Livingstone House is a care home providing support for up to 19 people with a learning disability Spread over four floors with level access throughout and lifts to all floors, each floor has its own kitchen and lounge areas. A communal lounge was also available on the ground floor for people to meet and socialise.

At the time of our inspection on 21 June 2018, 14 people lived at the service. At our last inspection on 06 January 2016, we rated the service Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Staff knew how to keep people safe from the risk of harm. People received support to take their medicines safely. Risk was well assessed and we saw guidance in place to ensure risks were minimised with as little impact as possible on people's independence. There were enough staff to keep people safe and meet their needs.

Peoples care and support needs had been assessed which were reflected in their support plans. The care provided by staff was in line with this.

Staff received effective support in the form of on-going training, induction and appraisals. Staff were motivated and worked together with strong teamwork and high morale.

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. Staff asked people's consent before any care or support was given, and we saw people had access to health and social care professionals when needed.

Menus were planned by people who used the service, and we saw people could choose and prepare meals for themselves.

Staff were kind and compassionate in the way they delivered support to people. There was a positive and fun atmosphere and we saw people and staff knew each other well. People's cultural and communication needs were well met.

People were confident they could raise concerns if they needed to and these would be addressed. There was a good approach to planning and supporting activities which people wanted to participate in.

The registered manager ensured the service was well run. There was a clear vision for the service, and we saw records and practice which demonstrated it was embedded in the service. Staff told us the registered manager and senior team were approachable, and we saw people who used the service felt free to approach them.

Further information is in the detailed findings below

The inspection took place on 6 January 2016 and was unannounced.

The service provides care and support to nineteen people who have a learning disability. There were 17 people living at the service when we inspected.

The service had two registered managers, one having been registered to cover a period of maternity leave for the other manager. 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.

Staff were trained in safeguarding people from abuse and systems were in place to protect people from all forms of abuse including financial. Staff understood their responsibilities to report any safeguarding concerns they may have and were confident they had the skills to do this. People who used the service had also received training to help them to stay safe.

Risks to people and staff were assessed and action taken to minimise these risks. People were encouraged to remain as independent as possible and any risks related to this were assessed.

Staffing levels meant that people’s needs were met. Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. New staff were able to shadow more experienced staff to help them gain confidence.

Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for. Staff were supported by the managers through supervision and appraisal.

People gave their consent before care and treatment was provided. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests. There was a good understanding of processes related to DoLS.

People were supported with their eating and drinking needs and people were fully involved in shopping and cooking. Staff helped people to maintain good health by supporting them with their day to day physical and mental healthcare needs.

Staff were caring and treated people respectfully making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for.

People were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Care was subject to on-going review and care plans identified people’s particular preferences and choices. People were supported to play an active part in their local community and follow their own interests and hobbies.

Formal complaints were well managed and had been investigated and resolved satisfactorily.

Staff understood their roles and were well supported by the management of the service. The service had an open culture and people felt comfortable giving feedback and helping to direct the way the service was run. Staff were positive about their work and the management team had worked hard to create a positive and inclusive staff team.

Quality assurance systems were in place and audits were carried out regularly to monitor the delivery of the service.

During this inspection we spoke with three people who used the service, four relatives, 13 members of the care staff and the registered manager. Not all of the people who used the service were able to communicate easily with us so we observed how people were supported by staff and looked at six people's care records. Other records we reviewed included staff files, staff training, medication and quality and monitoring records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

Care records were appropriately updated to ensure that people received the care they needed to keep them safe.

The service worked with other healthcare professionals to help meet people’s healthcare needs.

We saw that regular checks were carried out on equipment and systems, such as the fire alarm system, to make sure they were safe to use.

We looked at staffing rotas and found that there were enough trained and experienced staff on duty to meet people’s needs and ensure their safety.

We found that the service was keeping people safe when administering medication. We found overall that medication was administered correctly and records were clear. We had a concern that one person’s medication may not have been administered correctly and found that some staff, especially night staff, needed to update their medication training. We raised this issue with the manager.

We were concerned that some staff training needed to be updated and that the lack of current training could have placed people at risk.

We found that staff were not fully aware of their responsibilities under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards(MCA DoLS) and that most staff had not been trained in its use. However we found that people were not unlawfully deprived of their liberty.

Is the service effective?

People’s health and care needs were assessed in consultation with either the person themselves or relatives. People’s care plans reflected their healthcare needs and the service worked in conjunction with support from outside professionals to meet them.

People who used the service told us that they were happy and we observed that people regularly attended a variety of activities and were involved in their local community if they chose to be.

We saw that people were supported to increase their independent living skills.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We observed staff engaging positively with people and encouraging them to increase their independent living skills.

People who used the service told us they were happy with the care provided and spoke positively about the staff. One person told us, “It’s good here”.

Is the service responsive?

People's care records showed that where concerns about an individual’s wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance promptly from other health care professionals.

People’s preferences and choices had been recorded in their care plans and we observed that care and support was delivered in accordance with people’s wishes. People’s chosen preference for a male or female member of staff to support them was recorded and respected.

We saw that the service respected people’s culture and religion. Staff meeting minutes documented how the service would meet one person’s cultural dietary needs.

Is the service well led?

The service had a quality assurance system in place which, although detailed, had failed to identify some issues which affected the running of the service.

We were concerned that staff were not being supported with training and supervision to ensure they carried out their roles safely and effectively.