What life is like for people using this service:

• The service was safe and people were protected from avoidable harm. Risks people faced were well managed and staff had clear information on how to support people safely.

• Staff treated people in ways that maintained their dignity and privacy.

• Staff were well trained and there were enough of them to provide the support people needed. Staff were thoroughly checked before they worked at the service.

• The service worked well with other health and social care professionals to ensure they could meet people’s needs.

• Relatives were confident any complaints would be investigated and action taken to resolve them.

• The service was well-led. The registered manager had systems in place to assess the quality of the service provided and plan improvements where needed.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 19 May 2017).

About the service:

Hunters Moon is a care home for people with a learning disability. Seven people were living in the home at the time of the inspection. 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.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

Hunters Moon is a care home which provides accommodation and personal care for up to seven people with autism and learning disabilities. At the time of our inspection seven people were living at the home. This inspection took place on 02 May 2017 and was unannounced.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run. The registered manager was available during this inspection.

We previously carried out a comprehensive inspection of this service in March and April 2016. A breach of legal requirements was found. The service was rated Good overall and Requires Improvement in the 'Responsive' domain. After the comprehensive inspection, the provider wrote to us to say what actions they would take to meet legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act Regulated Activities Regulations 2014. Good Governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements and the Responsive domain. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hunters Moon on our website at www.cqc.org.uk.

We found on this inspection the provider had taken steps to make the necessary improvements.

The recording of the care and support people received was more detailed and enabled an audit to ensure people received support as required. Systems were in place to monitor the standard of record keeping.

People took part in a range of activities of their choice.

People were supported to raise any concerns they may have and there was a complaints policy and process in place.

Care was co-ordinated when people transitioned between Hunters Moon and other services.

Hunters Moon is a care home which provides accommodation and personal care for up to seven adults with a learning disability and associated complex needs. At the time of our inspection there were six people resident at the home.

At the last comprehensive inspection in June 2015, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service was not safe and well led. The registered manager at the time did not ensure people were supported against the risk of abuse. An investigation into an allegation of abuse was substantiated by the local authority safeguarding team. We found that staff did not come forward or whistle blow and the culture within the home did not evidence an open and transparent culture where abuse was not tolerated and where staff felt able to raise concerns without fear of recrimination. The registered manager did not follow the provider's disciplinary procedures as required. We served a notice of decision to cancel the registered manager’s registration.

In addition, we found that medicines were not being administered in a safe and competent manner. Agency staff did not have the required level of skills and experience to be able to support people safely and not all staff received timely supervision and support.

During this inspection we found the provider had made substantial improvements. Further work was required around record keeping which the provider had already identified as part of their continuing improvement plan. Activity and daily records did not contain sufficient information to be able to evidence that people were receiving appropriate stimulation with regards to activities, meaningful occupation and interventions.

We met with the manager who was now in place. Following this inspection they became registered with the CQC to manage Hunters Moon. People and staff told us they thought the service was well led. People told us they felt safe living at Hunter’s Moon and with the staff who supported them. Staff were confident the registered manager would take their concerns seriously around keeping people safe. The culture in the home was positive and safeguarding people was discussed openly and transparently. Staff told us 'it's a different team' and 'having the right staff makes all the difference, we respect each other and the people who live here'. Staff told us they would have no hesitation in whistleblowing to provider or the local safeguarding team if they had any concerns around people's safety and welfare including reporting inappropriate staff practice. The registered manager, deputy manager and staff were aware of their responsibilities in all areas of safeguarding people.

Staffing levels were safe. The registered provider continued to monitor staffing levels to ensure people received a personalised service. People received one to one support and some people received two to one support.

Staff were available to assist people when needed, including support for people to eat, drink and move around the home safely. Staff responded to requests for assistance from people. We observed staff interacting with people in a way that demonstrated a good understanding of their needs and showed warmth towards them.

Medicines were being managed safely and people received their medicines on time.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the action they needed to take if people did not have capacity to consent to their care.

Staff received supervision and support and told us they felt well supported by the manager.

A programme of mandatory and more specific training was in place and all staff had the required skills and knowledge to be able to support people effectively.

People's records contained care plans relating to their specific needs and there was evidence the plans were updated when people's needs changed. Some people told us they wer

At the time of our visit the home were supporting six people. The registered manager and five support staff were available throughout the inspection and were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

We spent time in the communal lounge and kitchen area with people who lived at the home so that we could observe the direct care, attention and support that they received. We observed there was constant interaction between staff and people in the home. People were relaxed, happy and comfortable in each other's company.

We saw that confidential personal information about people was stored securely. The provider had policies relating to record keeping, data protection and confidentiality of records.

It was a positive visit and we found that the provider was compliant in all five outcomes that we looked at.

The complex needs of people made it difficult for them to comment effectively about the service they received. We spoke briefly with two people who said that they liked living in the home and the activities they were supported to do. One person told us about their trip to Gloucester and their walk. They said they enjoyed having lunch while out.

Consent was obtained before staff assisted people. Their needs were assessed and comprehensive care plans were devised that supported people in all aspects of daily living. There was careful monitoring of people’s well being to enable staff to review people’s needs and update the care plans appropriately.

There were good arrangements in place to protect people from abuse. Staff attended training in safeguarding vulnerable people and when abuse was suspected appropriate responses were made.

Medicines were managed appropriately with good systems in place for the storage, administration and recording. Staff were required to be deemed competent to administer medicines before they were permitted to do so.

People were supported by sufficient staff, we observed them too work well together to support people. One member of staff we spoke with told us how they had previously worked at the home as an agency carer and applied for a permanent position because they liked the home.

When complaints were received they were handled appropriately.

The complex needs of people made it difficult for them to comment effectively about the service they received. We were told by two people that they enjoyed living in the home and the activities they were supported to do. One person told us how they enjoyed going swimming and going on holiday.

Outside professionals involved with the home said that the needs of people were well met and that the staff were caring and professional.

We were told that the staff worked well as a team and were well supported by each other and the management.

This inspection took place on 12 June 2015 and was unannounced. We returned on 16 June 2015 to complete the inspection. Prior to the inspection we received information of concern relating to abuse of a person who lives at Hunters Moon.

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 and associated Regulations about how the service is run.

Hunters Moon is a care home which provides accommodation and personal care for up to seven adults with a learning disability and associated complex needs. Prior to our inspection, the Community Team for People with a Learning Disability had carried out an investigation into an allegation of abuse towards a person who lives at Hunters Moon. We found that staff did not come forward or whistleblow.  People told us they felt safe when the staff involved were dismissed and no longer worked at the home.

During our inspection we spoke with two agency workers and found that they were not suitably skilled or experienced to be able to safely support people who live at Hunters Moon.

Permanent staff at Hunters Moon told us they received good training in order for them to do their job well.

Not all staff had received a supervision this year and no staff had received an appraisal within the last year. The registered manager told us they had fallen behind in them.

People liked the staff at Hunters Moon and families told us they were caring and kind. Staff treated people with respect and dignity and communicated with people in a way which empowered them to participate in making choices.

There were a range of activities which people could take part in and families said the staff supported their family member to visit them. Each person had a care plan in place which identified their preferences for the way they wished their care and support to be delivered. Risk assessments were used to identify what action needed to be taken to reduce potential risks which people may encounter as part of their daily living.

Applications had been approved where people’s liberty was restricted and people and their families had been involved in making a best interest decision.

The registered manager did not submit a statutory notification to the CQC when the police became involved in the abuse case. The registered manager did not follow the disciplinary procedures in place to ensure that the conduct and behaviour of the two members of staff involved was monitored and responded to. When the abuse was substantiated, there was a delay in the registered manager reporting the staff concerned to the Disclosure and Barring service.

The culture within the home did not evidence an open and transparent culture where abuse was not tolerated and where staff felt able to raise concerns without fear of recrimination.

There was a complaints system in place and families told us they had no complaints. The policy was available to people in an easy to read and pictorial format.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.