This unannounced inspection took place on 9 January 2017. At our last inspection on 10 June 2015 we found the provider was in breach of the regulation regarding need for consent. We asked the provider to take action to ensure there were arrangements in place to gain people’s consent. When we carried out this inspection the regulation had been met. Fallings Heath is a care home which provides accommodation and personal care for up to four people with learning disabilities or autistic spectrum disorder. At the time of our inspection four people lived at 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 2008 and associated Regulations about how the service is run.

People were supported by staff that recognised how to identify the signs of abuse and knew how to raise any concerns. Staff were aware of people’s individual risks and how to minimise these. People were supported by adequate numbers of staff who had been recruited safely. People received their medicine as prescribed and systems used to manage medicines were safe.

People were supported by staff who had the skills and training to meet their individual needs. People were asked for their consent before care and support was provided. Where people’s rights were restricted assessments had been completed of people’s capacity to consent. Where people were unable to consent to their care because they did not have the mental capacity to do this, decisions were made in their best interests. People were supported to have enough to eat and drink and had access to healthcare professionals when required. People had positive relationships with staff and staff were kind and caring towards people. Staff understood people’s needs and preferences and respected their dignity and privacy when supporting them. Staff communicated with people in a way they understood to ensure people’s choices were respected.

People were supported to maintain their interests and were given the opportunity to participate in a variety of activities which met their individual interests. There was a complaints policy in place and staff were aware how they could support people to raise any issues. Regular checks were undertaken to monitor the quality of the service and these were effective at identifying improvement required. Systems were in place to capture people’s feedback. Staff felt supported in their jobs and understood their roles and responsibilities.

This unannounced inspection took place on 10 June 2015. At our last inspection on 20 August 2014 we found the provider was meeting the requirements of the regulations we inspected.

Fallings Heath is a residential home providing accommodation for up to four younger adults with learning disabilities or autistic spectrum disorder. At the time of our inspection four people were living there. The home had 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.

Relatives told us they felt staff kept people safe from the risk of harm or abuse. We saw that the provider had systems in place to protect people from potential harm. Staff understood their responsibility to report issues of concern.

Risks to people had been assessed and appropriate equipment was available. Staff could explain how to use the equipment to support people safely.

People and their relatives told us there was enough suitably trained staff to meet people’s individual care needs. Staff supported people to go on trips or visits within the community.

People received their medicines at the correct time and as prescribed. Medicines were managed stored and administered safely.

Assessments of people’s capacity to consent and records of decisions had not been completed in their best interest. The provider could not show how people gave their consent to care and treatment or how they made decisions in the person’s best interest.

People were supported to eat and drink sufficient to keep them healthy. People’s health and care needs were assessed and care was planned and delivered to meet those needs. People had access to healthcare professionals when needed. Advice and guidance was provided to staff to support people with their health needs.

People and their relatives told us staff were caring and kind. Staff understood people’s choices and preferences and respected their dignity and privacy when supporting them. People were encouraged to be as independent as possible.

People were supported to maintain relationships that were important to them. Relatives we spoke with said they were made to feel welcome when they visited the home. People were supported to maintain their interests and hobbies and were given the opportunity to participate in a variety of activities with others or individually. Relatives told us they felt comfortable raising concerns with the registered manager or staff members. The provider had a system in place to respond to people’s complaints and concerns.

The provider had established audit systems in place to monitor the quality of the home. There were regular checks of people’s care plans, medicine administration, incident and accidents. There was evidence that learning took place and changes were put in place to improve the service. Relatives and staff told us the home was well managed with an open positive culture.

You can see what actions we told the provider to take at the back of the full version of the report.

We carried out an inspection on the 31 October 2013 and found that the provider was not meeting the regulations for the management of medicines and records. The provider wrote to us and told us what actions they were going to take to improve. During this, our latest inspection, we looked to see what actions had been taken.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were four people living at the home on the day of the inspection but due to their complex health needs they were unable to speak with us apart from one person. We observed how most people were supported to help us understand their experiences of care. We spoke with two members of staff who supported people, the manager who was supporting the inspection process and two relatives by phone after the inspection. We looked at two people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The relatives we spoke with told us their relatives were safe living in the home. One person said, "I do feel safe here". The interaction between people and staff were good and friendly. People responded to staff in a confident manner and staff were able to understand people's needs through their body gestures and knowledge of people. We asked a member of staff what they would do if they saw someone being abused. The member of staff was clear by saying they would, "Report it to the manager" This meant that people could be confident that staff would know how to keep them safe.

The home had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to people who lack capacity, and how decisions should be made in their best interests. The manager had a good understanding of MCA and DoLS and confirmed that there had been no DoLS applications submitted to the local authority. All the staff we spoke with told us they had received training in the MCA and DoLS and they were able to explain it to us. Records we saw confirmed the training had taken place and that more training was planned shortly.

We found from our previous inspection that medication was not secure. We found that improvements had been made to ensure medicines were now more secure. This meant that where people were being administered medicines, they were now being stored

securely.

Is the service effective?

We saw that the appropriate care records were in place that showed the service was effective. This included support plans and health action plans. These documents ensured that people's needs were being identified and the service was effective in meeting their needs. We found that people were able to go out of the home when they wanted with the appropriate support from staff. Records showed that people were able to shop for the clothes they wanted to wear and the food they wanted to eat. This meant that people were able to receive the support detailed in their support plan and make choices about how they were supported.

We found that where people needed support from health professionals this was available. The provider was currently changing how this was recorded as part of how they worked with the local authority. Records showed that people were able to make appointments with the dentist or optician. One relative said, "X is able to see a dentist when he needs one". This meant that people were able to see health care professional as part of meeting their health and wellbeing.

Is the service caring?

We found the environment that people lived in to be very family orientated and caring. For example, personalised bedrooms and the home was laid out like a traditional home rather than a residential home. Staff had a good understanding of people's needs and were also able to explain the personal differences between people. Where people were able they were encouraged to do as much as they could for themselves as part of developing the independence. We observed someone in the kitchen during lunch time helping to prepare the lunchtime meal. This meant that people could be confident that staff knew how to support them appropriately.

One person we spoke with told us how much they liked living at the home. Our observation was that staff were very caring in how they spoke to people and offered them support and encouragement. The staff all had a good understanding of how to communicate with people who had complex care needs and were able to read people's body gestures to support them appropriately. This meant that staff were caring in how they supported people.

Is the service responsive?

We found that since our previous inspection records were now kept securely. The provider had taken the appropriate steps to ensure all the areas that needed improvement were addressed. Records showed that one of the improvements made was to ensure staff were clear on their role when administering medicines. This meant the provider was able to ensure they were responsive in delivering an appropriate service.

Relatives we spoke with told us that communication with the home was good and they were always kept up to date with information related to how people were being supported. This meant there was good communication processes in place to ensure relatives were kept up to date.

Is the service well-led?

The service was led by a registered manager. During the inspection process they were supportive and assisted us with any information we needed.

We found that the provider had a system in place to allow them to learn from events like accidents, incidents and complaints. All the relatives we spoke with confirmed they knew how to make a complaint and the process was displayed in the home. This meant that there was a system in place so people or their relatives were able to share any concerns they had.

We found that the provider had quality assurance processes in place to gather views needed to improve the service. We found that there were appropriate audits taking place as apart of the provider ensuring the appropriate quality of service provision was being delivered.

This was an unannounced scheduled inspection.The service did not know that we would be visiting.

During our visit we met the four people who lived at the home. Because of their complex needs most people were unable to share their experiences of using the service with us. We therefore used a number of different methods to help us understand their experiences. This included speaking with staff, social workers (who were visiting the home), observing care and reviewing relevant information made available to us.

We spent time in the sitting room observing the activity and interactions between staff and people. We spoke with staff about the care and support they provided. They gave us a detailed account of the specific individual needs of people. We saw that staff treated people compassionately; they provided support to people in a timely way.

We saw that improvements were needed to ensure medication was stored securely.

We saw that the service had systems in place to ensure suitable people were employed to work with vulnerable adults.

Improvements were needed to ensure accurate records and documents were completed and maintained. We saw that records were not kept confidential or stored safely.

We carried out this inspection as part of our planned programme of inspections. The visit was unannounced and neither the staff nor the provider knew that we would be visiting.

The inspection included the observation of care experienced by people living at the

home, talking to people who were living in the home, talking with manager and staff on duty, looking in detail at all aspects of care for two people with complex needs, viewing people's rooms with their consent and discussing their care with staff. This process is known as pathway tracking.

The home provided care and support for people who had a learning disability. All four people who lived at FallingsHeath at the time of our visit were male. People were able to tell us that they liked living at Fallings Heath. We spoke to all four people who lived at the home. One person said, "Yes I like it here it's nice". Other people smiled or nodded when we asked if they were happy living there.

We found that the home was comfortable and spacious and that people were able to personalise their bedrooms as they chose to reflect their taste and interest.

People told us how they spend their day. They said that they got up and go to bed when they wanted and they chose what they had to eat. We were told about the activities people take part in. One person said, " I like going shopping in Wolverhampton, swimming and dancing".

People made positive comments or gestures about staff. One person told us, "Staff are kind". We observed that staff assisted people when needed and were polite and respectful.

We found that the service had responded positively to any concerns and had appropriate systems in place to protect people from harm.

We found that there were sufficient and appropriately qualified and experienced staff to provide care and support to people at Fallings Heath.