This unannounced inspection took place on 7 December 2016 and it was completed on 9 December 2016 when we had spoken with one relative by telephone.

The service provides care and support for up to three people with learning disabilities and or autistic spectrum conditions, and mental health conditions. Three people were being supported by the service at the time of our inspection.

When we inspected the service in April 2015, we found the provider needed to improve the staffing numbers so that people were supported safely. There was no evidence of how they dealt with behaviours that may challenge others and people’s risk assessments were not being updated. Staff training was not always provided in a timely manner and the training records were not up to date. There were not enough activities provided or opportunities for people to pursue their hobbies and interests. There was lack of accountability from senior staff, most records were not up to date and the manager had not sent us notifications about incidents that occurred at the home. We checked these areas at this inspection and we found they had made the required improvements. This meant that they now provided safe, effective, compassionate and high-quality care to people who used the service.

There was a registered manager in post, who was also the provider of 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 2008 and associated Regulations about how the service is run.

People were safe because there were risk assessments in place that gave guidance to staff on how potential risks to people could be minimised. There were systems in place to safeguard people and staff knew what to do if they suspected that a person was at risk of harm. The service now had risk assessments in place to safely manage behaviours that may challenge others. The provider had effective recruitment processes in place and there was sufficient staff to support people safely.

Staff received regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. Staff had received training to improve their understanding of the Mental Capacity Act 2005 (MCA) so that people’s rights were protected.

People were supported by staff who were kind and caring. People’s privacy and dignity was promoted. They were supported to make choices about how they lived their lives and their views were respected and acted on. People had enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People had care plans that took account of their individual needs, preferences, and choices. They were supported to pursue their hobbies and interests, and were active members of the community where they lived because they enjoyed social events with their neighbours.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives and other professionals, and they acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive improvements. The manager provided stable leadership and effective support to staff. They also promoted a caring culture within the service and staff were motivated to support people.

We undertook an unannounced inspection of Leyland house on 21 April 2015. Leyland House provides accommodation and personal care for up to three people with learning disabilities and /or mental health conditions. At the time of our inspection there were 3 people living in the home.

We last inspected this service in April 2014 and found that the service was not meeting the regulations with regard to care and welfare of people using the service, concerns around the safeguarding of people who used the service and the quality monitoring procedures were ineffective. During our most recent inspection in April 2015, we noted the home had made some improvements but we still had concerns.

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 2008 and associated Regulations about how the service is run.

People were mostly kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs, however the service lacked consistency around staffing levels. Staff were aware of people’s choices and provided people with support which was caring and compassionate.

The provider had a robust recruitment process in place which ensured that qualified and experienced staff were employed at the home. Staff had worked for many years at the home so continuity was very good. Staff received training and support and were able to demonstrate a good working knowledge of their responsibilities.

Detailed care plans were in place detailing how people wished to be supported. People were not routinely involved in making decisions about their care because they were unable to. However family were asked to contribute to the process and decision making. Although care plans were reviewed regularly ‘no changes’ were recorded repeatedly and this did not demonstrate individualised care planning.

People were supported to eat and drink sufficient amounts and had a choice about what food and drinks they liked. Likewise people were supported to access healthcare appointments when required. Staff were usually able to respond to peoples’ changing needs, however this was sometimes reliant on the availability of staff.

Medicines were administered by staff who had received training on the safe administration of medicines.

During this inspection we set out to answer our five key questions; Is the service caring, responsive, safe, effective and well led?

We checked to see if improvements had been made following our previous inspection on 2 October 2013 when the home was found to be non-compliant with three regulations including the care and welfare of people, the management of medicines and supporting staff.

Below is a summary of our findings.

Is the service safe?

We observed that overall people were kept safe. However we noted that there were not appropriate arrangements in place for the management of people's finances. Assessments had not been completed and staff were making decisions about how people "spent" their money.

Is the service effective?

We reviewed the care records for the three people who lived at the home. We found that detailed information was recorded in three files. These covered the various aspects of people's lives. However people who used the service had not had mental capacity assessments (MCA).

Is the service caring?

People were supported by staff who knew them well and were able to care for them in a personalised way. We saw that the support workers showed positive interaction with the people in their care.

Is the service responsive?

We observed the staff to be responsive. Throughout our inspection we noted that staff were aware of people's needs and responded quickly and appropriately when people required assistance, or in some cases reassurance.

Is the service well-led?

We found that there were a number of concerns noted, and these were discussed with the registered manager. Other information could not be located during our inspection.

During our site visit, on 20 July 2012, we met two out of three people using the service. One person was not able to communicate verbally, and therefore was not able to answer our questions directly, but indicated to us, through their gestures and expressions, that they were content with the service. The other person said they were 'happy' and mentioned the staff's names and smiled. The person said that staff 'help' them and that the staff were 'very good'. This indicated that people were content living in Leyland House.

A relative we spoke with was complimentary about the care and service provided, and commented, "I am happy with the care given. The staff are very good."

The people we spoke with told us that they are very happy living at Leyland House. They told us that they like the holidays and outings best. They showed us photographs of a recent trip to London and of their summer holidays where they told us of the good time they had.