This inspection took place on 8 February 2018. Our visit was unannounced. This meant the service did not know we would be visiting.

Fiddlers Green is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were seven people using the service at the time of our visit.

The last inspection of Fiddlers Green took place in February 2017 when we found three breaches of Regulations relating to training, quality assurance and making required notifications to CQC. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

At this inspection we found the provider had followed their action plan and improvements had been made in the required areas.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Throughout this report people who use the service are referred to as clients in line with their preferences.

Clients told us they liked living at Fiddlers Green and said staff were kind and caring towards them. There was a relaxed friendly and homely atmosphere when we visited.

Clients received care and support from a long standing group of staff who knew them well and understood their needs and preferences. Each client had individualised support plans to make sure they received the support they required. The service was responsive to client’s changing needs and linked well with external health professionals to help ensure positive outcomes for each client.

Staff were trained and well supported in their job roles. Staff members had been safely recruited and had received an induction to the service. They had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern.

Clients were supported to have their health needs met. We saw that their prescribed medicines were being stored securely and managed safely.

The registered manager supported staff to deliver appropriate care and support. Staff attended regular training which gave them the knowledge and skills to support clients effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were improved systems in place to monitor the safety and quality of the service and drive improvement where required.

Fiddlers Green provides accommodation and support to up to seven adults with physical disabilities and learning disabilities. At the time of our inspection seven people were using the service all of whom had been living at Fiddlers Green for a number of years.

At our previous inspection on 9 December 2014 the service was rated Good.

At this inspection we found the provider had not ensured that staff remained up to date with their training requirements to ensure they had the knowledge and skills to undertake their roles. Some staff had not completed their mandatory training and had not undertaken the required refresher courses, particularly in regards to medicines management, moving and handling and safeguarding adults.

The registered persons had not adhered to all the requirements of their registration with the Care Quality Commission and had not submitted statutory notifications about key events that occurred as required by law.

The provider held regular meetings to review service performance and the provider and registered manager checked on the quality of service provision. However, we found these checks were not sufficient to address concerns identified in regards to staff training, notifications and also in regards to regular checks on the stocks of medicines at the service.

The provider was in breach of the legal requirements relating to staffing, good governance and notification of incidents. You can see what action we have asked the provider to take at the back of this report.

The provider continued to keep people safe. Risk management plans were in place and staff assessed the risks to people’s safety as their needs changed. People received their medicines as prescribed. Staff were aware of their responsibilities to safeguard people from abuse and were aware of the reporting procedures if they had any concerns. There were sufficient staff on duty to meet people’s needs.

Staff supported people in line with Mental Capacity Act 2005 and obtained people’s consent before providing support. Where people did not have the capacity to consent, ‘best interests’ meetings were held. Staff continued to support people with their nutrition and health needs.

Staff continued to maintain friendly caring relationships with people. They respected people’s privacy and maintained their dignity. Staff supported people with their individual needs, including in relation to their cultural and religious needs. People had regular visitors and maintained contact with those important to them.

People’s care and support needs continued to be met and people received individualised care. People were involved in planning their care and identifying what goals they would like to achieve. Staff encouraged people to use their skills and maintain their independence. Arrangements were in place to manage complaints.

There were processes in place to obtain feedback from people and staff about their experiences of the service and to obtain any suggestions they had for improving service delivery. Staff felt well supported and able to access the registered manager for advice.

Further information is in the detailed findings below.

We visited the service on 9 December 2014 and the inspection was unannounced. At the last inspection on 28 November 2013 we found the service was meeting the regulations we looked at.

Fiddlers Green is a care home that provides accommodation and personal care for up to seven people. The service specialises in the care and support of younger adults who may have physical disabilities, such as cerebral palsy and learning disabilities. The accommodation includes seven single occupancy bedrooms each with their own en-suite toilet and shower facilities, an open plan communal lounge/dining area, kitchen, bathrooms and laundry room.

There were seven people living at Fiddlers Green when we visited.

There was a registered manager in post. 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.

People told us they felt safe living at Fiddlers Green. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these to keep people safe from harm or injury.

There were enough properly trained and well supported staff working in the service to meet people’s needs. People told us, and we saw, that staff had built up good working relationships with people using the service and were familiar with their individual needs and preferences.

People received their medicines as prescribed and staff know how to manage medicines safely.

People told us they were happy living at Fiddlers Green. They also said staff were kind and caring, and our observations and discussions with relatives supported this. We saw staff treated people with dignity, respect and compassion. Staff were aware of the values of the service and the care they provided was centred on each individual.

Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing. Staff also ensured health and social care professionals were involved when people became unwell or required additional support from external services.

People had a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.

People told us Fiddlers Green was a comfortable place to live. We saw the environment was well maintained. Furthermore, the layout, adaptations and equipment used in the home ensured people’s mobility needs were met. People could access all areas of their home and move around it independently.

Each individual was involved in making decisions about their care and had personalised care plans that they had helped create. People had agreed to the level of support they needed and how they wished to be supported. Staff supported people to make choices. Where people's needs changed, the provider responded and reviewed the care provided.

People had access to their local community and could choose to participate in a variety of interesting in-house and community based social, educational and vocational activities. We saw staff supported people to be as independent as they wanted to be and to take positive risks. People were also encouraged to maintain relationships that were important to them.

The service had a clear management structure and people who lived there, relatives and staff felt comfortable about sharing their views and talking with the manager and staff about any concerns or ideas to improve the service they might have. We observed an open and inclusive atmosphere in the service and the manager led by example. The manager demonstrated a good understanding of their role and responsibilities, and staff told us the managers were competent, supportive and fair.

There were effective systems in place to monitor incidents and accidents as well as the overall quality of the service provided at Fiddlers Green. The provider regularly sought people’s views about how the care and support they received could be improved. Where improvements were needed, action was taken.

The manager had sufficient training in Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

People we spoke with told us that they were very happy living at Fiddlers Green. One person told us: "This has been my home for many years and I want it to stay that way". Another said: "It is a very comfortable place to live. I love my room and the company". Some people expressed concern that one area where they felt uninvolved was in discussions and decisions about the long-term future of the home.

We observed staff engaging with people using the service in a way that was dignified and respectful. People we spoke to were positive about the care we received. One person told us: "I feel very comfortable and the staff here couldn't do enough". We saw that each person had care records which contained assessments and care plans and other information, such as health care provision, which were up to date. These were drawn up in such a way as to ensure people's dignity and rights were protected and were written from the individual's perspective.

Discussions with staff confirmed that safeguarding vulnerable people was a topic they were familiar with and had received training on. We saw evidence of staff training and the policies and procedures relating to safeguarding people from abuse. We found that the provider had ensured that the premises and its facilities were laid out in order to ensure that people had maximum autonomy and freedom of movement.

People we spoke with told us that they were very happy living at Fiddlers Green. One person told us that the home was "the best that could be" and another told us that it was "a very comfortable and friendly place". We observed staff interaction with people and found that it was respectful and ensured that people were able to be involved in decisions regarding how they spent their time and how they wished their needs to be met.

Staff we spoke with were able to demonstrate their knowledge of people's needs and preferences. The provider had also ensured that suitable equipment and assistive technology was in place to support people. The Manager was able to provide a clear understanding of the needs of people and of the challenges faced by the home, given its design and build.

We saw that the home had a very flexible approach towards meals and avoided an institutional approach to mealtimes and menus.

People spoken with expressed confidence in being able to express concerns and make complaints. Discussions with staff confirmed that safeguarding vulnerable people was a topic they were familiar with and had received training on.

The home was maintained by the care staff team and there was evidence that they committed a lot of time ensuring that the premises were an ordinary home in appearance.

The manager confirmed that "tenant" meetings were held regularly and that the meetings enabled everyone to to learn what the current issues were and discuss what could be done.