This inspection visit took place on 14 and 22 November 2017 and was unannounced.

Hope House 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. Hope House accommodates up to 11 people in two adapted buildings providing support for people with learning disabilities who may also experience mental health needs. At the time of our inspection visit there were five people using the service.

The care service had been developed and designed in line with the values that underpin the Building the Right Support and other best practice guidance. It underpins principles of choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were living as ordinary a life as any citizen.

The service had a registered manager in place whose registration had been completed on the day of our inspection visit. 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.

We last inspected the service in March 2017 and rated the service as ‘Requires Improvement.’ At that visit we found breaches of regulations in relation to consent, use of physical intervention, person centred care and the assessment and mitigation of risks. Following the last inspection, we asked the provider to complete an action plan to tell us what actions they would take to meet the requirements of the regulations that they were in breach of. The provider sent us weekly updates of their action plan in which they set out how they would meet the regulations and we saw according to the timescales, all actions were completed by August 2017. At this visit we saw improvements had been made and the service was meeting all regulations at this time.

The service was now safe. People, staff and relatives we spoke with told us they felt safe at Hope House. Staff and people were aware of procedures to follow if they observed or were aware of any concerns. Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff. Staffing levels were appropriate and a consistent staff team was in place, who were trained and supported to manage behaviour that may challenge through approved training. Staff also had access to regular sessions with external community professionals to discuss incidents, behaviour and strategies to support people with their anxieties.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner. Appropriate health and safety checks had been carried out on the building.

The service was now effective. Staff were now suitably trained and received ongoing training and support. Staff received regular supervisions and appraisals and told us they felt supported. People’s day to day health needs were met by the staff and the service had good relationships with external healthcare professionals. People were supported to lead a healthy lifestyle and where needed to lose or to gain weight. Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

The provider was working within the principles of the Mental Capacity Act 2005 (MC

This inspection took place on 28 March, 4 April, 10 April and 2 May 2017 and was announced. We announced the inspection to ensure the safe running of the service due to the complex needs of people living there. We last inspected the service on 18 May 2015 and found the provider was meeting the regulations we inspected against.

This service is registered to provide care, support and accommodation to a maximum number of 11 people with a learning disability and/or mental health conditions within two separate properties that are next door to each other. When we inspected six people were using the service.

The service did not have a registered manager. The previous registered manager left their employment in March 2017 and last worked at the home in January 2017. A peripatetic manager had supported the registered manager from December 2017 and took over as acting manager when the registered manager left. At the time of the inspection the acting manager was still in place when we inspected the home. The provider had recruited a new manager who was due to start their employment in June 2017. It was then intended the new manager would apply to register with the Care Quality Commission. 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.

During this inspection we found the provider had breached five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These regulations related to; safeguarding service users from abuse and improper treatment; safe care and treatment; need for consent; person-centred care; and, good governance. In particular, there were multiple failures to mitigate risks. The provider had not ensured risks posed to people and others were managed in a manner that ensured safety. Risk assessments had not been completed around the safety of people and staff when in confrontational situations. Physical intervention records showed staff regularly used restraint techniques that were not part of people’s care plans.

The provider did not routinely carry out debrief sessions to identify any lessons learnt following serious incidents.

Not all staff felt supported by managers and the provider. Staff were regularly subjected to assaults but there was no evidence available to show the provider had considered how these assaults affected staff member’s wellbeing. Records showed they did not have regular supervision sessions and an annual appraisal. We have made a recommendation about this.

We found care records did not always detail how staff should support people when displaying behaviours that challenge. Risk assessments and care plans had not been evaluated or reviewed to reflect people’s changing needs. Risk assessments were general and did not provide details of the measures required to mitigate specific risks.

Staff told us staffing levels were insufficient and impacted on their safety. There was a lack of evidence that staffing levels were reviewed and analysed to provide reassurance that sufficient staff were available to provide a safe service. Due to vacancies there was sometimes only one qualified nurse on duty.

New staff had been recruited with no prior experience of the nature of this work. Induction and training was not always effective in ensuring new staff were prepared for the challenges of working at the service. There were also difficulties with staff retention.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. We found restrictions were in place for some people but there were no records to show these had been made following a

We inspected Hope House on 18 May 2015. This was an announced inspection. We informed the provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day; we needed to be sure that someone would be in.

This service is registered to provide care, support and accommodation to a maximum number of 11 people within two separate properties that are next door to each other. One of the properties has six bespoke, self-contained flats each with en-suite facilities, kitchenette and a separate lounge for adults with a learning disability. The other property was not in use at the time of the inspection. The provider was in the process of discussing with the local authority and determining the service user group the property would be used for. It was then intended that the property would be refurbished.

The service has a 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.

There were systems and processes in place to protect people from the risk of harm. The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the right action to take if they were concerned that abuse had taken place.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Staff told us that they felt supported. There was a regular programme of staff supervision in place. Records of supervision were detailed and showed that the registered manager had worked with staff to identify their personal and professional development goals.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There was enough staff on duty to provide support and ensure that their needs were met. We found that each person who used the service had a designated staff team. This included a named nurse and a team of support workers. This helped to provide consistency to people.

The registered manager and staff that we spoke with had an understanding of the MCA principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions. We saw that appropriate documentation was in place for those people who lacked capacity to make best interest decisions in relation to their care. We saw that a multidisciplinary team and their relatives were involved in making such a decision and that this was clearly recorded within the person’s care plan.

We looked at the arrangements that were in place to ensure that staff were recruited safely and people were protected from unsuitable staff. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. We saw that medicines had been given in accordance with the person’s prescription.

There were positive interactions between people and staff. We saw that people were supported by staff who respected their privacy and dignity. Staff were attentive, showed compassion, encouraging and caring.

People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted.

People visited their doctor, dentist and optician. Staff told us how they supported and accompanied people on hospital appointments to manager their physical and mental health needs. People who used the service had good links with community nurses who had worked with them for many years and as such knew them very well. This meant that people who used the service were supported to obtain the appropriate health and social care that they needed.

Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified.

Person centred plans were developed with people who used the service to identify how they wished to be supported.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. The one person we spoke with during the inspection told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.