This inspection took place on 18 May 2017 and was announced. This was to ensure someone would be available to speak with us and show us records.

Foxglove Care – 1 The Causeway provides care and accommodation for up to three people who may have a learning disability. On the day of our inspection there were two people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in February 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and had regular meetings with the registered manager and team leader. However, these meetings were not formally recorded. We recommend that one to one meetings between management and staff are recorded as formal supervisions.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

Family members were complimentary about the standard of care at Foxglove Care – 1 The Causeway.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place. Family members we spoke with did not have any complaints about the service.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

Where people did not have the capacity to give consent we saw a care plan agreement signed by a family member or appointed representative.

We looked at two care records of people who used the service and saw that there were various entries of other health care professional’s intervention. We saw that other health care professionals contributed to a person’s care plan for example, epilepsy management, dietician and speech and language therapists.

We looked at records that showed the provider responded appropriately to behaviours that may challenge the service. Our review of care records in the home found that the action plans to keep people safe had been developed and implemented where required.

We saw there was a training plan in place which ensured all staff had training updated regularly. The provider had identified certain training as essential for all staff which included, amongst other topics, health and safety, mental capacity act, first aid and safeguarding vulnerable adults.

We saw there was a complaint procedure in place in pictorial format in people’s own care records. The procedure told people who they could complain to for example; a member of staff, the local authority or CQC.

We found the records to be up to date and accurate and were signed by the relative of the person that used the service. This ensured they were involved in care planning and delivery of support.

People who lived in the home had complex needs and we were unable to verbally communicate with them about their views and experiences. However, we observed the interactions between them and the staff team and saw that these were respectful and appropriate.

People's likes and dislikes were recorded and respected, with people being supported to make decisions in thier lives. Records reflected that people had good access to a range of health care professionals. Also people were supported by staff who had been recruited through a formal process to ensure that they were suitable for the role.

1 The Causeway is owned by Foxglove Care Limited. It is registered to provide accommodation for up to three people who may have a learning disability. The service is located close to local shops and amenities. There is easy access to public transport and sports and social facilities are nearby.

This inspection was unannounced; it took place on 13 and 16 February 2015. At the last inspection on 04 December 2013, the registered provider was compliant with all the regulations we assessed.

The service had a registered manager. 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.

The people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us. We saw positive interactions between people who used the service and staff throughout the inspection process. It was evident that people were content in their surroundings.

A quality monitoring system was in place at the service that consisted of stakeholder surveys, reviews and monthly assessments. The registered manager told us they completed regular audits of care plans, staff training, activities and other aspects of the service. However, we found when audits were completed they were not always recorded and action plans to address shortfalls were not documented.

People who used the service were supported to make their own decisions about aspects of their daily lives. Staff followed the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects people who are not able to consent to care and support and ensures people are not unlawfully restricted of their freedom or liberty. The Care Quality Commission is required by law to monitor the use of Deprivation of Liberty Safeguards (DoLS). DoLS are applied for when people who use the service lack capacity and the care they require to keep them safe amounts to continuous supervision and control.

People were supported by staff who had been recruited safely and trained to recognise the signs of potential abuse. Risks to people who used the service were minimised by the development of a range of assessments which helped to manage the risk.

Sufficient numbers of staff were deployed to meet the assessed needs of people who used the service at all times. Staff had completed training and received on-going support to ensure they had the knowledge and skills to support people effectively.

People were supported to maintain a healthy, balanced diet and to receive adequate nutrition. Staff completed food and fluid intake charts and contacted other health care professionals when they identified concerns.

Medicines were ordered, stored, administered or disposed of safely. People received the medicines as prescribed from staff who had completed safe handling of medication training.

Staff treated people with dignity and respect. People were encouraged to be as independent as possible and were given choices about which staff supported them.

A complaints policy was in place which was available in an easy read format to make it more accessible for the people who used the service. We saw when complaints were received appropriate action was taken.

The registered manager encouraged staff to raise concerns and question anything they were unhappy with. Care Quality Commission requirements in relation to the submission of notifications were met.