The inspection was unannounced and took place on 06 September 2018.

Walmley 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. Walmley provides care and support for a maximum of four people who are living with a learning disability. There were four people living at the home at the time of the inspection.

The home 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 manager in post at the time of our inspection who was in the process of registering with CQC. 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 cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were protected from risks associated with their health and care needs because risk assessments and associated care plans were developed holistically, reviewed and monitored. This ensured that people received the support they required to remain safe. Staff were aware of the risks to people when supporting them. People received support from staff to take their prescribed medicines as and when required. Systems and processes were in place to ensure medicines were managed safely.

Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them and we heard and saw positive communication throughout our inspection. It was evident that people had developed positive relationships with staff and there was a friendly, calm relaxed atmosphere within the home.

People were supported by sufficient numbers of staff who had the knowledge and skills they required to care for people safely and effectively.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The provider was aware of their responsibilities regarding the Deprivation of Liberty Safeguards (DoLS).

People were supported to enjoy a range of activities and were involved in their day to day care and chose how to spend their day. People were encouraged to maintain their independence and live active and fulfilling lives. Staff were caring and treated people with respect.

Staff understood their responsibilities in relation to hygiene and infection control. There were effective systems in place to monitor the quality of the service and areas needing improvement were acted on.

We visited this service and talked to people to gain a balanced overview of what they experienced, what they thought and how they were cared for and supported. We spoke with two relatives; we met the four people that lived there, four staff members and the registered manager. All the people that used the service had limited verbal communication skills so we observed their interactions with staff and their body language to understand their view of the support they received.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Is the service safe ?

We observed that people were treated with dignity and respect by the care staff. We saw that people were given choice in their care. A relative that we spoke with told us that they were very happy with the care at the home. They told us, "We have been very happy with the care and feel that X is safe living at the home".

We spoke with staff and the registered manager about Deprivation of Liberty Safeguards (DoLS). This applies to all care homes. The registered manager told us that there had been no applications and told us that they knew what to do if an application needed to be made. Training records looked at confirmed that all staff had received DoLS training.

The service was clean, hygienic and safe. The home had an infection control policy in place. Equipment was maintained and serviced so preventing any unnecessary risks.

We saw that systems were not well established to make sure that learning took place from accidents and incidents. We found that some records had not been accurately maintained which could place people at risk of harm. We have therefore asked the provider to tell us what they are going to do to meet the requirements of the law to ensure the service is safe.

Is the service effective ?

A relative we spoke with confirmed that they could visit throughout the day. We saw that facilities were available so people could meet in private if they wanted to. We saw that relatives were involved with people’s care. A relative told us, "The staff keep me informed about their care".

Referrals had been made to external professionals so people got the support they needed to maintain their health and wellbeing.

Staff had received the training they needed to ensure that they continued to maintain their skills and knowledge to care for people effectively.

Is the service caring?

We saw that staff treated people with dignity and respect. We saw that staff were patient and caring they took their time and did not rush people. We saw that people responded positively to staff.

We found that people’s preferences, interest and aspirations and diverse needs had mostly been reflected in their care records.

Is the service responsive?

We saw that people were supported to take part in a range of activities at home and in the local community. We saw that staff responded to spontaneous requests from people to do activities, or to spend their time in a way that they preferred.

We saw that when needed staff had requested the involvement of other health professionals in people’s care.

Is the service well lead?

The home had a manager who was registered with us, CQC. They were experienced and knowledgeable about the needs of the people that lived in the home.

Staff that we spoke with were clear about their role and responsibilities.

We found that systems in place to regularly assess the quality of the service that people received had not always been timely or effective. We have therefore asked the provider to tell us what they are going to do to meet the requirements of the law so that the service is well lead.

At our last inspection in June 2013, we set compliance actions as we found that the provider was not meeting two of the essential standards of quality and safety. During this inspection we saw that the provider had made the necessary improvements.

On the day of our inspection there were four people living at the home. All of the people and most of the staff were out on the day. We spoke with the registered manager and looked at the same people’s care records from the last inspection. This enabled us to identify if improvements had been made.

We found that appropriate care plans and risk assessments were in place so that staff had the information they needed to provide care in a consistent manner. This also meant that care was planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

At the time of our inspection there were four people living at the home. None of the people were able to verbally communicate with us due to their individual needs. To support people's experience of their care we looked for evidence in areas such as looking at care records, observing how people were cared for and speaking with some of their relatives. We also spoke with three members of staff and the registered manager.

Care was person centred and delivered in a manner that promoted people’s independence. One relative told us, "The care is good". Another relative said, "Staff do everything well". However, the lack of appropriate care plans and risk assessments meant that care was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider had a system in place to regularly assess and monitor the quality of service that people. However, the system was not effective in identifying areas that required improvement.

People’s care records were accurate, person centred and generally reflected people's needs.

On the day of our inspection there were four people living at the home. All four people had limited verbal communication skills. We used a Short Observational Framework for Inspection (SOFI). This is a specific way of observing care to help us understand the experiences of people who could not talk with us. We used SOFI with three people living at the home.

We also looked at other areas for evidence to support people’s experiences such as sampling a set of care records and speaking with staff. We spoke with three members of staff, the registered manager and the locality manager.

People were given the opportunity to contribute to their care and have their views considered. People were involved in day to day decisions.

People had a range of activities available to them and choice at meal times. Care was delivered in a person centred way and people appeared relaxed and comfortable with staff.

During the last inspections improvements were recommended relating to the safety and suitability of the premises. We found appropriate actions had been taken to improve the environment for people.

The staff we spoke with reported they were supported and supervised to deliver a good standard of care. Staff had received training in mandatory areas such as safeguarding, fire safety and manual handling. None of the staff had received an appraisal, the manager acknowledged this as an area for improvement.

We found records were detailed and personalised. Care plans and risk assessments were in place. Records indicated that people were unable to make significant decisions. Records did not demonstrate if any capacity assessments had been undertaken and how decisions were made in people's best interest.

All four people living at 189d Walmley Road had complex communication needs. It was therefore difficult to find out what they thought about the service through conversation.

Information we read in care plans about a person’s day, talking to the manager and staff our observations of the residents and the interaction we saw between carers and residents showed that people were comfortable living in the home. People were seen to walk easily around the home. Residents were relaxing in the lounge or their bedroom.

This was an unannounced inspection. The last inspection was carried out on 23 December 2014 and 12 January 2015. At that inspection we found that the provider was not meeting the regulation in relation to having suitable arrangements in place to monitor the quality of the service and to ensure steps had been taken to ensure sufficient numbers of staff were employed at all times. After the inspection the provider sent us an action plan setting out the improvements that they would make. At this inspection we found that the provider had made improvements and there were systems in place to monitor the service and improvements to the arrangements for staffing had been made.

Walmley Road is a care home which is registered to provide care to up to four people. The home specialises in the care of people with a learning disability. On the day of our inspection there were four people living at Walmley Road.

A registered manager was 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.

Adequate numbers of staff were on duty in the day to meet people’s needs. Night time staffing levels were being assessed so that the changing needs of people continued to be met.

There was a positive and inclusive atmosphere within the home.

People received care from a staff team that were kind and caring. People benefitted from opportunities to take part in activities that they enjoyed and that were important to them.

The provider had systems and processes in place to protect people from the risk of avoidable harm. Staff understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm.

People were supported to receive their medication as prescribed.

Staff sought people’s consent before providing care and support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) were to be followed.

Staff received the training and support they needed to carry out their role effectively.

People received food that had been prepared in a way that was safe for them to eat.

People were supported to stay healthy and opportunities were provided so people saw a range of health professionals.

People’s right to privacy was promoted and people’s independence was encouraged.

Staff were aware of the signs that would indicate that a person was unhappy, so that they could take appropriate actions. Systems were in place to monitor the quality of the service.