Jervaulx Road is a residential care home that provides a service for up to 18 adults who have learning disabilities. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection 12 people were living at the service.

The service operates from three houses joined by internal corridors and a separate self-contained flat situated within the grounds. Each of the houses provides an individual service for up to six people. These are, residential care, short breaks (respite) and ‘Stepping Stones’ which supports people to develop their independent living skills with the goal that they will move into their own home within the community. The self-contained flat offers accommodation for one person to experience living independently leading up to them moving into their own home.

The service has been developed and designed in line with most of 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.

At our last inspection we rated the service good. At this inspection we found the service remained good, however, had improved to outstanding in one area. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post at the time of our inspection. 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.

The service was extremely person centred and responsive to each individual person’s needs. People's care needs were assessed and dynamic plans were in place that changed with the person as their independence was developed. All people and their relatives that we spoke with told us how they were supported by staff, who knew them exceptionally well and empowered them to gain their independence.

We received exceptional feedback from people who used the service, their relatives and professionals about how responsive the service was. We heard, “The service is amazing, [relative’s name] has developed so much they are going to be moving into their own place soon”, “I can do things now that I never thought I would” and “The service is a really lovely place, well run and everyone is safe.”

People were protected from abuse by support staff who were trained and knowledgeable about safeguarding adults and understood their responsibilities. The provider had suitable policies and procedures in place for support staff to follow to keep people safe.

Where people had been assessed for a risk of harm we found that there were risk assessments in place for support workers to follow to minimise that risk.

People lived in premises which the provider maintained safely. The provider carried out a range of health and safety checks including fire safety, water temperatures and hygiene, window restrictors, electrical and gas safety, equipment maintenance and servicing.

Medicines were being administered and managed safely by trained and competent support staff. The provider checked that people received their medicines as prescribed.

There were enough support staff employed at the service to provide people with safe care. We saw that the provider regularly reviewed the staffing levels to ensure that people had the

We inspected Jervaulx Road on 2 and 8 December 2016. This first day of the inspection was unannounced, which meant the staff and registered provider did not know we would be visiting. We informed the registered manager of our visit on 8 December 2016.

When we last inspected the service in October 2015 we found two breaches of regulations. We found that staff had not received regular updates on their training to enable them to carry out the duties within their role and effective governance arrangements were not in place. Quality assurance and governance processes are systems that help providers assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation.

At this inspection on 2 and 8 December 2016 we found that the registered provider had followed their plan and legal requirements had been met.

The home had 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.

Jervaulx Road provides care to adults who have a primary diagnosis of a learning disability. The service is a purpose built, two-storey building, comprising of three separate units interlinked by internal corridors. Currently care and accommodation is provided to a maximum number of eighteen people. Stepping Stones is a six bedded unit in which people are supported to develop their living skills with a view to living independently. People are admitted for an agreed period of time and follow an agreed training programme whilst being assessed and supported by staff. Unit 17B has six beds. Two of the beds are for people who are permanent placements and the other four are for short breaks. Unit 17 C is a six bedded unit which accommodates a maximum number of 6 people on a permanent basis. Since the last inspection the garage at the service has been converted into a self-contained flat (two bedrooms) which can be used to support those people to live independently and who are to move onto independent living. This increases the total number of bedrooms within the service to 20. The registered provider is aware of the need to vary a condition of their registration to enable them to accommodate 20 people. The registered provider has assured us that the self-contained flat will not be used until the variation to registration is agreed. At the time of the inspection there were 12 people who used the service.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

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

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, behaviour that challenged, falls, burns and scalds. This enabled staff to have the guidance they needed to help people to remain safe.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undert

We inspected Jervaulx Road on 26 October 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

17 Jervaulx Road is a purpose built, two-storey building, comprised of three separate units interlinked by internal corridors. Care and accommodation is provided in 18 single rooms for people who have a learning disability. Stepping stones is a six bedded unit in which people are supported to develop their living skills with a view to living independently. People are admitted for an agreed period of time and follow an agreed training programme whilst being assessed and supported by staff. Unit 17B has six beds. Two of the beds are for people who are permanent placements and the other four are for short breaks. Unit 17 C is a six bedded unit which accommodates a maximum number of 6 people on a permanent basis. At the time of our inspection there were 12 people who used the service.

The home had a registered manager in place. 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 looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. We saw that the registered provider completed an annual health and safety in July 2015. This audit failed to pick up that only 38% of staff had completed fire training and that for the majority of staff infection control training had not been refreshed.

The registered manager told us that senior management completed a quarterly audit of the service. This audit was based on CQC standards to make sure the service was safe, effective, caring, responsive and well led. However the last audit of the service was 9 June 2015. The registered manager told us that they undertook care plan audits on a regular basis however; there was no audit document to inform what checks the registered manager was making. Senior staff and domestics had task lists, but there was not a formal audit for infection control which described the checks to be made.

Staff had not received regular updates on their training to enable them to carry out the duties within their role.

The registered manager and staff showed that they had an understanding on the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. MCA assessments were evident in care records looked at during the visit and best interest decisions were recorded, however MCA assessments were not decision specific. For example there was a general MCA assessment, however nothing specific for finance, health and welfare and medicines amongst others.

We looked at the support plan of one person who lived at the service and one person who was on the stepping stones project. The support plan for the person who lived at the service was person centred and written in a way to describe their care and support needs. The care records of the person on the stepping stones project contained a detailed assessment of needs and support that people required, however it wasn’t in a readily accessible format as there wasn’t an actual support / care plan. Care records had been regularly evaluated, reviewed and updated.

Risks assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighted on a regular basis, however nutritional screening was not undertaken to identify those people who are malnourished or obese.

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

We saw that staff had received supervision on a regular basis and an appraisal.

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.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were closely monitored. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

At our last inspection of Jervaulx Road in October 2013 we identified some concerns with the standard of record keeping. We carried out this follow up inspection to make sure that improvements had been made.

At this inspection we found that improvements had been made. Care plans had been reviewed and evaluated. We saw that care files were organised and contained up to date information which was signed, dated and accurate.

Records were accurate and fit for purpose which helped to protect people who used the service from the risks of receiving unsafe or inappropriate care and treatment.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

Relatives and service users spoke highly of the quality of care, quality of food and the dedication of staff.

A relative told us;

"He has improved, his speech has improved an awful lot, this is due to the staff."

They also said;

"It's a family, they have all lived together for many years".

The care records were of variable quality. The care records were very large and contained a lot of archive material. Staff acknowledged that the care records were large and unwieldy and that current information would be difficult to access for a new or temporary members of staff. Some of the medicine charts, care plan and risk assessment files contained loose papers which if lost or misplaced could also compromise continuity of care.

This meant that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

The home was clean and had recently been refurbished. All areas were furnished and decorated to a high standard.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained.

During the inspection we spoke with six people who used the service and one relative. We also spoke with the manager, co-ordinator and four staff. We observed interactions and found there was a friendly and relaxed atmosphere between the people living and working at the home.

We were able to observe the experiences of people who used the service. People seemed happy and we saw people and staff joking and relaxed with each other.

We observed people returning from activities, some with support workers from other agencies. The staff were attentive and encouraging when interacting with people. We found evidence of good communication with other agencies.

The five staff we spoke with had a good knowledge of the care needs of people living in the home and those coming into the home for respite care. One relative told us, “We have regular meetings to discuss care and any issues, I am very happy with the care. “

We found there were appropriate arrangements in place for the recruitment of staff.

We found that appropriate systems were in place to ensure the safe use and management of medicines.

We found that systems were in place to deal with comments and complaints.

People told us they felt involved and supported in the care delivered to them.

You can see our judgements on the front page of this report.

During the inspection we spoke with people who used the service and relatives. One person said "I use the respite facility a few times a year, I was able to come and visit the service beforehand". A relative spoken to said "It is like a big family. I have no complaints". Another relative said "Staff here are excellent and dedicated" and "The food is good. I would be the first person to be told if it wasn't".