This comprehensive inspection took place on 28 June 2018 and was unannounced. At our last comprehensive inspection on 17 July 2015, we found the provider was not meeting legal requirements in relation to staffing. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, effective, to at least good. We undertook a focused inspection on 19 January 2016 to check the provider had followed their action plan and to confirm that they now met legal requirements. We found the provider had taken the necessary action and improved the rating in the effective question to good. In May 2017 the provider informed us that the service was closed temporarily due to a planned refurbishment of the premises. The service reopened on 4 June 2018.

Living Ambitions Limited- 32 Ringstead Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Living Ambitions Limited- 32 Ringstead Road accommodates five people in one adapted building. Accommodation is provided on three floors. The service specialises in the care and support of people with a learning disability, autism and behaviours which may challenge the services they require. There was one person using the service at the time of our inspection.

The care service has been developed and designed in line with 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.

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.

Since our last inspection, the service had undergone major refurbishment to create more living space for people using the service. People had the use of an additional lounge and orangery in the garden which was furnished with sensory equipment. Bedrooms each had ensuite facilities and the service had been redecorated throughout.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans were well organised, kept up to date and contained personalised information about the individual person's needs and wishes. The person’s care plan gave direction and guidance for staff to follow to help ensure they received their care and support in the way they wanted. Risks in relation to their care and support were assessed and planned for to minimise the risk of harm. These records were reviewed regularly and whenever people's needs changed.

People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. The staff had developed positive working relationships with health and social care professionals.

Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. The provider followed an appropriate recruitment process to employ suitable staff. Staffing was managed flexibly so that people received their care and support when they needed it.

People received their medicines as prescribed and medicines were stored and managed safely.

The provider’s training programme was designed to meet the needs of people using the service. Staff had the knowledge and skills they required to support people. Training included supporting pe

The last inspection of this service was carried out on 17 July 2015 when we found the provider was in breach of the regulations. This was because the provider had failed to ensure all staff were suitably trained and supported by their line managers to carry out the duties and tasks they were employed to perform.

After the unannounced inspection we undertook in July 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach in respect of staff training and support. We carried out this focused inspection on 19 January 2016, to follow up the action the provider had stated in their action plan they had taken to meet legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Living Ambition Limited - 32 Ringstead Road’ on our website at www.cqc.org.uk’.

32 Ringstead Road is a home that can provide accommodation for up to six adults with personal care and support needs. The home specialises in supporting older people living with a learning disability, autistic spectrum disorder or Down’s syndrome. There were six people using the service at the time of our inspection.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our focused inspection, we found that the provider had followed their action plan, which they had said would be completed by December 2015. We saw legal requirements had been met because the provider had improved its arrangements for training and supporting staff who worked at the home. This meant staff were appropriately trained and supported to effectively carry out the duties and tasks they were employed to perform.

This inspection took place on 17 July 2015 and was unannounced. At the last inspection on 9 September 2013 we found the service was meeting the regulations we looked at.

32 Ringstead Road is a home that can provide accommodation for up to six adults with personal care and support needs. The home specialises in supporting older people living with a learning disability, autistic spectrum disorder or down’s syndrome. Two of the people using the service were also living with dementia. There were five people using the service at the time of our inspection.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Although people using the service and their relatives told us they were happy with the quality of the care and support provided by the home, we found people’s needs may not always been fully met because staff were not trained in some key aspects of their role and nor were they always appropriately supported by their managers. 

People were safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. There were appropriate plans in place to ensure identified risks to people were minimised. Staff had access to appropriate guidance and knew how to minimise identified risks in order to keep people safe from injury or harm in the home and the wider community. Managers ensured regular maintenance and service checks were carried out at the home to ensure the environment was safe.

Staff looked after people in a way which was kind, caring and respectful. Our observations and discussions with people using the service and their relatives supported this. Staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand. Staff knew how to ensure that people received care and support in a dignified and respectful way. When people were nearing the end of their life they received compassionate and supportive care.

People were encouraged to maintain social relationships with people who were important to them, which included their relatives. There were no restrictions on visiting times and we saw staff made peoples’ guests feel welcome. Staff encouraged people to participate in meaningful social, educational and vocational activities that interested them. Staff also supported people to maintain their independence so far as possible, as well as learn new independent living skills, where appropriate.

Care plans had been developed for each person using the service, which reflected their specific needs and preferences for how they were cared for and supported. These plans gave clear guidance and instructions to staff about how they should care and support people and ensure their needs were met. Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wanted this to be provided. Where people's needs changed, the service responded by reviewing the care and support people received, which included their care plan.

People and their relatives felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

People were supported to keep healthy and well. Staff ensured people were able to access community based health and social care services quickly when they needed them. Staff also worked closely with other health and social professionals to ensure people received the care and support they needed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration. People received their medicines as prescribed and staff knew how to manage medicines safely.

There were enough suitable staff to care for and support people. Managers continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people using the service.

Managers understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Managers demonstrated good leadership. It was clear managers understood their role and responsibilities, and staff told us they were supportive and fair. Managers encouraged an open and transparent culture. They proactively sought the views of people, relatives, visitors, staff and other healthcare professionals about how the care and support people received could be improved.

The provider and managers carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced. Managers took appropriate action to make changes and improvements when this was needed. Managers used learning from incidents and inspections to identify how the service could be improved. They worked proactively with other health and social care professionals to share and learn best practice so that the quality of care and support people experienced was continuously improved.

We identified one breach of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

There were five people who lived at 32 Ringstead Road at the time of our inspection. People at the home had varying levels of difficulties to express and communicate their views about the quality of the service. We saw all five of them when we arrived at the home and they appeared relaxed and comfortable while they were listening to music in the lounge and were preparing to go out for lunch later that day.

We spoke with one person who told us “I’m happy here” and they showed us a thumbs up. The person also said that “I do like the staff” and confirmed that they got the help they needed. We observed that people were free and able to make choices regarding how they spent their time. We saw that staff treated people as individuals and communicated with them in a calm and sensitive manner.

We spoke with three members of the staff team who made positive comments about working in the home. The comments included “It’s a good place to work, I can’t complain”, “It’s a nice place to work especially because of the management”, “The service users are looked after well” and that it’s a “Very nice place and the manager is good.” These three staff members had worked at the home for over five years.

We found that people were enabled to make day to day decisions about their care and support and their well-being was closely monitored through daily discussions and regular key-working sessions. We found that people were provided with a choice of suitable and nutritious food and drink.

At the time that we visited there were six people living at the home. We used a number of different methods to help us understand the experiences of people using the service, because not everyone was able to verbally communicate with us in a meaningful way. We gathered evidence of people’s experiences of the service by speaking to two out of the six people who lived there and three members of staff that were on duty at the time of our review. We also looked at three care plans, a sample of Medication Administration Sheets, and staffing records.

The two people who use the service both told us that they felt safe living at 32, Ringstead Road. People we spoke with also told us the staff were always kind and caring, and they felt able to talk with them about any concerns they might have. One person said “I am happy living here” and “I like the staff”. Another person told us “I like it here”.

During our inspection we used the Short Observational Framework Initiative (SOFI) and saw staff treated the people who use the service with respect and dignity. We observed saw staff encouraged and supported people to become as independent as they could and to learn new skills.