This inspection took place on 12 and 19 March 2018 and was unannounced. When we last inspected the service in March 2016 we found that the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and the service received an overall, rating of Good. However at this inspection we found the service was not meeting all the required regulations. We found some areas of the environment were poorly maintained and failed to provide a homely and comfortable place for people to live. We also found that although individual risks assessments were in place there was inadequate information provided on how staff should support and minimise the risk to people’s health and welfare.

Watford and District Mencap Society – Hillside 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 – Watford and District Mencap Society – Hillside accommodates eight people who have a learning need or who live with Autism. The service is not registered to provide nursing care. At the time of this inspection there were six people living at the home.

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.

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.

People’s relatives told us that they were confident that people were safe living at Hillside.

Risks to people were appropriately assessed but guidelines in place failed to ensure the person’s health and welfare was protected and maintained at all times.

Staff had received training, support and development to enable them to carry out their role effectively. The service is required to update records in relation to meeting the requirements of the Deprivation of Liberty Safeguards (DoLs).People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. People received appropriate support to maintain healthy nutrition and hydration.

People were treated with kindness by staff who respected their privacy and upheld their dignity. People’s relatives were encouraged to be involved with people’s lives where appropriate, to provide feedback on the service and their views were acted upon.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People’s relatives told us they knew how to complain but had not had occasion to do so. They said they were confident they would be listened to if they wished to make a complaint.

Staff were aware of the risk of cross infection and used personal protective clothing to reduce the risk.

We found that although records were written in a positive and respectful way some records lacked detail and guidance.

The registered manager had created an open and inclusive atmosphere within the service. People’s relatives, staff and external health professionals were invited to contribute their views in relation to further developing the service.

Further information is in the detailed findings below.

The inspection team was made up of one inspector. We set out to answer our five questions; 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, discussions with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

People we spoke with all said that they felt safe living at the home. People told us that they felt their privacy and dignity were respected. We saw evidence that risk assessments had been undertaken to help minimise the risk to people who lived at the home. The home had a complaints policy and procedure in place and people we spoke with all knew how they could make a complaint.

We saw that the home had a copy of Hertfordshire County Council safeguarding policy and procedure and staff had received training in how to safeguard people from abuse.

Is the service effective?

We looked at the care records of three people who lived at the home. We found these provided details of what support people needed. We noted that people were involved in the care planning process and that their opinions were taken into account and where possible acted upon.

People told us that they were happy with the care that they had received. We saw that staff had regular staff meetings during which they discussed issues relating to the home and people who used the service.

The provider had a clear protocol in place for dealing with Deprivation of Liberty safeguarding (DoLS). We saw evidence that staff had received training in the Mental Capacity Act (MCA) and in the DoLS.

Is the service caring?

People we spoke with all stated that staff were caring and helpful. One person told us that “Staff are wonderful”. Other people we spoke with all spoke highly of the care and support they had received. Is the service responsive?

People we spoke with all told us that they did not have to wait long for staff to respond to their requests for assistance and that staff were never too busy to assist them to undertake tasks such as laundry or cleaning their bedrooms.

We saw evidence that people were supported to attend medical appointments and relatives where appropriate were always kept informed of any changes to their relatives care and treatment.

Is the service well-led?

The provider had a robust quality assurance system in place which sought the views of people who used the service. We saw evidence that people’s views were listened to and, where possible, acted on.

Regular audits were undertaken to ensure that people received the best possible care and that the home was safe for them to reside in. A robust recruitment process was in place to ensure that staff were suitable for the role.

There was a registered manger in place and we found that the service was well-led. The leadership, management and governance of the organisation assure the delivery of high-quality person-centred care, in an open and fair culture.

During the inspection we spoke with three people who used the service and two members of staff. People who used the service were very positive about the care and support they received. They made comments such as, 'I like living here and staff look after us very well'. We saw care planning documents and risk assessments that were updated regularly.

People had a choice of suitable and nutritious food and were able to access food and drinks at any time. They were encouraged to help with meal preparation and shopping.

Quality assurance procedures were in place to monitor the effectiveness of the care and services provided.

We found that there were appropriate arrangements for the management of medicines.

We found that staff were supervised and trained appropriately to carry out their roles effectively.

A person we spoke with told us that they had been treated with respect and they received the personal care and support they needed. They were satisfied with the social activities available to them. We were told that staff were friendly, attentive and caring and always had time to listen to them. People felt very involved in their care and were always given a say regarding the activities and food choices provided.

Hillside is registered to provide accommodation and personal care for up to eight people who are living with learning disabilities or autistic spectrum disorders. There were seven people living at the service on the day of our inspection. There was a manager in post who was appointed in June 2015. At the time of the inspection they were not yet registered with the Care Quality Commission (CQC).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.

When we last inspected the service on 22 May 2014 we found them to be meeting the required standards. At this inspection we found that they had continued to meet the standards.

People told us that they felt safe and secure at the home. Staff were knowledgeable in recognising signs of potential abuse and understood how to report concerns both within the organisation and to outside agencies. Assessments were undertaken to assess risks to people and to the staff who supported them. There were sufficient numbers of staff available to meet people’s individual support and care needs at all times. People received appropriate support from staff to enable them to take their medicines. People received care and support that was based on their individual needs and preferences. Care and support plans were amended as necessary and in consultation with their relatives or their representatives to meet their changing needs. Relatives of people who used the service felt confident to raise any concerns and were in no doubt that they would be managed appropriately. People received their care and support from a staff team that fully understood people’s care needs and the skills and knowledge to meet them. People who used the service were treated with kindness and respect, and their privacy and dignity was maintained.

The majority of the people who lived at the home were able to communicate verbally but for people who were unable to speak to us we observed staff supported them with a range of communication aids, which included sign language and interpreting people’s body language with regards to meeting their needs and wishes. Staff supported people with their personal care, medicines, activities/hobbies, cooking and domestic tasks in a cheerful and kind way.

Staff were supported by the manager and received the training and supervision necessary to support them to provide safe and effective support for people. People’s views about the service were generally gathered informally through daily contact and observing their body language and the choices made. This ensured that the provider and registered manager could assure themselves that the service they provided was safe and was meeting people’s needs.

Information on how to make a complaint was available for people and staff knew how to respond to any identified concerns or suggestions.

Arrangements were in place to ensure that the quality of the service provided for people was monitored and action had been taken when necessary