About the service: Greatwood House is a large detached bungalow situated in the extensive grounds of Somerset Court which is owned by the provider and has a number of other separately registered care services on site.. The home accommodates six people who have autism and complex support needs. Up to four people live in the main part of the home; two people live in two self-contained flats attached to the main house. People living at Greatwood House can access all other facilities on the Somerset Court site which include various day services.

At the time of our inspection there were five people living in the home; three people in the main house and both flats were occupied. The people we met had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements

People’s experience of using this service: People were supported by a consistent staff team who were kind and caring. Staff had good relationships with people and knew them well. People were encouraged and supported to maintain their independence.

The provider and senior staff had completed audits on the home to support quality checks. However, for some areas these had not been undertaken as required and had not prevented shortfalls in the quality of service provision. This was in respect of safe care and treatment and good governance.

Medicines were not always managed safely and measures to prevent infection control did not meet relevant guidance.

Care plans were personalised but did not always contain accurate and complete information. Corresponding records such as health action plans and hospital ‘grab packs’ contained different information and did not correlate.

There were sufficient staff to support people. Staff felt supported by the manager and the provider. Staff had received training to support their role however supervision had not taken place as frequently as required.

People had good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address people’s health care needs. Staff followed guidance provided to support people with their care.

People enjoyed their meals and their dietary needs had been catered for. This information was detailed in their care plans. Staff were aware of people's routines and preferences and they used this information to develop positive relationships and deliver person centred care. Relatives told us that they felt people were well cared for by staff who treated them with respect and dignity. People participated in/enjoyed person centred activities on offer and staff encouraged people to participate in things of interest to the them.

The manager worked in partnership with health and care professionals and the local community. The provider had displayed the latest rating at the home and on the website. Statutory notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and good governance. Details of action we have asked the provider to take can be found at the end of this report. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that the quality of service required improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 6 and 8 July 2016 and was an unannounced inspection. It was carried out by two adult social care inspectors.

Greatwood House is a large detached bungalow situated in the extensive grounds of Somerset Court. The home accommodates six people who have autism and complex support needs. Four people live in the main part of the home; two people live in two self-contained flats attached to the main house. People living at Greatwood House can access all other facilities on the Somerset Court site which include various day services.

At the time of our inspection there were six people living at the home. The people we met with had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff to help form our judgements.

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 registered manager was available on both days of our inspection. Staff and people’s relatives described them as being open and approachable.

People were generally safe however; there were some potential risks associated with the management and administration of people’s medicines.

Staffing levels were good and staff understood people’s needs and provided the care and support they needed. There were sufficient staff available to people to enable them to take part in a range of activities according to their interests and preferences.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure people’s legal and human rights were protected.

There were effective systems in place to monitor and improve the quality of the service provided.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at. Due to the nature of people’s disabilities we were only able to gather limited comments with the support of staff.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The acting manager informed us that they were covering maternity leave.

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

This is a summary of what we found:

Is the service safe?

We found the service was safe because staff we spoke with where able to tell us about the different types of abuse and were aware that they should report any concerns to an appropriate person. Staff records demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living at the home.

Each of the people living at Greatwood House had personal emergency evacuation plans and there was also a disaster recovery plan in place for dealing with foreseeable emergencies. A member of the Somerset Court management team was available on call in case of emergency.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager advised us that people were subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed that the staff were following the correct procedure and that policies and procedures were in place.

Is the service effective?

Speaking with staff it was evident that they understood individuals’ care and support needs. We saw that support plans were based on people’s assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People living in the home had complex needs and some people were unable to fully express their views. During our visit we observed that staff provided support and engaged with people positively. We saw that people appeared relaxed and comfortable with staff and saw staff treated people in a sensitive, respectful and professional manner. In people’s support plans we saw that there was detailed information about what they needed help with and how staff should support them. We asked one person if they liked living at the home and they replied “Yes thank you”.

Is the service responsive?

People met with staff on a one to one basis every Sunday week to discuss any issues and to plan what they wanted to do the following week. People were also involved in planning their regular person centred planning reviews and were able to invite their relatives or representative.

Is the service well-led?

The home had quality assurance systems in place. These included audits undertaken by the provider’s representative and quality monitoring audits undertaken by registered managers for other homes ran by the provider. The home undertook regular quality assurance surveys with the people who lived at Greatwood House, their relatives and professional who supported them. Incidents all incidents were recorded and monitored which helped staff monitor patterns in people’s behaviour’s.

Because of people's complex needs and varied communication abilities we were not able to speak with people who used the service. However we spoke with two parents and five staff.

There were appropriate arrangements in place to assess people's capacity to make specific decisions such as a need for medical treatment. People were empowered to make choices about their daily living arrangements and in achieving goals and aspirations. Where people were assessed as not being able to make informed decisions best interests meetings had been held. Decisions had been made on their behalf in consultation and discussion with other professionals and people's representatives. People had access to independent advocates to help them in making decisions and ensuring decisions had been made in people's best interests.

Comprehensive assessments had been completed to ensure people received a consistent and reliable service. Assessments were in place to address potential risks to people's health and welfare and provide support to staff in responding and alleviating identified risks.

There were appropriate and safe arrangements for the administering and management of people's medicines. We saw there were individualised plans in place for the effective administering of medicines.

Staff told us they felt well supported and had regular individual supervision. We found some inconsistencies in the frequency of individual supervision. However we were told an audit tool had recently been put in place to monitor the frequency of supervision. There were appropriate arrangements for staff to undertake the appropriate training so they had the necessary skills and knowledge to fulfil their role and responsibilities effectively.

There were effective systems in place to monitor and review the quality of the service. The agency was proactive in learning from incidents and seeking support from professionals to alleviate risks to people. There were a range of quality assurance audits which had identified areas for improvement. The service had put in place action plans to address the identified areas and these were in progress.

This inspection was to follow up information of concern that we had received. We looked at Outcome 2 consent to care and treatment, Outcome 4 care and welfare of people who used services, Outcome 7 safeguarding people who used services from abuse, Outcome 13 staffing and Outcome 16 assessing and monitoring the quality of service provision.

People who lived in the home had limited verbal communication so we spent time observing people. We observed one person around their area of the home and preparing their lunch. We observed how staff interacted and communicated with them.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed one person who used the service in an activity. We saw staff interaction with people was frequent and positive. We observed the atmosphere was relaxed and informal.

We observed staff interactions with people. We saw people moving around the home and accessing various communal areas. Staff engaged with people well and supported them sensitively. We observed staff provided reassurance and redirection with consideration and respect for people’s individual personalities. We saw staff demonstrated a good knowledge and understanding of people’s communication.

We found the home was well decorated, clean and comfortable. People’s bedrooms were personalised to their own tastes and preferences. We found furniture and fittings to be of a good standard.

We spoke with five members of staff about Great Wood. One staff member told us “We do give people the best support we possibly can.” Another staff member said “My reward is getting out and taking people out, getting their timetable right so people have a day they choose to have.” Staff told us “I have a voice here and other staff listen to what I can contribute to people’s support”.