The inspection took place on 25 and 26 July 2017 and was unannounced. The provider knew we would be returning for the subsequent day. Florfield Home provides accommodation and personal care for up to four people with physical and learning disabilities. There were four people using the service at the time of our inspection and each person had a room with an en-suite shower room. The service was in a new build block and there is not a garden at the service but it is located close to a park. The service was last inspected in June and July 2015 and was rated as Good. However, the service needed to make improvements to be safe. The written risk assessments needed to be clear and accurate to keep people safe from the risk of harm.

There was a registered manager at the service at the time of our 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 felt safe and were protected from the risk of potential abuse. Staff were knowledgeable about safeguarding procedures and knew what to do if they had concerns about the service. The staff were suitable to work in the caring profession and were recruited appropriately.

People were protected from risks to their health and wellbeing because risk assessments to guide staff were accurate and provided sufficient detail for staff to know how to manage specific risks.

Medicines were well managed and the service conducted regular audits of medicine administration.

There were enough staff to meet people’s needs and they were suitable to work in the caring profession. Staff were trained to carry out their roles and newly appointed staff were supported in their role by a robust induction period. Staff developed caring relationships with people using the service and respected their diversity and dignity.

People were supported to get enough to eat and drink and people had access to healthcare professionals.

People and their relatives were involved in planning their care and care records included information about people's likes and dislikes and promoting their independence. 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.

There was a positive and open culture at the service. People using the service and their relatives felt they could raise concerns if necessary.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We looked at our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were in place to keep people safe and minimise the risk of abuse. Medicines were effectively and safely managed and handled appropriately.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and report on what we find. The provider sought consent from people and or their relatives in relation to their care and was reviewing procedures under the Mental Capacity Act. The manager told us that they were aware of what constituted a deprivation of liberty and were in the process of considering what implications the new Supreme Court ruling had on people who lived at Florfield.

Is the service effective?

People’s needs were assessed and individual care plans included how to support people with their care. People’s needs were met in line with their individual plans. People were protected from the risks of inadequate nutrition and dehydration. Staff were knowledgeable about how to meet people's needs when caring for particular individuals. Staff received training, support and supervision to help them to carry out their roles more effectively.

Is the service caring?

Relatives and professionals involved in the care of people were positive about the behaviour and attitude of staff. People's diversity, values and human rights were respected. The provider consulted people and their representatives about individual needs and wishes. These were taken into account when planning their care.

Is the service responsive?

People’s care needs were reviewed and their plans updated to ensure they received a service that met their current needs. Staff worked with and followed the advice of other professionals who were involved in people’s care. Staff used assessment tools to monitor the health and wellbeing of people. The provider was responsive to addressing any issues raised by family members.

Is the service well led?

The provider had a registered manager in place to manage the service to ensure they shared the legal responsibility for meeting the requirements of the law with the provider. The provider undertook regular audits to check the quality of service, including the views of family members and professionals responsible for the care of people.

At the time of our visit there were four people living at Florfield Home. All the people using the service were unable to communicate verbally. People communicated through pointing at pictures or objects. We spoke with three members of staff including the registered manager, three people who use the service and two relatives of people using the service.

People using the service indicated they were happy at Florfield Home. One relative said, “I’m very happy my relative is here. The staff are very good. I have peace of mind knowing my relative is safe.”

We saw that people were involved in their care planning and all written information was given in an easy to read format which included pictures. A relative told us, “the staff make day-to-day decisions about my relative; they know what is best for them. I am always consulted about anything major.”

There were suitable arrangements in place to ensure people using the service were safeguarded against the risks of abuse.

Staff received appropriate professional development and further training relevant to their job.

There were quality monitoring processes in place. People and their representatives were asked for their opinion of the service through regular meetings and a survey. People’s relatives knew how to complain if they needed to.

Florfield was a safe, bright, clean and modern home with wheelchair access for up to four people with physical and learning disabilities. At the time of our visit three of the people using the service were unable to communicate verbally, some people could communicate through sign language and some communicated by pointing to pictures or objects. They seemed content and settled at the home. One person nodded that they were happy there and liked their room. Another signalled by clapping that they were very happy. People were encouraged to engage with each other and we saw staff engaging in activities with people who use the service.

Staff encouraged the people who used the service to live an active life, there were daily activities at the home and there was the opportunity to take part in community activities and an annual holiday.

Staff said that "the key-workers stand up for the people who use the service and care so passionately, we work like a family."

People seemed settled and happy at the home. We saw people enjoying dinner together and being supported well by the staff. One person said "It's going all right. It's all fine". This person also said they felt safe at the home. Relatives of people living at the home were also very positive. They felt involved and said that when they raised concerns or questions the home responded. They had confidence in the manager and the staff at the home.

The inspection took place on 30 June and 1 July 2015 and was unannounced. At our last inspection on 24 June 2014 we found that the provider was meeting all of the regulations we checked

Florfield Home provides accommodation and personal care for up to four people with physical and learning disabilities. There were four people using the service at the time of our inspection and each person had a room with an en suite shower room. There is not a garden at the service.

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 kept safe from the risk of abuse by well trained staff who felt confident to raise concerns about poor practice. The available risk assessments were detailed and clearly explained how staff could manage potential risks. However, one risk assessment did not fully encapsulate the de-escalation techniques that had been agreed with family members and health and social care professionals.

The provider had used a robust recruitment procedure to employ enough suitable staff to meet people’s care needs. The staff developed caring relationships with people using the service and people appeared happy and relaxed.

Medicines were stored, administered and disposed of properly. Staff were well trained and completed accurate records.

Staff supported people to eat and drink enough and to obtain treatment from health and social care professionals.

The provider followed the latest guidance and legal developments about obtaining consent to care. Staff used a range of communication methods to support people to express their views about their care. There was evidence that people and their relatives were involved in planning their care and care records included information about people’s likes and dislikes. In the event of a change in someone’s needs staff discussed a change in the support plan and we observed these changes were implemented.

Staff knew how to support people whose behaviour may challenge the service. Clear guidance was provided in care records.

The registered manager had been in post since 2007 and implemented robust monitoring procedures to ensure the care was of high quality. The team worked well together and there was a positive and open culture at the service. Relatives felt that they could raise concerns and their complaints would be taken seriously.

We have made a recommendation about risk assessments.