Honeybrook House is registered to provide accommodation and personal care for people for 10 people. At the time of our inspection nine people were living there. The inspection took place on 20 and 25 April 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. This person became registered with the Care Quality Commission in September 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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 previously inspected Honeybrook House on 30 March and 1 April 2016. At the time of that inspection we rated the location as requires improvement overall. We found three of the five questions to require improvement. These were in the safe, effective and well led questions. The registered manager and his team had worked to address the areas for improvement identified at our last inspection. Further improvement was identified to be made in the safe question.

We found there were some shortfalls in how risks to people’s welfare. These did not always consistently match what staff told us to provide assurance identified risks were always managed safely. The registered manager was aware improvement was needed.

Staff told us how they would recognise concerns to people’s safety. There were occasions when management had not been informed as necessary about incidents involving people who lived at the home.

People medicines were administered and stored safely. Healthcare professionals were involved in people’s care and advice was sought from professionals when required.

Staff had undertaken training relevant to their role and in order to meet the needs of people. Staff were confident they had the skills need and felt supported by the management of the home. The registered manager was recruiting staff to fill staff vacancies. Regular agency staff were used to provide consistency in the level of care provided.

People were supported by staff in a kind and caring way. People were involved in planning their care and how they spent their day. Staff were aware of people’s interests and sought to engage people in these to stimulate them. Staff sought permission from people before care and support was provided. The registered manager and staff were aware of the importance of gaining consent and were aware of the need to involve other relevant people if looking at people’s best interests.

People were supported to remain as independent as possible. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

Members of staff and the registered manager worked together to provide quality care. Staff and relatives were complimentary of the registered manager and improvements made. Quality checks were in place to continually drive improvements in the service people were provided.

Honeybrook House is registered to provide care and accommodation to up to 10 people with a learning disability and autism. At the time of our inspection eight people were living there.

The inspection took place on the 30 March and 1 April 2016 and was unannounced.

At the time of our inspection a manager was in post. They were present during the afternoon of the 30 March and for most of the time we were at the home on 1 April 2016. The previous registered manager had left Honeybrook House a few weeks prior to our inspection. The new manager had been in post for a couple of weeks and was preparing to apply to the Care Quality Commission (CQC) 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 carried out an unannounced comprehensive inspection on 10 November 2014. A breach of a legal requirement was found. After the inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponded to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was due to short falls in how people were lawfully restricted.

Improvements had been made although an application to restrict one person’s liberty had not been made once a previous decision had expired. Staff were not aware of who’s liberty they were lawful able to restrict.

We looked at people’s medicines and found one person had regularly received incorrect pain relief since the start of 2016. Staff were not aware they had made these continual errors. These findings were taken seriously and immediate action was taken.

People who lived at the home responded positively to staff. Staff supported people in a kind and caring way and communicated with people in a way they preferred. People were supported by staff who had received training and support in order they were able to meet people’s care needs. Staff were aware of their responsibility to report any safeguarding matters to the management team and had an awareness of other organisations.

People received care and support from staff who were supported by senior staff and were able to seek guidance on aspects of people’s care and support. Staff enjoyed working for the provider. Staff were able to attend staff meetings during which people’s care needs as well as practices within the home were discussed. The suitability of new staff members was checked before they started working for the provider.

People’s consent was obtained by staff before care and support was provided and people were encouraged to make choices about how they spent their time and in the food they eat. People were involved in their own care and were supported by family members. Best interest decisions were in place and had involved relatives and healthcare professions as needed. There were however occasions when decisions had taken place without referring to the people or their representative.

People were seen to be supported to do things they enjoyed doing in the home and in the wider community. Staff understood what people liked doing and how best to meet these needs. People’s health needs were had accessed regularly by professionals to support them and to maintain their health and well-being.

The quality of the care provided was checked and reviewed by provider and staff at the home. Management systems were not always in place to identify trends within the home. Staff were unable to inform us why notifications following incidents or event which effected people’s welfare were not always sent to the CQC.

This inspection took place on 10 November 2014 and was unannounced. At our previous inspection no improvements were identified as needed.

Honeybrook House provides accommodation and personal care for people with a learning disability and autism. The home is registered to accommodate a maximum of 10 people. At the time of our inspection nine people lived at the home.

At the time of our inspection 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. Since our inspection we have received an application for the registered manager to remove their name from our register as they have taken a new role within the company. The home has a new deputy manager in place who now has responsibility for managing the home.

We had not been notified of two Deprivation of Liberty Safeguards (DoLS) authorisations which were in place. DoLS are safeguards used to protect people where their liberty to undertake specific activities is restricted. The registered manager had also not applied for DoLS authorisations for two more people who had restrictions placed on them within the home.

We saw that systems were in place to monitor and check the quality of care and to make sure the environment was safe and well maintained. However we found that some records were not always completed correctly by staff.

People were supported by staff who knew their needs, behaviours and preferences. Staff knew how to protect people against the risk of danger and harm and how to report concerns they may have. They understood how to help keep people safe and followed instructions to reduce risks that had been identified. There was evidence that learning from incidents and investigations took place and changes were put in place to improve the service.

Most staff knew how to support people in line with the Mental Capacity Act 2005 (MCA). The MCA sets out how to support people who do not have capacity to make a specific decision. Systems were in place which made sure people’s rights were upheld when they had to make decisions about their care.

People were supported by sufficient numbers of staff who had the skills to meet their needs. Staff had received appropriate training and felt supported in their roles by the registered manager. The registered manager had recently reduced the number of agency staff working at the home and was employing permanent staff. People had started to benefit from a more stable staff team and were building positive relationships with the newer staff members.

People were supported to express their views and be involved in making decisions about their care. Care records were personal to each person and gave clear information on the needs of the person and what was important to them. This helped staff to support people as individuals and be aware of their hobbies and interests.

Feedback from relatives about how staff cared for their family members was positive. We saw staff treated people with kindness and compassion and were aware of each person’s needs. People’s privacy and dignity was respected and staff encouraged people to maintain their independence.

Most relatives and staff we spoke with told us communication within the home was open and honest. Some relatives told us they were not always kept up to date on what was happening with their family member. Relatives were comfortable raising concerns and complaints with the staff and registered manager. Staff were encouraged to report concerns and question practice if needed.

You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection in July 2012 we found that the provider was not meeting essential standards in involving people who used the service, consent to care and treatment, care and welfare, safeguarding people from abuse, and monitoring the quality of the services provided. We found at this inspection that improvements had been made.

We observed how care was provided for the people who lived at Honeybrook House. People who used the service were involved in decisions about their care. Consent from people had been obtained before care and treatment was provided or arrangements were made to support people who were unable to consent to their treatment or support.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were aware of each person’s needs. Staff demonstrated that they knew how to give care and support to meet those needs to ensure people’s health and welfare was maintained.

People who used the service were protected from the risk of abuse. We saw that staff had a kind and caring approach towards people they supported. People appeared happy, comfortable and relaxed in their home. Staff told us they would: “Not hesitate to tell a senior or the manager” if they had any concerns about the care people received.

The service had been reviewed during 2012 and showed that people’s views of the service had been obtained and taken into account in the way the service was provided.

We inspected Honeybrook House and used a number of different methods to help us understand the experiences of people who lived there. We spent some time with four people who lived at Honeybrook House, spoke with members of staff on duty and other staff on the telephone, and spent some time with the acting manager.

We saw that people were relaxed and at ease with staff and within their home environment. We saw that staff interacted with people who lived at Honeybrook House in a friendly, courteous and respectful manner.

We found that people were treated with respect and their dignity and choices had been considered by staff. People told us that they “liked the food”, and they “could have something else if I don’t want it”.

We found that people who used the service had not always been involved in making decisions about their care and treatment, or that best interest meetings had been held where people had been unable to express their views.

Staff told us they understood how to meet people’s basic needs and gave the support people needed. Staff confirmed they had received the required training, supervision and appraisal. This made sure that people who lived at Honeybrook House received an appropriate standard of care to safeguard them from any unacceptable risk of harm.

We found that staff knew about and had access to up to date local authority safeguarding information. However, we found however that the Safeguarding policy for the service was not up to date and contained inaccurate information. This meant that people who lived at Honeybrook House were not fully protected from the risk of abuse. The acting manager and the provider had not taken reasonable steps to make sure that policies and procedures were accurate and kept up to date.

Staff told us that they worked to make sure people felt safe and that they were supported and knew how to complain should they need to.

Some people who lived at Honeybrook House had not been given the opportunity to express their views on the service they received. This was because people’s views and experiences had not been asked for and taken into account in the way the service had been provided and delivered in relation to their care.