The inspection took place on 26 November 2018 and was unannounced.

At our last inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, maintenance of the building and equipment, staff recruitment and governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. We found the service had made improvements in the key questions and were no longer in breach of the regulations.

Hail – Great North Road 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.

The care home accommodates five people in one adapted building, at the time of our inspection four people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 protected from the risks of abuse as staff knew how to identify abuse and where to report it to. Staff told us they would whistleblow if they thought the registered manager and senior management at the service were not taking their concerns seriously.

People received their medicine on time and staff at the service administered medicines safely. Staff told us they would report missed medicine to the registered manager or the on-call service and complete an incident form. The registered manager audited medicines and checked them daily to support safe handling of medicines.

People had risk assessments that mitigated against known risks and were reviewed regularly.

Staff were recruited safely and checks were carried out ensure they were suitable to work with people at the service which included criminal records checks, references and right to work.

People were protected from the risks of infection as staff wore personal protective equipment.

People were supported by staff who had the skills and knowledge to do the role. People were observed to receive good care from staff.

Staff were supported through regular supervision, appraisal and observations by the registered manager to check people were receiving good care.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and to support people to make their own decisions. Where people lacked capacity for health decisions people had advocates to support them in making best interest decisions.

People had a choice of healthy meals and drinks at the service. Staff were observed making people their favourite drink at the service and following guidelines from health professionals to support healthy eating.

People were supported to maintain good health at the service and attend health appointments and screening appointments.

People were looked after by staff who were kind and caring. People’s privacy and dignity was respected at the service and people’s preferences were well known by the service.

Care plans were individual and person centred. People’s needs were known by staff and staff were always observant in a change in people’s health or wellbeing.

People participated in a number of activities of their choice and feedback was sought by staff to see whether people had any co

This inspection took place on 19 September and 4 October 2017, the first day was unannounced.

Hail – Great North Road is a care home registered to provide accommodation and personal care for up to five adults with learning and physical disabilities. At the time of our inspection there were five people using the service.

At our last inspection in August 2015 the service was rated as overall Good.

At this inspection we found the provider had not maintained that level of service and there were a number of concerns.

The service did not have a registered manager in post. A new manager had been appointed in September 2017 and told us they would submit an application to become the 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.

We found the equipment used to provide care and the upkeep of the building had not been maintained. Annual servicing of equipment was last carried out in 2015.

Medicines were not always managed safely; we found gaps in recording on medicine administration records and procedures for management of medicines were not always followed.

Systems for recording incidents and accidents did not always provide details of the outcomes and learning from these.

People were protected from abuse as staff knew the signs to look for and the action to take to ensure that people were safe.

Staff treated people with dignity and respect. People received individualised care in accordance with their plan of care and by staff who understood their needs and preferences; however, care records were not always accurate and up to date. People had choice and their likes and dislikes were taken on board.

Risk assessments provided staff with guidance on how to manage risks to people. Staff understood risks and how to manage these. However, we found conflicting information in the risk assessment for one person whose behaviour challenged the service.

Some staff received training relevant to their role and were supported to effectively carry out their role. However, we found gaps in training for some staff.

We have made a recommendation about staff training.

Staff recruitment practices were not always safe; we found a number of gaps in records relating to references and employment.

The service was not organised in a way that promoted safe and quality care through effective monitoring systems.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, maintenance of the building and equipment, staff recruitment and governance. You can see what action we asked the provider to take at the back of the full version of this report.

This inspection took place on 5 August 2015 and was unannounced. Hail – Great North Road is a care home for up to five adults with learning and physical disabilities.

There was no registered manager in post at the service, however an acting manager was in place who was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the 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 last inspected this service in March 2015. At that inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to quality assurance, staff support, consent, activities outside the home and complaints handling. There were continuing breaches of the regulations relating to supervision and appraisal of staff performance, and quality management at the service, for which we issued warning notices to be met by 19 May 2015.

During the current inspection visit we found that the warning notices and requirements had been met, with significant improvements to the quality management and staff support within the home.

We found that there had been an improvement in the number of opportunities for people to take part in activities outside of the home, improved recording of people’s consent or best interest decisions made on their behalf, and improved complaints handling within the home.

People were content and well supported in the home, with good relationships with staff members who knew them well, and understood their needs. People, and their family members where relevant, had been included in planning the care provided and they had individual plans detailing the support they needed.

The service had an appropriate recruitment system to assess the suitability of new staff. We found that staff were sensitive to people’s needs and choices, supported people to develop or maintain their independence skills, and helped them work towards goals of their choosing, such as planning a holiday.

People were treated with respect and compassion. They were supported to attend routine health checks and their health needs were monitored within the home. The home was well stocked with fresh foods, and people’s nutritional needs were met effectively.

Staff in the service knew how to recognise and report abuse, and what action to take if they were concerned about somebody’s safety or welfare. Staff spoke highly of the training provided to ensure that they worked in line with best practice.

There were improvements made in the systems in place to monitor the safety and quality of the home environment and appropriate systems were in place for managing people’s medicines safely.

This inspection took place on 25 March 2015 and was unannounced. Hail – Great North Road is a care home for up to five adults with learning and physical disabilities.

There was no registered manager in post at the service, as the previous manager had left in November 2014. The provider had taken steps to recruit a new manager, but had not yet been successful. A registered manager is a person who has registered with the 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 last inspected this service in June 2014. At that inspection we found the service was not meeting four of the regulations that we assessed. An action plan was provided following this inspection, however during the current inspection visit we found two continued breaches of regulations relating to quality assurance within the home and supervision and appraisal of staff performance.

We also found that there were not enough opportunities for people to take part in activities outside of the home, and a need for improved recording of people’s consent, or best interest decisions made on their behalf, and complaints handling within the home.

People appeared content and well supported in the home, with good relationships with staff members who knew them well, and understood their needs. They, their relatives and health care professionals spoke positively about the service. People and their family members where relevant, had been included in planning the care provided and they had individual plans detailing the support they needed.

The service had an appropriate recruitment system for new staff to assess their suitability, and we found that staff were sensitive to people’s needs and choices, supporting them to develop or maintain their independence skills, and work towards goals of their choosing, such as planning a holiday. People were treated with respect and compassion. They were supported to attend routine health checks and their health needs were monitored within the home. The home was well stocked with fresh foods, and people’s nutritional needs were met effectively.

Staff in the service knew how to recognise and report abuse, and what action to take if they were concerned about somebody’s safety or welfare. Staff spoke highly of the training provided to ensure that they worked in line with best practice.

There were some gaps in the systems in place to monitor the safety and quality of the home environment. However there were rigorous systems in place for managing people’s medicines safely.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to quality assurance, staff support, consent, activities outside the home and complaints handling. We have also made a recommendation about staff deployment in the home. You can see what action we told the provider to take at the back of the full version of this report.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

At the time of the inspection there were five people living at the home. Two were out when we arrived at the home, but we had the opportunity to meet with them later during the day. One person was unwell and did not wish to speak with us and some people had complex communication needs. We also spoke with the service director, deputy manager and four staff working in the home.

People appeared to feel safe and relaxed at the home, with support from staff who knew their needs well. Staff had undertaken safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home internal environment was safe, clean and hygienic. However the home had failed to take sufficiently prompt action to deal with a build-up of clinical waste bags in the front garden which may have placed people living in the home and members of the public at risk. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risk of infection.

Is the service effective?

People indicated that their care and support needs were met effectively. We saw people receiving their medicines on time and having care needs met promptly and discreetly. Care plans and person centred plans were reviewed regularly to ensure that staff met people’s needs consistently. However health action plans contained some inaccurate information about the frequency of people being weighed, and having blood pressure and glucose checks which might lead to insufficient monitoring of their health needs.

Staff received some support and supervision to enable them to deliver care and support to people to an appropriate standard. However insufficiently regular supervision and appraisals meant that not all staff felt supported and that gaps in training were not always addressed promptly. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supervising staff appropriately and ensuring health care records are accurate.

Is the service caring?

People we spoke with indicated that staff were caring and responsive to their needs. We observed staff interacting with people warmly and patiently, treating them with respect, and maintaining their dignity. Staff showed concern and provided encouragement and support to one person who was unwell during the inspection and had remained in bed. Staff we spoke with showed that they understood the needs of individual people they cared for. People’s preferences, interests, aspirations and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

Is the service responsive?

We saw that staff had identified people’s cultural and religious needs, and people were supported to attend a place of worship if they wished to.

However there was insufficient evidence of suitable arrangements in place for recording people’s consent or best interest decisions made on behalf of people unable to consent to the care provided to them. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service well-led?

The acting manager for the home had left since the previous inspection and the provider was in the process of recruiting a new manager.

Monthly audits were taking place but the findings had not been shared with staff or the deputy manager at the home. No service user survey had been undertaken in the last two years and there were gaps in some fire safety records. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing rigorous systems to identify, assess and manage risks to the health, safety and welfare of people who use the service.

We visited Great North Road and spoke with two people who used the service. We observed the care being delivered and met everyone who lives in the home. We spoke with four members of staff. The manager listed on this report is no longer managing this service. We met with the new manager who had been in post for three weeks at the time of our inspection. We looked at the records for all the people who lived there.

We found that people were provided with care which met their needs. They were treated with dignity and respect. We saw that people had up to date care plans and risk assessments which reflected their personal needs. There was information available to people in different formats, such as pictorially, which made it easier for people to understand. Some people were not receiving regular physical health checks as specified in their care plans.

Staff attended regular and appropriate training and felt supported by the organisation. Some staff had not received supervision and appraisals as frequently as the provider specified that they would be. The provider had systems in place to ensure that people had an opportunity to provide feedback about their service.

We met and spent time with all of the people who live at the home. They had complex needs, and some of them were not well able to tell us about their experiences.

People were relaxed and at ease within the home, and indicated that they were provided with the care that they needed. We saw people being given choices, and noted that they had formed good and supportive relationships with staff.

People’s privacy and dignity were respected within the home, and they received respectful and appropriate support to meet their needs, including personal and health care needs, and support to engage in a variety of activities.

The home environment was maintained appropriately, and was clean, and comfortable.

Staff working in the home were trained and supervised, and appropriate quality assurance procedures were in place to ensure that people received appropriate care and support.

We spoke with two people living at the home, and observed staff interacting with people who had communication difficulties. People were positive about the home, indicating that they were provided with the care that they needed, were given choices, and had formed good and supportive relationships with staff and management.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. They were happy with the food served in the home, and encouraged to be involved in household tasks.

However some improvements are needed in particular areas including more regular review of people’s care plans and risk assessments, some improvements in interactions with residents, more picture aids, and more varied activities for some people living at the home. The deployment of staff in the home should also continue to be monitored to ensure that people's needs are met effectively. More rigorous quality control procedures should also be put in place for the home.