This unannounced inspection of Lethbridge Road took place on 11 January 2017. The inspection was conducted by an adult social care inspection.

Lethbridge Road is a large detached house in a residential area of Southport. The service is run by Autism Initiatives and provides accommodation, care and support to six people with learning disabilities. There is parking available to the front of the property and a garden area to the rear. The home is located close to Southport town centre, giving access to public transport and other amenities.

The home was last inspected in November 2014, and was rated ‘good’ overall, with one domain, the safe domain, rated as ‘requires improvement’. We found the provider was in breach of regulations relating to the safe management of medications. Following our last inspection the provider wrote to us and told us what action they were going to take to meet this breach. We checked this during this inspection, and found the provider had taken appropriate steps to address the anomalies found at the inspection in November 2014. The provider was no longer in breach of this regulation.

A registered manager was 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.

During our last inspection in November 2014, the provider was in breach of regulations relating to the safe management of medications. We saw however, during this inspection that medications were now managed safely, in accordance with clinical guidance, and only administered by staff who had the training to do so. The provider was no longer in breach of this regulation.

Everyone we spoke with told us they felt safe and well cared for at the home.

Staff were able to describe the course of action they would take if they felt someone was being harmed or abused in any way. Staff had received the correct training in adult safeguarding, and information regarding who to contact was displayed around the home. Staff also told us they would not hesitate to whistle blow if they needed to.

Risk assessments were in place, and were detailed. They provided staff with information about how to keep people safe, while ensuring their rights and choice were respected. Risk assessments were reviewed every month as part of the quality assurance process, and any changes were implemented and discussed at key worker meetings.

Staff were being safely recruited to ensure they were suitable to work with vulnerable people.

There was a procedure in place for recording and analysing incidents and accidents.

Rotas showed there were enough staff employed by the organisation to deliver a safe, consistent service. Each person had the required number of staff working with them to help keep them safe and access the community.

There were regular checks taking place on the equipment in the home, such as the fire extinguishers, gas, and PAT (potable appliance testing).

Staff were aware of their roles in relation to the Mental Capacity Act 2005 (MCA) and DoLS. We saw that appropriate applications had been made to the Local Authority for people who were required to have a DoLS in place, and these were kept under review.

Staff were supported through regular training, supervision and appraisal. Supervisions were taking place every few weeks, and all staff had had an annual appraisal. The induction process for staff was in line with national guidance as well as the providers own requirements.

People were supported to eat and drink at times that fitted in with their routines. Each person had a dedicated section in the fridge where they kept their ingredients.

We observed staff delivering support and they were kind and compassionate when working with people. They knew people well

We visited the home to conduct a follow-up inspection. We had carried out a full inspection of the home in October 2013, and found non-compliance in one particular area, which was the assessment and monitoring of quality of service provided to people who live at Lethbridge Road. Since that inspection, the provider has submitted an action plan, detailing what steps they are taking to make sure this standard is reached and maintained.

At the time of our follow-up visit, we found people in the home preparing for Christmas. Since our visit in October, there had been a programme of improvements to the home, which included re-decoration of communal areas and some of the bedrooms. The improvements to the kitchen and dining area will take place after Christmas when any disruption to people's routines would be minimized. The home appeared a lot fresher and homely as a result of the improvement worked already carried out. We noted many positive comments had been received from relatives of people who lived at Lethbridge Road.

During our inspection we found that people were cared for and supported by staff who had a good understanding of their needs. We saw how staff helped people they cared for, take part in activities that provided social interaction and encouraged their interests. For example a person who was interested in animals had helped a dog that was lost to be reunited with it's owner. In doing this, the opportunity to exercise dogs living at a local rescue centre presented itself, which the person concerned was supported to take part in. We found sufficient numbers of suitably qualified staff were on duty to meet the needs of people being supported in the home.

When we reviewed people's care records, we found any treatment or care was consented to and staff understood people's right to make choices about how their care and support was delivered. People living in the home had access to other clinicians in the community, for example a GP, dentist or district nurse. This meant their overall health and welfare was maintained.

The provider had a robust safeguarding policy in place and training for staff on this was up to date. Staff we spoke with demonstrated their understanding of the term safeguarding and knew how to report any incidents or concerns.

We found quality monitoring systems were in place, but some areas of audit had been overlooked in the past. When we spoke with the provider they confirmed the new manager at the home was addressing these areas.

During our visit we spent time with people and invited them to share with us their experience and views of living at the home.

Three people told us they were able to make decisions and had control over their day to day lives. Two people told us of the holidays that they had planned and taken with family members. Another person told us " I go out shopping and for a walk when I like".

People told us they were involved in all day to day decisions within the home. We saw that care plans reflected people's needs and wishes and were periodically updated. People told us how they planned their own food menu, went shopping and prepared their own food choices.

We observed good interaction between people who use the service and staff who were on duty on the day of our visit. Staff were observed supporting people in a calm and supporting manner.One person told us "the staff are great, they are the best here".

When writing our inspection reports we generally include the views and comments of the people using the service. This ensures we are reflecting their experiences and the support they receive. However, at the time we visited Lethbridge Road only two people were available as others had gone out for the day. We spent time talking with them and observing the support they received. In order to maintain their right to privacy we have taken into account the things they told us but not referred to them directly within this report.

Overall we found people we spoke with to be happy in the home and they all appeared comfortable and relaxed when talking to staff.

Lethbridge Road is registered to provided accommodation and personal care for up to six adults with a learning disability / autism. It is a large detached house in a residential area of Southport. The service is run by Autism Initiatives. From the observations we made of the care in the home and from talking to people who lived in the home, as well as staff and visitors, it was clear that people living at the home were able to enjoy many aspects of daily living as well as learn adaptive strategies aimed at encouraging more independence.

This was an unannounced inspection which took place over two days on 27 and 28 November 2014. The inspection team consisted of an adult social care inspector.

The service had 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.

During our inspection we saw that staff and visitors were made aware of the need to ensure safety at all times. Visitors to the home commented that they always felt safe in the home environment as there was always staff available. Staff were seen as flexible in their approach which reflected the diversity of peoples care needs and support plans.

People living at the home were ‘safe’ from abuse because the staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported. Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People and their families told us there was sufficient numbers of staff on duty at all times.

We found some anomalies with the medication administration records [MARs] which meant that they were not always clear and there was risk that some medicines may be missed. We found some peoples records difficult to follow; especially those who had had medication changes recently. We told the manager our observations that staff had not followed some of the homes own policies around recording as well as good practice guidance. Staff felt that the current risk was low in terms of any medication errors as they were familiar with the people living at the home and their different medicines. We did not find any evidence that people had not received their medicines. The medication administration records did not support a safe practice however.

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

We observed staff supporting people in a way that ensured their safety whilst maintaining their dignity and promoting their independence. The care records we looked at showed that a range of risk assessments had been completed depending on people’s individual needs. These assessments were detailed and specific to specific behaviours and were aimed at trying to get the person to be as independent as possible, including accessing the local community safely.

Staff had been specifically trained in this approach which was also supported, in some instances, by the use of visual aids to make it easier for people to understand. We spoke with a relative who said this approach had been consistent and helpful and there relative was becoming more independent.

Professionals who visited the home gave us feedback about the care. This was wholly positive. We heard about how one-person living in the home had come on ‘‘leaps and bounds’’ and have extended their coping skills immensely. The professional explained that the person was now able to enjoy time in the community whereas previously they had been confined in the house. All professionals we spoke with gave positive feedback about the home. They described a proactive service which identified any issues regarding people’s health and ensured they received the right support and intervention.

We looked at the training and support in place for staff. We saw a copy of the induction for new staff and staff we spoke with confirmed they had up to date and ongoing training. One staff showed us the induction programme they had attended. This included sessions on autism which included Autism Initiatives five point ‘star’ framework to help understand people with autism. Specific communication strategies involving visual aids had also been learned.

The manager told us that most staff had a qualification in care such as NVQ [National Vocational Qualification] or Diploma and this was confirmed by records we saw where 60% of staff had a qualification. This helped show staff had the knowledge and skills to work with people at the home.

We looked to see if the service was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions. We were told that all of the people at Lethbridge Road had capacity to make decisions about their daily life and care needs. Staff told us that time needed be taken to ensure information was clear and the right support was in place so that people could be enabled to make decisions. We saw this followed good practice in line with the MCA Code of Practice.

We were told that the home does not currently support anybody who is on a deprivation of liberty authorisation [DoLS]. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

We discussed with staff and the people living at the home how meals were organised. We saw that people were involved in planning their own meals but there were also communal meals available. We saw that in the kitchen staff had put up meal suggestions aimed at promoting a more healthy diet. Individual meal plans were also displayed.

Communication was seen as a priority to carrying out care. We saw references in care files to individual ways that people communicated and made their needs known. We saw that these entries were detailed and were reviewed regularly. We also saw examples were people had been included in the care planning so they could see and play an active role in their progress. We noted there was positive and on-going interaction between people living at the home and staff. We heard staff taking time to explain things clearly to people in a way they understood. A relative told us staff were consistent in their approach and displayed a lot of patience and a caring attitude.

The staff we spoke with had a good knowledge of people’s needs. The pre inspection report (PIR) completed by the manager states: ‘’All staff members have an excellent knowledge about the individuals that we support and deliver all support in a caring, pro-active and personalised way. All staff are eager to learn and develop their own skills and knowledge and utilise this in a way that will benefit each service user.’’ This theme was supported by the observations, interviews and records we saw on the inspection.

People told us the staff respected their preferred routine. This could mean that plans agreed previously might have to be changed due to people making a different choice. Staff explained that this process in itself was important as the person was learning to manage how to change and plan their day depending on different circumstances. This showed a respect of the person’s right to choose as well as an understanding of the main aims of the support.

We looked at the care record files for three people who lived at the home. We found that care plans and records were individualised to people’s preferences and reflected their identified needs. They were very detailed and there was evidence that plans had been discussed with people and also their relatives if needed. We could see from the care records that staff reviewed each person’s care on a regular basis.

We observed a complaints procedure was in place and people, including relatives, we spoke with were aware of this procedure. An easy read version was displayed on the notice board in the entrance hallway. We saw that any concerns or complaints made had been addressed and a response made.

We enquired about the quality assurance systems in place to monitor performance and to drive continuous improvement. The manager was able to evidence a series of quality assurance processes both internally and external to Lethbridge Road that senior managers for the organisation carried out. These provided feedback and monitoring so that the service could continue to develop.