About the service: Leighton House provides personal care and support to people living in ‘supported living' settings, so that they can live in their own home as independently as possible. Some people using the service lived in shared houses with a member of staff on duty 24 hours a day. Other people lived independently with staff support for specific needs, such as meal preparation. 28 people were receiving the service across a number of households.

People’s experience of using this service: The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• People were supported to have meaningful opportunities and activities.

• Staff supported people to access mainstream services and specialist health and social care support.

Improvements were needed to ensure people’s medicine would always be managed in accordance with current best practice guidance.

The provider’s quality assurances processes had not always been effective in identifying shortfalls in the service. Where shortfalls had been identified plans were not always in place to manage the risks these could pose to people till the required improvements were completed.

Staff had not always received regular supervision and timely refresher training to support their professional development and ensure they remained up to date with current practice.

People told us they were supported by a team of caring staff who knew them well. We saw staff were kind and respectful towards people.

There was an open culture where staff and people could raise concerns or issues. People told us they felt safe at the service and felt happy to speak up. People’s views were sought and were used to improve aspects of the service.

Rating at last inspection: The last comprehensive inspection rating was Good (This report was published on 14 September 2016). A follow up responsive inspection took place on 26 January 2017 and the rating was Good. The service is now rated Requires Improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Action we told the provider to take: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will meet with the provider and request an improvement plan following this report being published to show how they will make changes to ensure the legal requirements are met and the rating of the service is increased to at least Good. We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an announced inspection which took place on the 26 January 2017. Leighton House provides personal care support to people who have learning disabilities, mental health problems and sensory impairments. People either lived independently in flats or lived in shared houses. The level and amount of support people need is determined by their own personal needs. We only inspected parts of the service which supported people with the regulated activity of personal care.

There was a registered manager in post. 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. However the care coordinator helped us with our inspection as the registered manager was unavailable.

We carried out an announced comprehensive inspection of this service on 17 August 2016. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation 11.

We undertook this focused inspection to check that they had followed their plan and to confirm they now met legal requirements in relation to a breach of regulation 11. This report only covers our findings in relation to this requirement within the domain of ‘Is this service effective?’ and a recommendation we made within the domain of ‘Is this service safe?’ You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Leighton House on our website at www.cqc.org.uk”

At this inspection we found action had been taken to record and assess people’s mental capacity to consent to specific decision about their care. The registered manager and care coordinator had received additional training in the Mental Capacity Act (MCA). They had plans to deliver workshops to staff to enhance their awareness in supporting people within the principles of the MCA.

We also found that the provider had acted on our recommendation and had reviewed their recruitment process to ensure all staff were physically and mentally able to carry out their role.

This inspection took place on 17 August 2016 and was announced. Leighton House provides personal care support to people who have learning disabilities, mental health problems and sensory impairments. People either lived independently in flats or lived in shared houses. The level and amount of support people need is determined by their own personal needs. We only inspected parts of the service which supported people with the regulated activity of personal care.

There was a manager in place at the time of our inspection who was in the process of applying to be the registered manager as required by their conditions of registration. 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.

People were supported by staff who were kind and caring and understood their responsibility to protect them from harm. Staff knew people well and adapted their approach and communication according to their needs. We observed people were comfortable amongst staff and they chatted together in a friendly manner. People enjoyed a healthy diet and took part in activities and chores around their home.

People were supported to attend health care appointments as required. The management and administration of their medicines was based on people’s individual support needs. People’s level of support was varied and tailored to their needs. Their individual needs and risks had been assessed and recorded. People’s support plans gave staff adequate information about their preferences and how they wished to be supported. However, the details of people’s mental capacity assessment and consent to receive care were not always evident when people could not make a decision about their care and support for themselves.

Suitable staffing levels were in place so people could be adequately supported in their home and carrying out activities. Staff had been trained and were supported to carry out their role. Plans were in place to update the training of staff. The employment and criminal history had been checked before staff started to support people. However the mental and physical well-being of staff to carry out their role had not been assessed. We have made a recommendation about the recruitment of staff.

The service had recently been purchased by another provider. The manager was working with the new provider to ensure that adequate governance processes were in place to ensure the service was safe and effective. The managers and the coordinators of the shared houses carried out frequent audits and checks of the quality of service being delivered. People and their relatives concerns were listen to and acted on immediately. A complaints policy was in place although there had been no recent formal complaints.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that people were supported to express their views regarding their care and support through regular meetings and involvement in care planning. We found people had been supported to develop independence and increase their community involvement.

The provider had carried out thorough risk assessments of how people would be supported. At the time of the inspection a number of people were away on holiday with staff support. We found that these holidays took into account peoples assessed needs.

We found that all staff had been trained in safeguarding and the staff we spoke were able to tell us what they would do if abuse was suspected, witnessed or alleged. One person supported told us if they were concerned about how they were being treated they would "tell the manager or my social worker".

The provider had effective systems in place to ensure that people were cared for, or supported by, suitably qualified, skilled and experienced staff. We found that the provider had ensured that there were enough qualified, skilled and experienced staff to meet people's needs. We were told by one person that "the staff are excellent" and by another that "they're all lovely, I like them all".

We found the provider had systems in place to assess and monitor the quality of service provided. We were told by a family member that they do "try to keep channels of communication open". The provider told us "continuous quality improvement is important to us".

We found that the provider was providing a service which had respected the privacy and dignity of people who used their service. Assessment and reviews conducted by the service had consulted with people who used the service and recorded how they wished to be supported. People told us:” that staff are really good and look after me" and” this is the best place that I have ever lived". Regular reviews by senior staff had ensured that staff followed support plans and respected the wishes and choices of people using the service. There were sufficient skilled and experienced staff to safely meet the needs of people who used the service. There had been only a relatively small turnover of staff over recent years. The standard of induction and subsequent training for staff was of a good standard. The home had been well maintained and there were detailed systems to monitor health and safety at the property. There were also regular audits conducted of the environment, and other areas of how the service was operating, as an element of quality assurance monitoring. In summary, this inspection found that Leighton House was providing a good standard of care and support to the people were using the service.