This inspection was announced and took place on 25 May 2017. Hellesdon Bungalows is a service that provides accommodation and personal care to people with a learning disability or autistic spectrum disorder. The home is registered for up to 8 people. It is not registered to provide nursing care. Hellesdon Bungalows is comprised of two properties; number 27 and number 45, each accommodating up to four people. On the day of our visit there were 8 people living in 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the management team understood the MCA and DoLS and its impact on the support they provided. The service was not fully ensuring they were acting in accordance with the MCA as people’s capacity and best interest decisions were not being formally assessed. We have made a recommendation that the provider reviews this legislation and associated guidance to ensure they are acting in full accordance with the MCA. Staff had a good understanding of the MCA and how to support people to make decisions.

People were safe living in the home. The service took a positive approach to risks and risks to people were identified and managed. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns. Incidents and accidents were reported and the registered manager analysed these in order to identify any patterns and ensure actions had been taken in response.

There was enough staff to meet people’s needs. Some staff raised concerns about the use of agency staff in the service however the provider had taken action to minimise the impact of using agency staff as much as possible.

Medicines were managed and stored safely. There was guidance in place so staff knew how to administer medicines. Regular audits were taken on medicines to check and ensure they were managed safely.

People were supported to maintain their health, this included supporting people to eat healthily and address nutritional risks. Staff ensured people received the health care they required.

Staff were supported to provide effective care through training, good team work, and supportive management.

People were supported by staff who cared for them and treated them respectfully. Staff supported people to discuss their views on the support provided. Some people using the service had complex communication needs. Staff understood people’s individual gestures and how they communicated so people were able to express themselves. People were supported to be as independent as possible.

Staff ensured they knew people’s individual preferences and needs. Support was provided in a way that met these. People were supported to access activities and maintain their personal interests and hobbies.

Care plans contained sufficient guidance for staff. They were accurate and up-to-date.

Relatives felt able to raise concerns. They felt confident that action would be taken to resolve any concerns they raised.

There was an inclusive culture in the home. Staff were positive about working in the service and felt supported. Relatives and staff were positive about the management team and the way the service was managed. There were quality monitoring processes in place to help monitor and identity issues that might affect the quality of the service provided.

The inspection took place on 19 and 20 May 2016 and was unannounced.

Hellesdon Bungalows provides accommodation and support with personal care for up to eight adults with a learning disability who may also have autism. At the time of our visits there were five people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 people received was not consistently safe. Action to minimise risk was not always taken and so compromised people's safety. Medicines were generally given as the prescriber intended. However, there were minor shortfalls that audit systems for checking for omissions had not always picked up.

People were supported by enough staff to meet people’s needs safely. They were properly recruited to make sure they were suitable to work in care services. Staff understood the importance of reporting concerns about people's safety and welfare. They had access to training to enable them to support people competently and effectively but there were gaps in this. However, pending formal training, staff were supported by more experienced colleagues to gain the skills they needed. More staff had been recruited and were undergoing induction so that people would be able to receive support from a consistent, permanent staff team.

Staff and the management team were aware of the importance of supporting people to make their own decisions. The management team had sought professional advice in determining whether people understood the implications of decisions. They were aware of the need to ensure that people's best interests were taken into account and, where appropriate, had involved an advocate to support the person.

There had been some difficulties in ensuring the staff team always and consistently implemented professional advice to promote people's health. However, where complex health needs warranted it, staff implemented additional checks on people’s wellbeing. This contributed to them being aware at an early stage of any changes in health requiring intervention or professional advice.

Staff understood people's needs and preferences and delivered support which took these into account. They had developed good relationships with people using the service and promoted their dignity and respect. Where there were concerns about staff conduct, the provider had systems in place to ensure they were addressed and monitored if necessary.

The registered manager for Hellesdon Bungalows was also registered in respect of another of the provider's services as well as fulfilling the role of operations director. This meant that they were overseeing quality and safety issues, management performance and staff practice within nine services in total. During 2015 a replacement manager had been appointed at this service but had subsequently left. The registered manager's ability to oversee the service on a day-to-day basis was compromised due to the additional responsibilities. Significant difficulties with performance, teamwork and attitude had developed, adversely affecting staff morale. Quality assurance systems were not being implemented consistently to ensure that improvements were made promptly.

The provider was aware of the issues and had appointed an acting manager who was able to spend more time within the service and help to promote improvements. It was that person's intention to apply to CQC for registration in due course. Staff saw more regular management presence within the home as supportive. It also contributed to addressing concerns about lack of management 'on the ground' that were raised with us in feedback from professionals. However, arrangements had not had time to

We considered all the evidence we had gathered under the outcomes we inspected. This included evidence from what we saw about how people interacted with staff. We looked at this because some people needed regular and familiar staff to make themselves understood. We used the information to answer the five 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?

This is a summary of what we found:-

Is the service safe?

People told us they liked the staff. We saw that people had no reluctance in approaching staff to ask questions or just to chat. This indicated that they did not feel anxious or uncomfortable in the presence of staff.

The home had information for staff about where to seek guidance in case someone's freedom was being restricted to keep them safe. This included how to contact and seek advice from the 'supervisory body' in case any applications under the Deprivation of Liberty Safeguards should be considered.

Systems were in place to make sure that the safety of the service was checked regularly. This included checks on how medicines were managed. There was guidance for staff about cleaning and infection control and checks made that tasks were completed properly. This reduced the risks to people and helped the service to improve.

Is the service effective?

People living in the home had regular residents' meetings where they could raise concerns or suggestions with staff support. Staff meetings reflected how people could be supported to do as much as they could for themselves and join in the running of their home. People joined in getting their meal ready, setting the table, clearing away or washing up for example.

Staff knew how to communicate with people and people could make themselves understood.

People’s health and care needs were assessed and, as far as practicable, they were involved in developing their plans of care. Information was presented in pictures and simple language to help with this.

We were able to see that people were supported in the way their plans said was necessary. Staff were able to tell us about people's preferences, support needs and health.

Is the service caring?

Staff spoke respectfully to people and there was a lot of laughter between staff and people living in the home. People who had other difficulties in addition to a learning disability were treated inclusively and encouraged to take part in activities and routines inside and outside the home.

People using the service and their relatives had the opportunity to complete a survey so that the manager could see if anything needed to improve.

Is the service responsive?

People joined in activities inside and outside their home regularly if they wanted to. One person had been shopping for clothes and showed staff what they had bought. Two people had bought books during the morning, which reflected their interests. People had planned holidays and were looking forward to these. One said, “I’m going to Blackpool.” They were hoping to go up the tower. Another told us, “We’re going to a big cottage in Bury St Edmunds.”

A group of people were intending to visit the pub during the evening of our visit. One person showed us around the garden, which they enjoyed helping to keep tidy with staff support.

A staff member was able to tell us how someone's needs had changed and how they fluctuated. Staff took this into account when they were supporting the person or planning any activities with them. Where people's health changed, staff sought appropriate advice promptly.

Is the service well-led?

The service had regular checks to make sure things were happening as they should and that the service was safe. Where necessary, improvements were identified and prioritised for following up.

Staff had a clear understanding of the needs of people living in the home. This helped to ensure that people received a good quality service at all times. They had opportunities for training, for staff meetings and for supervision and appraisal. This helped ensure staff were competent and worked consistently to meet people’s needs.

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

People spoken with told us that they were happy with the support they received. They said that staff spoke to them about their care and what was in their plans. In the records we reviewed, everyone had signed to agree that plans for their care had been discussed with them. This showed that care was responsive to their needs and wishes.

People had their needs assessed and plans of care were drawn up showing how their needs were to be met. Staff spoken with understood how people's needs were to be met, as well as being aware of their social and recreational interests, contact with family and likes and dislikes. We saw that people were asked about the sorts of activities they would like to do during the forthcoming week so that these could be accommodated where possible. However, in one case we found that a person's care plan was out of date and if relied upon by new, inexperienced or agency staff as guidance for delivering care, the person would not be safe. We also saw that one person did not receive the required level of supervision to ensure their safety when they were eating and drinking.

People had a choice of what they ate and drank and their suggestions were incorporated into menu plans. They told us that the staff were good cooks and everyone had enjoyed their evening meal.

Staff supported people with their medicines. They had access to training to ensure they knew how to do this safely. However, systems for recording medicines were insufficiently robust to make sure records were always completed when medicines were given and to show who had given them. Medicines in use were appropriately stored but the home had not made any arrangements for controlled drugs should these be prescribed at any point.

We found that people were given regular opportunities to express any concerns or complaints they had about the service, so that these could be followed up if necessary.

We met and spoke with five people during our inspection and used a number of different methods to help us understand the experiences of people using the service. This was because some people had more complex needs and were not able to specifically tell us about their experiences. However, the people we met with said they were happy and that the staff were good.

One person we spoke with told us that they enjoyed gardening and feeding the birds. During our visit we saw this person setting up a new bird feeding station in the garden. This person also told us that they could talk to the staff if they had any problems or were bothered about anything.

Two people showed us their individual rooms, which they said they were happy with. A third person, who was spending time singing along to music in their room, told us they were happy and that they had everything they needed.

When asked if there was anything they would like to change to further improve people's lives in the home, staff responded that they would like to develop the garden, with raised flower beds and have the kitchen work surfaces adapted to better accommodate people who used wheelchairs.

A member of staff told us that people were regularly asked if there were any improvements or changes that they would like. They also explained that support was given to help people make informed choices, such as using colour charts or carpet samples when considering any redecoration of the home.

People told us that they liked living at the home and one person described the staff as their friends. They said they felt safe and were happy. People said they could go out to day centres and other places during the week and that they had outings sometimes in the evenings and at weekends. They told us they could choose where they went and that they could also make choices about other things such as what they had to eat.

We were told by people using the service that they liked their rooms and described how they had the things they wanted around them. One person said they spent time working at their desk and that they enjoyed doing this.