Our inspection was unannounced and took place on 10 January 2017.

The provider is registered to accommodate and deliver personal care to eight people. At the time of our inspection five people lived at the home. People lived with complex needs relating to their learning disability or an associated condition.

The manager was registered with us as is required by law. 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.

At our last inspection on 5 January 2016 although the evidence we gathered did not show that there had been a breach of regulations we found that some improvement was required as some incidents of aggression between people had not been reported to us or the local authority safeguarding team. We found that improvements regarding this had been made.

People were not always offered or enabled to engage in community recreational activities that they enjoyed and met their preferred needs. Formal provider feedback forms and questionnaires had not been used for some time to determine people’s views. Systems were in place for people and their relatives to raise their concerns or complaints.

Staff had received training and had taken appropriate action to minimise any risk of harm or abuse to the people who lived at the home. People were kept safe by the staff. Staff were trained and assessed to manage medicines safely. Medicines had been given to people as they had been prescribed. Staff were available to meet people’s individual needs. Recruitment processes ensured that unsuitable staff were not employed. People were supported by an adequate number of staff.

Staff received induction training and the day to day support they needed to ensure they met people’s needs and kept them safe. Staff had received or were to receive the training they required to support the people in their care. People received care in line with their best interests ensuring they were not unlawfully restricted. Staff supported people with their preferred diet and fluids. People had access to a range of health and social care professionals which helped to promote their health and well-being.

People were cared for by caring staff who knew them well. Relatives were made to feel welcome when they visited.

Relatives and staff felt that the quality of service was good. The management of the service was stable. Audits and checks were undertaken to ensure that the service was run in the best interests of the people who lived there.

Our inspection was unannounced and took place on 5 January 2016.

The provider is registered to accommodate and deliver personal care to eight people. At the time of our inspection four people lived at the home. People lived with complex needs relating to their learning disability or an associated condition. All four people had lived at the home for a number of years.

At our last inspection in December 2013 the provider was meeting the regulations that we assessed.

The manager was registered with us as is required by law. 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.

The provider was not meeting all legal requirements as they had not notified us of one DoLS approval or of incidents of physical aggression between the people who lived at the home as they should have done.

Although staff had received training on procedures they should follow to ensure the risk of harm and/or abuse was reduced they were not always following them. Some incidents of aggression between people had not been reported to safeguarding at the local authority as is required.

The staff had been trained and assessed to manage medicines safely. Medicines were given to people as they had been prescribed.

Staff were available to meet people’s individual needs. Recruitment processes ensured that unsuitable staff were not employed.

People were supported by an adequate number of staff who were kind and caring.

Staff received induction training and the day to day support they needed to ensure they met people’s needs and kept them safe.

Staff had received or were to receive the training they required to fully equip them with the skills they needed to support the people in their care.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

Staff supported people with their nutrition and dietary needs to promote their good health.

All people received assessments and/or treatment when it was needed from a range of health care and social care professionals which helped to promote their health and well-being.

People were offered and enabled to engage in recreational activities that they enjoyed and met their preferred needs.

Systems were in place for people and their relatives to raise their concerns or complaints.

Relatives and staff felt that the quality of service was good. The management of the service was stable.

There were four people with learning disability living at the home on the day of our visit; no one knew we would be visiting. We spoke to two staff, two relatives, and the manager. People with learning disability are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

We saw that staff knew what people's individual needs and preferences were so that they received care in a way that they preferred. One staff told us, ‘’People will choose what they want to do and we help them.’’ Both relatives told us they were consulted about their relative's care and were kept informed about their relative's health so they felt involved in their care.

All staff spoken to were able to tell us about people's needs and records seen confirmed that staff were knowledgeable about the people they cared for. We saw positive interactions between staff and people that lived at the home

Medicines were prescribed and given appropriately to the people who used the services.

The needs of people living at the home were met through the provision of sufficient and appropriately skilled staff. One relative told us, ''The staff are great, they look after X really well.''

There were systems in place to monitor how the home was run, to ensure people received a quality service.

There were four people with learning disability living at the home on the day of our visit; no one knew we would be visiting. We spoke to one person who lived at the home, two staff, one relative and the manager.

People with learning disability are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them. Throughout the day we saw staff communicating with each person in the way that they could understand.

We saw that choices were offered and that people's views were sought and acted upon. Staff spoken with were able to tell us about people's needs and how they ensured that people received care in a way that they preferred. A staff told us, ‘’People show us their likes and dislikes which helps us meet their needs.’’

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm. A range of training was provided to staff so that they had up to date knowledge and skills in order to support the people who lived in the home. There were systems in place to monitor how the home was run, to ensure people received a quality service. A relative, said ‘’ they actively support X to do as much as they can.’’

We visited 1 -5 New Street North on 16 February 2012. We met all the people that currently live there and observed what life was like during this visit. We also spoke with the manager, two staff and looked at the care records for two people living at the home. We also looked at some other records relating to medication and the monitoring of the service.

People living at the service had limited verbal communication. The manager and staff told us that this could make it difficult to fully involve people in decisions. Staff told us that this means they had to be very aware of how people expressed themselves, and how they indicated that they are happy, or unhappy with something. We saw in people’s records that there was detailed recording that showed what made people happy or unhappy and how they expressed this through body language or behaviour.

We spoke with staff and they told us about what was important for some of the people living at the home. This matched what was recorded in people’s care plans. Our observations also confirmed the accuracy of some of the information in these plans.

At the time of our visit we saw positive responses between staff and people that lived at the home. We saw people readily sought staff assistance, and staff were quick to provide support as needed. People we met and observed seemed relaxed most of the time. We saw people who had little verbal communication use gestures that staff understood and responded to. We saw that when people were anxious staff were quick to respond to them.

People living at the home presented as healthy, well groomed and were dressed appropriately according to their age, diversity and choice.

We saw that people living at the home were able to move freely around the communal areas of the home. Where people made choices that had the potential to encroach on others we observed staff redirect and support people to make more appropriate choices. We saw and heard that staff offered people choices throughout the time we visited, and supported them to make these where ever possible.

We saw staff respond appropriately to situations to protect people’s privacy and dignity on a number of occasions.

We looked at two people’s behaviour management plans and risk assessments and saw that these were in place, well recorded and easy for staff to follow. They set out what may cause a person to become upset, how they would express raised anxieties and what staff should do to respond appropriately. Staff we spoke with knew how to respond to any behaviour people expressed as identified and documented in people's individual plans. This meant that people were better protected when staff may need to use restraint to protect them, or others living at the home.

We looked at two people’s medication records, compared these with other care records and discussed the same with the manager. We saw that medication records were well maintained. We also saw that there was clear guidance and recording about when ‘as required’ medication was used to ensure people are protected against the risks associated with the unsafe or inappropriate use of medication.

From talking with staff and looking at staff records we saw that people’s health and welfare needs are met by staff that had been subject to effective checks that ensured they are as safe as possible for work with vulnerable adults.