranged in a flexible way to respond to people’s individual needs.

People were provided with regular opportunities to express their needs, wishes and preferences regarding how they lived their daily lives.

Each person was supported to access and attend a range of social activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People’s needs were regularly assessed and resulting support plans provided guidance to staff on how people were to be supported. Support in planning people’s care and support was personalised to reflect people’s preferences and personalities.

There was a robust staff recruitment process in operation designed to employ staff that would have or be able to develop the skills to keep people safe and support people to meet their needs.

Staff demonstrated a detailed knowledge of people’s needs and had received training to support people to be safe and respond to their support needs.

Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded.

We saw that the service took time to work with and understand people’s individual way of communicating in order that the service staff could respond appropriately to the person.

This inspection took place on the 3 October 2015 and was unannounced. When the service was last inspected in September 2013 we identified that there was one breach of the regulations. This related to the safety and suitability of the premises.

Ellsworth House is registered to provide care and support for up to eight people with a learning disability. At the time of our inspection seven people were living at the home. Five people were living in the main part of the home. Two people lived in self-contained bungalows situated next door to the main house.

A registered manager was in post at the time of inspection. 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 were not cared for in a safe, clean and hygienic environment.

People’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. We saw information in people’s support plans about mental capacity and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been applied for appropriately. These safeguards aim to protect people living in homes from being inappropriately deprived of their liberty.

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

People maintained contact with their family and were therefore not isolated from those people closest to them.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff we spoke with felt the staffing level was appropriate. People were supported with their medicines by staff and people had their medicines when they needed them.

Staff were caring towards people and there was a good relationship between people and staff. People and their representatives were involved in the planning of their care and support. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted personalised information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service. The systems had failed to identify the shortfalls found at this inspection such as the concerns surrounding the environment and infection control. Arrangements were also in place for obtaining people’s feedback about the service.

We found one breach of 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 this report.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. Communal areas had been redecorated. New soft furnishings and pictures had been purchased. People who lived in the home had chosen the new colour schemes. Additional improvements, such as laying new carpets, would be completed after the Christmas holidays.

Communal areas were used more effectively. One room, which had been used as a dining room, was now used as an additional lounge area. This gave people more communal space to use as they wished.

At the last inspection which was conducted in May 2012 we identified concerns with regard to the care and support that had been provided to people who live at the service. In addition we had received a number of concerns from the local authority who commission services from the provider. Following the last inspection we met with the provider to express our concerns about the care and support that was being provided at the home. In addition we have attended several safeguarding meetings with the local authority to ensure the safety of people at the home.

This inspection was conducted to follow up the concerns raised in the last inspection report and concerns raised by the local authority.

Since the last inspection a new manager has been employed. Systems are now in place to ensure that people who live at the home undertake a range of social and recreational activities. We saw that each person now has a weekly plan of activities both in the house and at outside venues. This has resulted in a reduction in the number of challenging behaviours and incidents at the home.

The care plans are in the process of being reviewed. Where the plans have been reviewed these now give clear guidance to staff of the care and support need of the individuals who lived Ellsworth House.

A programme of staff training is in place with the majority of staff now completing all mandatory training. Some staff vacancies are still evident but staff recruitment is on going with some new staff due to commence employment once all necessary checks have been completed. Staff now feel supported by the manager team. There is a rolling programme of staff supervision.

Records relating to people and incidents occurring at the home are now well maintained.

We were unable to speak to people that used the service because they had complex

needs. We spent time observing people that lived at the home, staff and the

interactions between them. One person was able to tell us that he "liked living at Ellsworth and that he enjoyed going swimming."

In January 2012 we carried out an inspection of the service. At this time we made compliance actions. In addition we had received concerns from the funding authority.

We carried out this unannounced inspection to ensure the provider was compliant with

the required actions and to review progress towards meeting the concerns raised by the funding authority. We were unable to speak to people that used the service because they had complex needs. We spent time observing people that lived at the home, staff and the interactions between them.

Due to the concerns raised the service was not accepting any new admissions. The funding authority were conducting reviews of the care required by people that lived at the home. This would ensure that Ellsworth House was an appropriate placement for the people that currently lived at the home.

We found that care plans did not reflect the care and support that was provided to people at the home. We saw that staff were unclear about the care that should be provided to two people at the home. Activities were not provided in line with the care plans. We saw that at times interactions between people that lived at the home and staff were good. At other times we observed that staff sat drinking coffee and did not interact with people.

We found that maintenance at the home was ongoing. Some work was still required. There had been some delays in equipment being sought. This has now been provided.

Some people at the home had been assessed as requiring one to one or two to one care for periods of time. We could not confirm if this was being provided in line with contracting arrangements. This was because when individual staffing levels were provided it was not recorded. Staffing at night may not be adequate as there was only one staff member for five people who lived at the home.

Staff told us that a system of staff supervision had been implemented. Some staff training remained outstanding. This training was required to meet the specific needs of the people at the home. The lack of training meant that staff may not have the skills and competencies to meet the needs of people who lived at the home.

We had identified that the quality of service provided at the home had not been satisfactory. This had included a high turnover of staff including managers and senior staff at the home. The number of incidents of that involved people that lived at the home had been high. This included people becoming aggressive towards other people that lived at the home and staff. The provider’s quality assurance systems had not recognised these issues.

Due to the concerns raised by the funding authority the providers had completed a review of the services at the home. As a result of this investigation the provider had developed an action plan. The action plan aimed to address the concerns raised both in this report and those that were raised by the funding authority. We will be meeting with the provider to discuss this issues found at the inspection.

We previously reviewed this service in June 2011, and found that there were a number of areas where improvements needed to be made in order to sustain compliance. We asked them to make improvements with staffing levels, the way in which details about ‘how to make complaint’ were produced, and the systems in place to monitor and assess the quality of care provided. We had been due to review the service to make sure that these improvements had been implemented. Concerns had been raised with Bath and North East Somerset and we had met with them prior to our visit. We decided to review additional areas, to look at the care being delivered to people living in the home, and to ensure they were safe.

When we visited there were six people living at Ellsworth House. We met three of them, and had a momentary chance to meet a fourth person. One person was not well and the sixth person was out from the home.

People who live at Ellsworth House have learning or mental health disabilities, and had difficulty in communicating verbally. It was not possible to ask people about life in the home. One person was able to say “I am alright and I am going out soon”.

People appeared very relaxed in the company of staff and there was a good rapport between the staff and the people who live in the home. We saw staff responding to people’s gestures and behaviours, and found staff to be attentive and caring.

Staff we spoke with during the visit were able to talk confidently about each person and how they liked to be looked after. They told us how they supported people to go out in to the community and to undertake meaningful activities. They told us how they supported those people who need additional support.

During our visit we found a number of areas where improvements are needed.

We looked at the daily records that were being kept for each person. Some of the recordings were brief and inadequate. The records did not evidence any interaction between the person and the staff member. Some people living in Ellsworth House were being provided with additional staff support in order to maintain their safety and manage their care. We found from looking at their daily records that it was not possible to determine that those people were getting the correct level of support that they needed.

We looked at accident and incidents records and found that there was no logging system in place and no overview of the events that had happened. Staff were not able to look for trends and identify any preventative measures. Learning from any incidents was not being acted upon effectively.

We found that some of the fixtures and fittings in the home were in need of repair or replacement, in order to make the home a safe and comfortable place for people to live in.

We found that staffing levels had not always been sufficient to meet people’s needs, in the previous couple of months. We found that the staff team were unsupported and were not being consistently supervised.

People at Ellsworth House have different modes of communication therefore not all of them were able to tell us about what it is like to live in the home. We received some short comments. “I like living here and I am very happy”, “We saw other people who have no verbal communication skills receiving support and looking relaxed at ease with the staff who looking after them.

When we visited the home we found that the people living in the home appeared to be relaxed and there was a good rapport with those staff on duty. The staff were attentive to people’s needs and acted appropriately. All staff demonstrated a good understanding of each person’s needs and how each person liked to be cared for.

Some staff require some refresher training however this had been booked by the manager as will be completed by August 2011.

Staffing levels over recent months have been reduced and may have impacted on the ability of people living at the home to undertake some community activities.

There are limited formal quality audits to assess the quality of care and support given. There are systems in place to deal with comments and complaints however we did not see any information in accessible formats to meet the needs of people at the home.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Most people who lived in the home had communication difficulties so we were not able to discuss life in the home with them. Some people used non-verbal communication, such as pictures or sign language. We spoke with one person who told us they liked living at the home. They made their own decisions and staff respected the choices they made. They said “The staff make sure I’m alright. Staff ask me if I’m happy.”

Staff supported people well and understood their needs. The level of care people received had improved in recent months and was now more consistent. New permanent staff had been recruited and the use of agency staff had reduced significantly.

People were protected from the risk of abuse. Some people who lived in the home could become anxious or present aggressive behaviour. Staff supported them in a calm, confident and professional way.

Some parts of the home required redecoration and refurbishment to ensure they met the needs of people and that they provided a safe and homely environment.

People’s views, and the views of those close to them, were taken into account by the provider when planning or reviewing care. People who lived in the home benefitted from a well monitored service.