About the service: Luke’s Place is a care home that provides personal care to up to four people with a learning disability and/or autistic spectrum conditions. At the time of the inspection there were three people living at the service on a permanent basis. A fourth person had recently started using the service on a respite basis.

People’s experience of using this service:

The registered manager was working with the provider and the staff to develop the service in line with the values that underpin 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.

Although significant improvements had been made since our previous inspection in October 2017, the registered manager and the provider acknowledged that further work was still needed to embed their values and philosophy into day to day life at Luke’s Place.

People were not able to tell us in detail about their experience of living at the service. However, they appeared at ease in the presence of staff, and appeared comfortable with the support they were offered. Relatives all confirmed that their family members were happy living at Luke’s Place.

Risks to people’s health and well-being were identified and monitored. Guidance was in place for staff on how to support people with these risks.

Staff were knowledgeable about safeguarding and how to report their concerns internally and externally to local safeguarding authorities.

People`s dignity and privacy was promoted and respected by staff.

People’s care plans were developed and personalised to give guidance to staff on how to support people effectively. However, records of care provided to people did not always reflect the impact of the support provided.

People were encouraged to eat a healthy balanced diet and to drink plenty of fluids. Staff supported people to attend health appointments.

Relatives told us staff were caring and that there was a marked improvement in the way they spoke to people. People`s personal information was kept confidential.

People and their relatives were not always involved in discussions about their care or in developing their care plans. The registered manager was taking steps to address this.

Staff encouraged people to maintain their interests and take part in activities, both at home and within the community. Some relatives felt that people did not always have enough to do or enough structure in their day.

There were enough staff to meet people`s needs. Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider to develop their skills and knowledge.

The registered manager was working to improve the ways in which people and their relatives were encouraged to feedback on the quality of the service provided. However, relatives told us there was still work needed to improve the communication between them and the service.

The provider`s governance systems and processes were improving and the registered manager had a clear plan in place to continue to develop these systems to support ongoing improvements.

Rating at last inspection:

At the last inspection in October 2017 the service was rated ‘Requires Improvement ‘with several breaches of regulations. This was because the provider and the registered manager had not had good oversight of the service. Improvements were needed in the management of medicines, the way incidents were managed and reported and how staff skills were assessed. Improvements were also needed to the culture of the service, including how staff spoke to people, supported them to have goals and the right assistance to achieve them, and involved them and their relatives in planning their care. Improvements have been made since the last inspection and no continuing breaches were found, although work was still needed in some areas.

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The inspection took place on 18 October 2017. Luke’s Place is a residential care home which supports people who have a range of learning and physical disabilities. Luke’s Place offers ground floor accommodation. The home supports a maxim of four people. At the time of the inspection three people were living at Luke’s Place.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Staff had an understanding of what constituted potential harm and abuse, but following these conversations with some members of staff we were not fully confident staff would always respond to safeguarding events. The registered manager and provider had not responded fully to a potential event when a person experienced harm. There had been another occasion when a person potentially experienced neglect. These situations had not been managed in a strong and open way.

Accidents and incidents records were not fully completed, detailing a course of action to try and prevent them from happening again.

People’s medicines were not always being managed in a way which ensured people received their medicines in a safe way and as the prescriber had intended. The provider did not have a current building safety check from the fire service.

People had risk assessments in place with a plan for staff to follow in order to promote people’s safety. The service was being supported by an appropriate number of staff on each shift.

Staff competency was not being regularly observed and monitored. Staff competency after their induction to their work was not being well evidenced. The service was not checking if staff had retained their understanding and knowledge to key areas of their work.

People were being supported to make their own decisions and had sufficient to eat and drink.

The staff were not always caring and respectful to people. The registered manager and provider were not monitoring this element of the service despite historical concerns with how staff have treated people at the home.

We found that people had person centred assessments but their reviews were not meaningful and did not involve the person. People’s goals and aspirations were not promoted with practical plans in place to make them happen. The service was supporting people with some of their social needs but this needed further development, with timely action taken to ensure ideas were developed and put into action.

There was a lack of an open and transparent culture at the home which involved professionals, relatives, the people who used the service, and the community. The culture of the staff group needed further development with systems in place to monitor the culture of the home.

Quality monitoring audits were either not effective or they did not fully test the quality of the service which people were experiencing. Issues were not always responded to and there was no emphasis of developing and improving the service from these audits.

We could see that improvements had been made to the service and the registered manager told us that there was still more work to do.

We carried out an unannounced inspection at Luke’s Place on 08 August 2016.

This service provides accommodation and personal care for up to 4 people with learning disabilities, physical disabilities or mental health conditions. At the time of this inspection there were three people living at the service.

There was a registered manager in place. A registered manager was not required by law at this location because the registered provider was an individual rather than an organisation and previously managed the service themselves. However, to support improvements to the service, the provider recently employed a manager to oversee the running of the service. Registered managers, like registered providers, 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 11 April 2016, the service was in breach of Regulations 9, 11, 16, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service received an overall quality rating of inadequate, and was placed into Special Measures. An existing condition placed on the provider’s registration to restrict admissions remained imposed. We issued warning notices to tell the provider what improvements they needed to make and gave them a timescale to do this. We carried out this inspection to check on the improvements made since the last inspection.

During this inspection we found that significant improvements had been made to the service. As a result, the decision was made that the service would no longer be placed in special measures.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were sufficient numbers of staff on duty and recruitment processes were safe.

Staff had received ongoing training to equip them with the skills to support people. They understood their responsibility to ask people to consent before providing care and demonstrated an understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

People had enough to eat and drink and had access to health care services as appropriate.

Staff had positive interactions with people and treated them with kindness. People’s dignity was upheld.

Person centred care plans had been developed and were currently out for consultation with people’s families. Key worker sessions were held to support people to be involved in planning their care. Relatives were not always as involved as they would like in the full process of assessing their family member’s needs and planning their care.

There was an effective complaints system in place although some family members did not feel that complaints were always effectively resolved. Information was available to people about how they could make a complaint should they need to.

There were systems in place to support people and their relatives to share their views of the service. However, some families felt that communication between them and the service could be improved.

There were effective systems in place to assess and monitor the quality of the service.

We carried out an unannounced inspection at Luke’s Place on 11 April 2016.

This service provides accommodation and personal care for up to 4 people with learning disabilities, physical disabilities or mental health conditions. Following our inspection in November 2016, the Care Quality Commission (CQC) placed a condition on the provider to restrict new admissions to this service. At the time of this inspection there were three people living at the service.

A registered manager was not required by law at this location because the registered provider was an individual rather than an organisation and previously managed the service themselves. However, to support improvements to the service, the provider recently employed a manager to oversee the running of the service. At the time of the inspection, the manager was not registered with CQC but had submitted their application to do so. Registered managers, like registered providers, 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 17 November 2015, the service was in breach of Regulations 9, 10, 11, 12, 13, 16, 17, 18, 19 and 20a of the Health and Social Care Act (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulation 2009. The service received an overall quality rating of inadequate, and was placed into Special Measures.

We carried out this inspection to check on the improvements made since the last inspection.

During this inspection we found that although some improvements were in progress and more were planned, some of the concerns identified at the previous inspection had not been addressed. We identified continued breaches of Regulations 9, 11, 16, 17, and 18, of the Health and Social Care Act (Regulated Activities) Regulations 2014. As a result, the service is still rated as inadequate and remains in special measures. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff on duty although some staff had not received effective training to ensure they had the skills to support people. Staff did not demonstrate an understanding of, or meet, the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

Staff recruitment processes were safe.

Risk assessments were in place in relation to people’s basic care needs but were lacking in relation to their behavioural needs.

People had enough to eat and drink and had access to health care services as appropriate, although advice from health care professionals was not always followed consistently.

Staff had positive interactions with people and treated them with kindness. People’s dignity was mostly upheld.

People and their representatives were not always supported to make decisions and were not sufficiently involved in assessing their needs and planning their care.

There was a complaints policy which was also available in an easy to read format although some staff were not aware of this. Relatives were aware of the complaints process but some were not comfortable to raise complaints due to the way complaints had been received by the provider in the past. Complaints were not recorded appropriately.

There was a lot of work still to be done in order to build up the trust of people and their families so that they would be comfortable in sharing their views and be confident that those views would be listened to.

The manager and the provider were developing systems to assess and monitor the quality of the service and some aspects of these were in place at the time of the inspection, whilst others were under development.

The manager had an action plan to address the improvements required at the service, but had only been in post for five weeks at the time of t

We carried out an unannounced inspection at Luke’s Place on 17 November 2015. This service provides accommodation and personal care for up to 4 people with learning disabilities, physical disabilities or mental health conditions. At the time of our inspection there were three people living at the service.

A registered manager was not required at this location as the registered provider was an individual rather than an organisation and managed the service themself. An individual who is the registered provider is a ‘registered person’. 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 11 June 2015, the service was in breach of Regulations 9, 11, 12, 13, 16, 17, 18, 19 of the Health and Social Care Act (Regulated Activities )Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulation 2009. The service received an overall quality rating of inadequate, and was placed into Special Measures. We asked the provider to send us an action plan to tell us what improvements they were going to make to meet the regulations. They provided an action plan on 07 September which stated that they would achieve compliance with all the regulations by 31 October 2015 with the exception of Regulation 18 HSCA (Regulated Activities) in relation to staff training which would be compliant by 31 January 2016.

We carried out this inspection to check on the improvements made since the last inspection.

During this inspection we found that insufficient improvements had been made. We identified continued breaches of Regulations 9, 11, 12, 13, 16, 17, 18, and 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulation 2009. We also found breaches in Regulation 10 and Regulation 20A of the Health and Social Care Act (Regulated Activities) Regulations 2014. As a result, the service is still rated as inadequate and remains in special measures. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff on duty although some staff had not received effective training to ensure they had the skills to support people. Staff and the provider did not demonstrate an understanding of, or meet, the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

Staff recruitment processes were not safe.

Risk assessments were not regularly reviewed and did not contain sufficient information.

People had enough to eat and drink and had access to health care services as appropriate, although advice from health care professionals was not always followed.

Staff did not always show respect for people and their confidentiality was not always upheld.

People and their representatives were not always supported to make decisions and were not sufficiently involved in assessing their needs and planning their care.

Relatives were aware of the provider’s complaints system and information about this was available in easy read format. The provider did not respond to complaints appropriately or in line with their policy.

The provider did not promote a positive and open culture where people and their relatives were involved in developing the service.

The provider did not demonstrate strong visible leadership or give consistent direction to the staff team.

The provider did not have effective systems in place to assess and monitor the quality of the service.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'.The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

We carried out an unannounced inspection at Luke’s Place on 11 June 2015. This service provides accommodation and personal care for up to 4 people with learning disabilities, physical disabilities or mental health conditions. At the time of our inspection there were four people living at the service.

A registered manager was not required at this location as the registered provider was an individual rather than an organisation and managed the service them self. An individual who is the registered provider is a ‘registered person’. 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 31 December 2013, the service was meeting the required standards that we looked at.

During this inspection we identified breaches of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff on duty although some staff had not received adequate training to ensure they had the skills to support people effectively. Staff and the provider did not demonstrate an understanding of, or meet, the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

Staff recruitment processes were not safe.

Risk assessments were not always kept up to date and risk related to the environment had not all been assessed.

People were supported to eat well and were encouraged to choose healthier food options to maintain their health and well-being.

Staff were caring and respected people’s privacy and dignity. People and their representatives were not always supported to make decisions and were not sufficiently involved in assessing their needs and planning their care. Staff supported people to maintain relationships that were important to them.

People and their relatives were aware of the provider’s complaints system and information about this was available in easy read format. Some relatives did not feel their complaints were appropriately handled.

The provider did not promote a positive and open culture where people and their relatives were involved in developing the service.

The provider did not demonstrate strong visible leadership or give consistent direction to the staff team.

The provider did not have effective systems in place to assess and monitor the quality of the service.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

When we inspected Luke's Place on 29 August 2013, we found that some of the premises and surrounding grounds were not being used properly. We also found the service's complaints process was not brought to the attention of people who use the service in a suitable manner. We judged this to have a minor impact on people using the service.

We inspected the service again, to check improvements had been made. We found that a number of large items that may have posed a risk of injury had been removed from the service's grounds. We saw the grounds were free from dog mess in the areas we checked. We saw a double garage had been partitioned to allow staff allocated storage space for items belonging to the service. We found that access to some of those items was easier. This meant people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw the service had its complaints process displayed in an accessible area near the main entrance. The displayed copy was in an easy read and pictorial format and covered all the main elements of how to make a complaint and how the service would respond. This meant people were made aware of the complaints system. This was provided in a format that met their needs.

During our inspection of Luke's Place on 29 August 2013, we used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant they were not able to have in-depth conversations with us about their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We also spoke with the relatives of a person using the service.

The people we spoke with during our inspection said their relative was cared for by a sufficient number of friendly staff and he was enjoying life at the service.

We saw people who use the service were engaged in activities they liked and enjoyed. People appeared clean, tidy and well cared for. We found well documented support plans of how the service would meet each person's needs. We saw those needs were met by a competent, friendly and adequate staff team. Staff were completing a program of training and were knowledgeable in such things as protecting people from the risk of abuse. The service had appropriate systems in place to safeguard people from the risk of abuse.

We found the service had a complaints system in place. However, the complaints system was not brought to people's attention in a suitable manner. We saw that some parts of the premises and surrounding grounds were not being used properly.