About the service:

Little Acre – The Annex is a residential care home that accommodates up to three people living with a learning disability or Autistic Spectrum Disorder. At the time of our inspection there were three people living at the service. The service has been designed to be a next step for the children’s residential care home ‘Little Acre’. The outcomes for people using the service reflected the principals of Registering the Right Support and other best practise guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary life as any citizen. ‘Registering the Right Support’ CQC policy.

People’s experience of using this service:

Improvements had been made since our last inspection which was in October 2017 to address concerns and breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The risks to the quality and safety of the service had been identified and acted upon. People’s records were well organised and checked to make sure that they included up to date and accurate information about people’s needs. Information from audits and quality checks were used to drive continuous improvements to the service people received.

The breach of regulation at the previous inspection had been regarding unsafe staffing levels. The provider had worked with a dependency assessment tool, they had reviewed the recruitment process and employed additional staff to ensure the service had sufficient to meet the needs of people.

The environment was safe, clean and suitable for people’s needs. Staff were well trained, and training had been kept up to date and monitored. Staff had regular supervision with the registered manager.

Staff supported people to enjoy a variety of activities and outings. The registered manager and the staff knew what people liked to do and had consulted with families and the people living at the service.

There were formal and informal ways the registered manager at the service gathered complaints and compliments. The registered manager was keen to act on any concerns promptly and welcomed feedback on all aspects of the service from relatives and professionals.

They were sensitive to equality diversity and human rights, and worked to ensure people’s cultural needs were supported

Planning of care was outcome focussed and showed what people had achieved. This was reflected in all aspects of care planning and reviews including three monthly audit reports.

Rating at last inspection:

Required Improvement, the report was published on 11 December 2017.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service met the characteristics of good in all areas.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to re-visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We carried out an unannounced inspection of the service on 19 October 2017. Little Acre – The Annex is a small home which provides residential care for up to three people who have a learning disability and complex needs. On the day of our inspection three people were using the service.

At the last inspection, in September 2015, the service was rated Good. During this inspection we found concerns in relation to the safety of the service. This resulted in us finding a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to staffing. You can see what action we told the provider to take at the back of the report.

The service had a registered manager in place at the time of our inspection. 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 found that the service was not consistently safe. There were not always enough staff to meet people’s needs and ensure their safety and this placed people at risk of harm. The provider was aware of this and had had been proactive in trying to increase staffing levels. However, this remained a concern at the time of our inspection visit. Risks associated with people’s care and support were assessed. However, these were not always effectively managed due to challenges with staffing levels.

People received their medicines as prescribed. Some improvements were required to ensure that medicines were safely managed. There were systems and processes in place to minimise the risk of abuse and safe recruitment practices were followed.

People were supported by staff who received training, supervision and support and staff had specialist training to enable them to meet people’s complex health needs. People were enabled to make decisions and where they lacked capacity to make a certain decision, they were protected under the Mental Capacity Act 2005. People’s nutritional needs were met and risks associated with eating and drinking were managed. People’s health needs were monitored and responded to and this had a positive impact on their physical wellbeing.

Staff knew people well and were kind and caring in their approach. Staff understood how people communicated and when possible people were involved in making choices relating to their care. People had access to advocacy services if they required support to express themselves. People's diverse needs were recognised and accommodated and their rights to privacy and dignity were valued and respected.

People received care and support which met their needs and respected their preferences. Staff practice was not always consistent with guidance in support plans and improvements were required to ensure that staff had access to accurate information. People were provided with opportunities for social activity at home and within the community. However the quality of activities was limited by staffing levels. There were processes in place to deal with complaints. We found that complaints had been recorded and responded to in accordance with the provider’s policy.

The service was not consistently well led. There were systems in place to monitor and improve the quality and safety of the service. However, these were not always effective in identifying and addressing areas of concern and this resulted in action not being taken to address issues. We made a recommendation that improvements should be made in this area. People who used the service and their families were offered opportunities to provide feedback on the service and this was used to drive improvement. Staff felt supported and were involved in giving their views on how the service was run.

Further information is in the detailed findings belo

We inspected the service on 15 September 2015. 24 hours’ notice of the inspection was given because the service is small and people living there are often out and we wanted to be sure people would be at the home. Little Acre – The Annex is registered to provide accommodation for up to two younger adults with physical and learning disabilities. The service is located in Hickling Pastures, Nottinghamshire and is situated in the grounds of a children’s home run by the provider.

The service had a registered manager in place at the time of our inspection. 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 protected by systems designed to keep them safe from harm. Staff knew how to respond to incidents and how to escalate concerns to external agencies if required.

Medicines were managed safely and people received their medicines as prescribed. There were enough staff to ensure that people received care and support when they needed it.

People were supported by staff that had the knowledge and skills to provide safe and appropriate care and support.

Decisions about the care and support that people received were not being made in line with the requirements of the Mental Capacity Act (MCA) 2005.

People were supported to maintain their nutrition and other health needs. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were treated with dignity and respect. We saw staff were kind and caring when supporting people.

The care that people received was based around their individual needs. Staff were knowledgeable about people’s likes and dislikes and what support people required. Relatives knew who to speak with if they had any concerns and were confident that these would be responded to

Relatives described an open culture at the service and good communication. Audits had been completed in order to monitor the quality of the service and these had resulted in some improvements to the service.