This unannounced inspection of 31 St Domingo Grove was conducted on 21 December 2016. The inspection was conducted by an adult social care inspector.

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.

The service at 31 St Domingo Grove provides accommodation, care and support for up to six people who have a learning disability. The home is located in the Anfield area of Liverpool and it is located close to local amenities and public transport routes. At the time of our inspection there were four people living at the home.

This service was last inspected in February 2015. During this inspection we found the service was in breach of regulations relating to the safe management of medication, fit and proper persons employed, staff training, and governance. The overall rating for this service was ‘requires improvement’. The provider sent us an action plan detailing how they would meet these breaches and we reviewed this as part of this inspection. We found that the provider had taken action and improved in these areas. The service was no longer in breach of these regulations.

During our last inspection in February 2015, the service was in breach of regulations relating to the safe management of medications. This was because the procedure for managing medicines was not in line with good practice. The provider sent us an action plan detailing what action they were going to take and we checked this as part of this inspection. We found that the procedure for managing medicines had improved. Regular checks, training, and auditing were being completed with regards to medication, and medication was being stored in line with good practice. The provider was no longer in breach of this regulation.

During our last inspection in February 2015, we found that recruitment procedures were not always robust. This was because robust recruitment procedures were not always evident within staff files. The provider sent us an action plan detailing what action they were going to take, which we checked as part of this inspection. We saw that recruitment procedures had been changed and additional checks were made and recorded to ensure procedures were robust. The provider was no longer in breach of this regulation.

During our last inspection in February 2015, we found that staff did not always have the skills they needed to support people appropriately. This was because staff had not been trained regularly or engaged in regular supervision. The provider sent us an action plan detailing what action they were going to take to address this. We checked this during this inspection. We found that the provider had enrolled all new and existing staff onto a national training programme. We saw that a system had been implemented to check when staff were due updates, and this also documented when staff were due supervisions. We saw that supervisions were taking place regularly and all staff had had an appraisal. The provider was no longer in breach of this regulation.

During our last inspection in February 2015, we found that regular audits (checks) were taking place, however they were not effective. This was because they had not picked up a number of anomalies we found with regards medication. The provider sent us an action plan detailing what action they were going to take and we checked this as part of this inspection. We saw during this inspection that the approach to auditing had improved, and where errors or omissions were found, we saw that action plans had been drawn up with realistic time scales of when to address these. The provider was no longer in breach of this regulation.

Family members and people we spoke with throu

People who used the service that were present during our inspection visit were not able to provide verbal feedback on the care and support they received. We observed care and support being delivered by staff and this was done in a manner that respected people's rights and choices. Staff conducted themselves in a calm manner and were respectful towards people. Responses to behaviour and requests for support demonstrated that the staff were confident and had a good understanding of the complex needs of people who used the service.

We spoke with the manager and we looked at care records which demonstrated that the service had suitable arrangements in place for obtaining, and acting in accordance with, consent of people who used the service.

We spoke to four people about the home this included the manager, senior team leader and two members of staff. We also spoke to relatives of two of the people who lived at 31 Domingo Grove by telephone.

Relative’s comments included:

“She has the option to do things…there’s a good team round her”.

“Yes they’re a lovely people…they seem to do quite a lot with her”.

There were three people who lived in the home and they had a range of learning disabilities. On the day of the inspection one of the people who lived at 31 Domingo Grove was at college and another person was unable to contribute to our inspection. We spoke to the third person who lived there and observed interaction between them and staff on duty.

We also spoke with a guardian of one of the people who lived in the home and they told us the manager always kept them up to date in relation to any issues regarding the person who lived at the home that they were the guardian of.

We asked staff what it was like working at 31 Domingo Grove and they told us:

“Staff and service user’s really nice”.

“Love it, got family with autism…really like it”.

We spoke with one of the people using the service and they gave us good feedback about all aspects of the home and their support. They told us they felt listened to and respected by staff and they told us they felt supported to make their own decisions and to be as independent as possible. The person described an active and varied lifestyle which was of their choice.

We found that people were involved in decisions about the service and the service was centred around people's individual needs.

People were well supported with their physical and emotional health care needs. People's needs were clearly reflected in their care plan and staff presented as having a good understanding of people's needs.

Systems were in place to protect people from the risk of abuse. Staff had undergone training in safeguarding and they were clear in their responsibilities to report concerns.

Staff felt well supported and appropriately trained. Communication across the staff team was good and staff were being provided with regular supervisions and team meetings.

The provider had a system in place for monitoring the quality of the service and this included asking people who used the service for their views.

This inspection was carried out by an adult social care inspector on 18 February 2015. The inspection was unannounced.

The service at 31 St Domingo Grove provides accommodation, care and support for up to six people who have a learning disability. The home is located in the Anfield area of Liverpool and it is located close to local amenities and public transport routes.

There was no 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.

We found that people living at the home were protected from avoidable harm and potential abuse because the provider had taken steps to minimise the risk of abuse. Procedures for preventing abuse and for responding to an allegation of abuse were in place. Staff were confident about recognising and reporting suspected abuse and the manager was aware of their responsibilities to report abuse to relevant agencies.

People were provided with good care and support that was tailored to meet their individual needs. People had a plan of care which was detailed, personalised and provided clear guidance on how to meet their needs. Risks to people’s safety and welfare had been assessed and plans were in place to support people to manage these.

Staff worked with health and social care professionals to make sure people received the care and support they needed. Staff referred to outside professionals promptly for advice and support.

Practices for managing medicines were not always safe and in line with good practice. You can see what action we told the provider to take at the end of this report.

Staff were able to tell us about the different approaches they used to support people to make choices. People’s care plans included detailed information about their preferences and choices and about how they were supported to communicate and express choices.

The manager had sufficient knowledge and understanding of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. They were able to tell us how they ensured decisions were made in people’s best interests.

Staff presented as caring and we saw that they treated people who lived at the home with respect during the course of our visit. Staff told us they felt there was an open culture at the home. They said they would not hesitate to raise concerns and felt that any concerns they did raise would be dealt with appropriately.

Throughout our visit staff demonstrated how they supported the aims and objectives of the service in ensuring it was person centred and inclusive. ‘Person centred’ means people’s individual needs, wishes and preferences are at the centre of how the service is delivered.

There were sufficient numbers of staff on duty to meet people’s needs and keep people safe.

We found that staff recruitment checks had not always been carried out appropriately before staff started working at the home and the manager was in the process of chasing up some pre-employment references for a member of the staff team which should have been obtained prior to them commencing work. You can see what action we told the provider to take at the end of this report.

Staff told us they felt supported in their roles and responsibilities. We found that most staff had been provided with relevant training. However, we found there was no record of training for one member of staff who had been employed at the home for approximately nine months. You can see what action we told the provider to take at the end of this report.

The premises were safe and well maintained and procedures were in place to protect people from hazards and to respond to emergencies. The entrance to the home was accessible to people who used wheelchairs as there was ramped access at the front of the property. However, the accommodation was provided over four floors and there was no passenger lift and therefore people who were physically disabled could not be accommodated to live at the home.

Systems were in place to regularly check on the quality of the service. However, we found these had not always been effective in driving improvements at the home. The checks included regular audits on areas of practice and seeking people’s views about the quality of the service. You can see what action we told the provider to take at the end of this report.