About the service: Matson House is a residential care home that was providing personal and nursing care to 12 people at the time of the inspection. People in care homes receive accommodation and 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. There were eight people living at the home at the time of our inspection. The care service 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.

People’s experience of using this service:

• People received a service which was responsive to their needs and support requirements.

• Family members spoke positively about the care their relatives received at Matson House. One relative spoke fondly about their relative living at the home and said, “I can’t think of a better place for him to be.” They complimented the caring nature of staff and managers. All the relatives felt that people were treated with dignity and respect.

• Staff treated people equally and ensured they maintained relationships with those who were important to them.

• The home was actively recruiting new staff which meant people were now being supported by a consistent staff team who were familiar with their needs.

• Improvements had been made to the recording of people’s care and support needs and the daily records of their physical, social and emotional well-being to ensure they were personalised and reflected people’s needs.

• People’s care plans provided staff with the information they needed to support people. New and detailed behavioural management plans were being implemented to provide staff with additional guidance.

• People were supported where possible to have maximum choice and control of their lives. Where people were unable to provide consent to their care and support, staff acted in people’s best interests, based on their knowledge of people’s preferences.

• Effective systems were in place to manage people’s medicines.

• Staff worked with specialist health care professionals to ensure their care practices were current and people received appropriate support.

• Staff told us they worked well together as a team and felt trained and supported to carry out their role.

• There were sufficient numbers of staff available to ensure people’s safety and well-being.

• New staff were suitably vetted before they supported people.

• Staff understood their responsibility to report concerns, accidents and poor practices.

• Systems were in place to identify shortfalls in the service and drive improvement.

• People and their relative’s views were valued and acted on if any concerns had been identified.

• The registered manager understood their regulatory duties to ensure people received a safe and effective service.

The service met the characteristics of Good in all areas. More information is in ‘Detailed Findings’ below.

Rating at last inspection: Requires Improvement (Last report was published on 17 October 2017)

Why we inspected: This was a planned inspection based on the previous rating at the last inspection.

Follow up: At this inspection we have rated the service as Good. The rating of this inspection and the information and intelligence that we receive about the service will determine the timeframe of our next inspection.

This inspection was unannounced and took place on 17 and 18 August 2017. Matson House is a residential care home and provides accommodation and personal care for up to 12 people with learning and physical disabilities. At the time of our inspection there were 11 people living at the home. The people living at Matson House had a range of support needs.

The last comprehensive inspection of the service was on 21 and 22 September 2016 and there were was one breach of Regulation 18 Staffing at that time. We found that there were not sufficient members of staff to keep people safe and meet their needs and staff were not being supported effectively. Staff had also not always received supervision and appraisals. At this inspection we found improvements had been made and the provider was now meeting this regulation.

There was no registered manager in post. A manager had been responsible for the service since July 2017 who was applying to become a registered manager at the home. 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 responsibilities for meeting the requirements in Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was the subject of on-going monitoring by the local authority. This was because when they visited in 2016, they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was still in progress during our inspection.

The new manager who is to become registered with CQC had commenced employment in the role in July 2017. A senior manager had been overseeing the service since March 2016 and making positive progress with the local authority service improvement plan.

Our inspection identified areas where improvement was required such as; systems to ensure staff training is up to date and not expired and to ensure people’s care records were up to date. The manager and provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around the monitoring of staff training and had not ensured people’s records were always up to date. We made a recommendation regarding the recording of people’s goals, targets and outcomes.

Risk assessments were implemented and staff knew how to keep people safe.

Medicines were stored appropriately and people were given their medicines as prescribed. Systems were being reviewed and more regular medication audits were planned.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they liked to do and how they wanted to be supported.

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff felt integral to the process of providing effective care to people. Management and care staff had a good understanding of people’s needs and wishes and communicated effectively to support them. Where it was clear people’s needs had changed, the manager worked with the person, their families and health professionals to check if the support needed had changed.

There were some positive comments from relatives and health professionals about the care provided and the staff who cared for their family members. Relatives used words such as 'Caring' and 'Great'.

The daily notes had a section for targets and goals to promote independence and improve the quality of their lives. These were all blank

The inspection took place on 21 and 22 September 2016 and was unannounced. Matson House is a residential care home providing individualised support for people with a learning disability. At the time of the inspection there were 12 people living at the home. The people living at Matson House had a range of support needs.

There was no registered manager in post. There was a manger who had submitted an application for registration with CQC in June 2016 and was this was being processed. 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 responsibilities for meeting the requirements in Health and Social Care Act 2008 and associated Regulations about how the service is run. The deputy manager of the home had left the week before our inspection.

The service was the subject of on-going monitoring by the local authority. This was because when they visited earlier in 2016 they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was almost completed when we arrived for our inspection.

The service was last inspected in November 2014 and was in breach of the following:

Regulation 9 HSCA (RA) Regulations 2008 Care and welfare of people who use services. The registered person had not taken proper steps to ensure each person was protected against the risks of receiving care that was inappropriate or unsafe, by means of the planning and delivery of care in such a way as to ensure the welfare and safety of people. This breach of regulation had now been addressed and people were eating safely and not at risk of choking.

Regulation 12 HSCA (RA) Regulations 2008 Cleanliness and Infection Control. The registered person had not ensured people were always protected from avoidable harm with regard to infection control. We found that the provider had put procedures in place to reduce the risk of infection control and this breach of regulation had been addressed and people were not at risk.

Regulation 18 HSCA (RA) Regulations 2008 Notification of other incidents and consent to care and treatment. The registered person had not notified the Commission with authorisations received from the supervisory body to deprive people of their liberty. The registered person did not have suitable arrangement in place for establishing, and acting in accordance with, the best interests of people. This breach of regulation had been addressed and peoples best interests were being assessed appropriately.

Regulation 20 HSCA (RA) Regulations 2008 Records. The registered person did not have accurate records including appropriate information and documents relating to the care and treatment provided to each person. People were not protected against the risks of unsafe or inappropriate care. This breach of regulation had been addressed and people had accurate records.

Regulation 23 HSCA (RA) Regulations 2008 Supporting Staff. The registered person did not have suitable arrangements in place to ensure staff were appropriately supported to deliver care and treatment safely including by receiving training, professional development, supervision and appraisal. This breach of regulation had not been met although some progress had been made.

Our inspection highlighted shortfalls where some regulations were not met. We also identified areas where improvement was required.

There were not sufficient members of staff to keep people safe and meet their needs. The use of agency staff had reduced consistency and this in turn had negatively impacted on people’s care. Some people were not being supported to reach their full potential.

People and relatives were positive about the care they received. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they like to do a

We haven’t been able to speak to people using the service because of their complex needs. We gathered evidence of people’s experiences of the service by observing care, reading care records and speaking to staff about people’s individual needs. We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were able to demonstrate very good knowledge of people's needs and they explained how they had input into their care records.

People were able to go on outings as two people went out during the inspection. Other people were attending college with support of staff. We found people had access to activities that were based on their choices and needs.

This inspection took place on 4 and 5 November 2014 and was unannounced. Matson House is a care home providing accommodation and personal care for up to 11 adults with a learning disability or an autistic spectrum condition. The people living at Matson House had a range of support needs. Some people could not communicate verbally and needed help with personal care and moving about. Other people were physically able but needed support when they became confused on anxious. Staff support was provided at the home at all times and most people required the support of one or more staff away from the home.

There was not 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 and associated Regulations about how the service is run. The person currently managing the service was in the process of applying to us to become the registered manager.

At our last inspection in May 2014 we found the recording of daily notes, medicines administration, support planning documentation and cleaning records to be inconsistent and unreliable. The provider told us they would take action to address our concerns. Since we received this feedback from the provider, a new area manager and new manager had been appointed. They were making significant changes within the service at the time we visited.

The staff and relatives told us the service had changed a lot since the new manager had come to post. Staff felt more able to share concerns and were confident they would be listened to. The manager told us about changes he had made following feedback from people and staff. This included using agency staff until a full staff team had been recruited.

The manager was open with us about elements of the service that still needed improving. The need for improvements had been identified through internal audits and quality checks by the provider. The initial focus had been on making the service safe and now the quality of care was being addressed. Both staff and relatives told us the focus of the service was now the people being supported. The activities available to people, the quality of food and the way staff communicated with people were also being addressed.

We observed some unsafe practices. For example, staff not following infection control procedures and not following mealtime guidelines. We found some breaches of our regulations. You can see what action we told the provider to take at the back of the full version of this report.

We observed some staff supporting people in a caring and patient way. However, other staff focused on the task not the person or did not communicate with people as much as they could. Some staff required further training and the quality of record keeping was not consistent. We had not received relevant notifications from the service. Services tell us about important events relating to the service they provide using a notification.