We inspected this service on 23rd November 2016. The inspection visit was announced. The service combines a care home and a Domiciliary Care Agency (DCA).

The care home provides care and support for one person living with autism. The DCA service supports two people with learning disabilities and autism in a supported living environment. Supported living means people have their own tenancy and can choose who supports them.

The provider also managed the service. Registered providers are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act and associated regulations.

We last inspected the service on 9 November 2015 where concerns identified. The provider had implemented an action plan to improve the service. We found improvements in most of the highlighted areas including, as required medicines protocols, risk assessments, staff training and ensuring that they were meeting the requirements of being a DCA. Despite this the provider did not have robust quality assurance systems, which led to them failing to pick up on an area of concern including shortfalls with the implementation of the Mental Capacity Act 2005 (MCA).

We have recommended that the provider implement quality assurance systems that aid continuous improvement.

Although the staff had good knowledge of consent the provider was not meeting the requirements of the Mental Capacity Act 2005 (MCA). The provider informed us that people did not have capacity in certain areas but had failed to assess this capacity in line with legalisation. The registered provider said they will ensure they understand their responsibility when it comes to the MCA. Although the registered provider needs to make changes in this area we found the impact on people was low.

People told us they felt safe with the staff that came to their home. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. Recruitment practices were followed that helped ensure only suitable staff were employed at the service.

Risks of harm to people were identified and their care plans included the actions staff would take to minimise the risks. Staff understood people's needs and abilities because they had the opportunity to get to know people well through shadowing experienced staff during induction before working with them independently.

People were supported by regular members of staff who supported people in a timely manner. Staff were trained in medicines management, to ensure they knew how to support people to take their medicines safely to keep accurate records.

Staff received the training and support they needed to meet people's needs effectively. The provider had implemented a robust training matrix to ensure they were on top of staff training and when it required updating. Staff felt supported by management team and were encouraged to consider their own personal development.

People were supported to eat meals of their choice and staff understood the importance of people being involved in preparing their meals. Staff referred people to healthcare professionals for advice and support when their health needs changed.

People told us staff were kind and respected their privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's wishes and preferences.

People and relatives said that the service was responsive to their needs. The service assessed people’s needs so they received support when they needed it. Peoples wishes were respected. When people did not want relatives involved in the care planning process this was respected.

People knew how to complain and were confident any complaints would be listened to and action taken to resolve them. When areas of improvement were recognised plans were put in place to resolve them.

People and relatives agreed that the service was managed well. The provider had implemented

We had not spoken to the one person who used the service, because they were not in the service on the day of the inspection.

We found the provider had displayed the service’s complaints policy and guidelines so that they were easily accessible to people who used the service, staff and visitors.

We inspected this location based on two regulated activities, Personal care and Accommodation for persons who require nursing and personal care.

Please note, no nursing care was carried out at this location.

Two people who used the service told us they were involved in their care and were able to make changes to their care. People told us they were happy with the care and support they received from the staff. One person said, “The staff consulted with me, and I signed the care plans to show I agree to the care and support in the plans”.

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care. People received their medicines at the times they needed them from staff qualified and skilled to do so. Suitable precautions were in place to protect people and staff from cross infection of health care associated infections. People were aware of the information about them that was being transferred to other care providers.

People's comments or complaints were carefully considered and responded to. However, the provider had not acted in accordance with legal requirements to bring the complaints system to the attention of service users and those acting on their behalf in a suitable manner and format.

We were told by the person who used the service that they were involved in the planning and delivery of their care. They told us their right to privacy was maintained at all times and the advice and support they received from the registered manager and staff were given in a way that maintained their dignity.

The person told us they had choice in the food they were served. The person said, “The food is very good and the servings are just right. They know what I like and do not like. I get enough food”.

We saw that the service followed their recruitment policy. All gaps in staff's work history were investigated and reasons obtained and documented. All candidates were required to show documented proof that they were legally entitled to work in the UK.

The person told us they received their medicines on time and staff explained to them why they were prescribed their medicines. The person said, “The staff keeps an eye on my medicine, to make sure I have sufficient medicine. They also order my medicines for me”.

People told us they knew who to speak to if they had to make a complaint. They said any comments or concern raised were listened to and dealt with to their satisfaction

People told us staff are respectful of their privacy and dignity. People said they and their family are involved in their care. They said they made the decisions about their care with help and support of their carer.

People told us they loved their home, they did things they wanted to do and they had to obtain special permission to do some things because the manager wanted them to be safe.

People said they and their parents visited the service before they made the decision the service would be able to meet their needs. People told us they liked living in their own home on their own with the staff for company. They said it was more natural.

People told us they would complain to the manager if they were not feeling safe. They said they felt very safe in the service and had wonderful staff which supported them.

People who used the service told us their views were sought about the service delivery and their comments were taken into consideration and acted upon. An example given was we now have a wide variety of cereal for breakfast. Staff took them out shopping and they can become involved with domestic and household chores if they wished to.

We inspected Hill View Care Home on 9 and 10 November 2015. The service combines a care home and a Domiciliary Care Agency (DCA).

The care home provides care and support for one person living with autism. There accommodation was provided in a mid-terraced house in a residential cul-de-sac. There was a small garden at the rear of the property. This person had lived at the service for 13 years.

The DCA service supports two people with learning disabilities and autism in a supported living environment. Supported living means people are supported to live in the way they want, for example they choose who supports them and how they are supported. The two people are in their early twenties. The care and support takes place in the people’s own accommodation approximately two miles away from Hill View care home.

The provider also managed the service. Registered providers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had not ensured risk assessments held within people’s care files provided effective guidance for staff to mitigate the identified hazards. Although staff were able to confidently explain the steps they took to reduce risk new staff would not have immediate access to this information to refer to for guidance.

Although there were systems in place for the safe receipt and storage of medicines we found one person records did not have clear guidance for staff on the administration of PRN ‘as required’ medicine.

The provider’s administration related to staff training and induction required improvement. The provider was unable to routinely evidence which staff had completed what courses and when. They did not retain a copy of staff’s certificates once they had completed a course. Staff were seen to be having supervision however meeting minutes did not evidence clear objectives had been identified.

The provider was had not consistently recorded the steps taken to reach a decision about a person’s capacity for decisions. Not all staff had completed MCA training however were able to confirm how they sought consent. The provider had not fully explored their responsibilities under DoLS.

We found daily care notes which were used to record what the person who lived at Hill View care home had done each day did not consistently protect their dignity, the language used was not always respectful.

The provider had not taken steps to ensure care planning was reflective of the care and support people were receiving. Care plans were seen to be missing for some areas where people were receiving support and others required updating.

The provider was not consistently operating the service in line with their registration requirements. We have asked the provider to ensure they are working under the correct registration requirements. Documentation for all people should be accessible at Hill View care home, however some was being held at the homes of people being supported in the supported living environment.

There were limited quality assurance processes in place and these had not effectively identified the shortfalls in the service that we found during the inspection.

However there were several areas that showed care was provided appropriately. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

The provider had taken steps to ensure appropriate checks and routine servicing to the building and equipment were undertaken to keep people safe.

People told us they liked the food and relatives spoke highly of the meals and snacks provided. Systems were in place to ensure there were sufficient quantities of fresh food available that catered for people’s preferences.

People were supported to access health care professionals routinely and as required as a result of changes in health. Staff were aware of the processes they needed to follow to raise concerns about people’s health.

People felt well supported, and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. All people were supported to have clear structured involvement in activities that were appropriate for their age and interests. We heard staff offering clear explanations to people in ways they understood. Staff were seen to be kind and caring to people.

People spoke positively about the provider and that they could approach them about any issues they felt required raising.

We found a breach in Regulation. You can see what action we told the provider to take at the back of the full version of this report.