This inspection took place on 17 December 2018. The inspection was unannounced.

233 Yardley Fields 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. 233 Yardley Fields provides care and support for a maximum of five people. There were five 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 using the service can live as ordinary a life as any citizen.

We last inspected 233 Yardley Fields Road on 25 November 2015 when we rated the service as ‘Good’ in all Key questions. At this inspection we found the service was rated ‘requires improvement’ in two of the five questions and rated ‘requires improvement’ overall. This was because we identified a breach of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we plan to take at the end of this report.

There was a registered manager in post 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 .

There were systems in place to monitor the quality and safety of the service provided. However, these systems were not always effective as they had not identified issues we found at our inspection. Processes in place to manage risk were not always consistently managed.

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 received support from staff to take their prescribed medicines as and when required.

Staff understood people’s communication needs so people could be involved in aspects of their care. People were supported to have enough to eat and drink and to manage their health care needs.

People were supported to enjoy a range of activities. People were encouraged to maintain their independence and live active and fulfilling lives. People could maintain relationships that were important to them. Relatives we spoke with felt their family members was well cared for.

Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them. It was evident that people had developed positive relationships with staff and there was a friendly and calm 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 received the support they needed to carry out their role.

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).

Staff understood their responsibilities in relation to hygiene and infection control. There were systems in place to ask people their views about the service and to listen and respond to concerns about the service.

This inspection took place on 25 November 2015 and was unannounced. The previous inspection was carried out on 18 September 2013 when all the assessed regulations were met.

233 Yardley Fields Road offers long term residential care for up to five people with a learning disability and mental health disorders.

At the time of our 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.

People living in the home were happy with the service provided and were kept safe from abuse and harm because staff were able to identify the signs that would indicate if a person was unhappy and were aware of the actions to take if they had any concerns.

People were supported to receive safe care because there were sufficient numbers of suitably trained and recruited staff to care for people.

People were supported to make decisions about their care where possible and safeguards were in place when they were unable to make their own decisions. This ensured that decisions were made in their best interests.

People received personalised care because staff knew them well and had the information they needed to ensure their privacy and dignity. People were treated as individuals and birthdays and other special days were celebrated in the way they wanted.

People received meals that met their nutritional needs and were supported to receive medical attention when needed. People’s health care needs were monitored and other healthcare professionals were involved when needed.

People were supported to maintain links with their friends and families, go on holiday and undertake activities that they enjoyed doing.

Systems were in place to monitor the quality of the service and people were supported to have their voices heard in how the service was developed.

There were five 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, one commissioner, 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 people's views and choices were sought and acted upon. Staff spoken with was able to tell us about people's needs and how they ensured that people received care in a way that they preferred.

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

The needs of people living at the home are met through the provision of sufficient and appropriately skilled staff.

There were systems in place to monitor how the home was run, to ensure people received a quality service. The commissioner said, “People are actively supported by the home to achieve their optimum functioning.’’

On the day of our visit there were five people living at the home. No one knew we would be visiting. We spoke to three people who lived at the home, three relatives and three staff.

We saw that people's needs had been assessed and care plans had been devised to describe how people liked to be supported. Risks to people's health and well being had been identified and measures had been put in place to protect people. Staff we spoke to was able to tell us about people's care needs so that they received support and care in a way that they preferred. Relatives told us they were kept informed about their relative's health so that they felt involved with their relatives care. One relative said ‘Staff are always talking to me about her care.’’

We saw that systems were in place to keep people safe from harm. A relative told us about their relative and said ‘’She is very safe.’’ Staff received a range of training so that they were able to support the people who lived in the home. One person told us ‘’Staff are nice to me.’’ There were systems in place to monitor how the home was run, to ensure people received a quality service.

We found that the people living at 233 Yardley Fields Road were happy with their home. People told us “I like living here,” “I’ve lived here for a long time,” and “the staff are nice.”

People we spoke with and information we read in care files told us that people are supported to choose how they live their day-to-day lives. We saw that people are actively involved in choosing activities and visits outside of the home and making decisions in how the home is run.

People told us that they have a meeting with their key worker on a weekly and monthly basis. The meetings are used to plan how each person wants to spend their days and arrangements made for any activities or events they want to take part in.

We saw good interaction between people who live in the home and the staff that helped them to meet their everyday needs. There were five women living in the home at the time of our visit one of the women had been admitted to hospital. An example of the close and friendly relationship that had developed between people in the home was seen when the women wanted to go and visit the person in hospital. Information in their care files showed that they had visited her on a regular basis. We also heard people calling each other a friend.

Information available in care files showed that the women take part in activities that help them to express their gender. Activities they had taken part in include pampering sessions, luxurious baths, visiting the hairdressers and choosing how they have their hair styled and having a manicure. People were able to tell us that they had been on holidays, celebrated their birthdays by going to the theatre and concerts for example.