Our inspection of 1 Milton Avenue took place on 6 & 11 October 2017. This was an unannounced inspection. At our previous inspection of 10 & 26 August 2015 The service was rated good.

1 Milton Avenue is a care home registered for five people with a learning disability situated in Kenton. At the time of our inspection there were no vacancies at the home. The people who used the service had significant support needs because of their learning disabilities. The majority of people had additional needs such as autistic spectrum conditions, mental health conditions, and communication impairments.

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 2008and associated Regulations about how the service is run.

Family members told us that they thought that their relatives were cared for safely. We saw that people were comfortable and familiar with the staff supporting them and were treated respectfully.

People who lived at the home were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported immediately.

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Medicines at the home were well managed. However we found that there were gaps in the medicines administration record for one person. This had been identified by a pharmacist’s audit on the day before our visit and the home was taking action to address this.

Although people had up to date risk assessments, the most recent versions were not contained within their care files and staff did not have access to these. Personal emergency evacuation plans for people were also not available to staff should there be a need to evacuate the home. The registered manager assured us that paper copies of this information would be made immediately accessible to staff.

We saw that staff at the home supported people in a caring way, and responded promptly to meet their needs and requests. There were enough staff members on duty to ensure that people had the support that they required. Staff members interacted well with people who were unable to communicate verbally, and we saw that people responded well.

The staff who worked at the home received regular training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about capacity was included in people’s care plans. Up to date Deprivation of Liberty Safeguards (DoLS) authorisations from the relevant local authority were in place to ensure that people who were unable to make decisions were not inappropriately restricted. Staff members had received training in MCA and DoLS.

People’s nutritional needs were well met. Meals provided were varied and met guidance provided in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day.

Care plans were person centred and provided detailed guidance for staff around meeting people’s needs. Daily records of care were well written and easy to understand. However, we noted that staff members had failed to record the actions that they had taken to manage behaviours that were considered challenging. Where a person had been given medicines to reduce their behaviours, there was no record showing that staff members had followed the

We saw evidence that people were involved in their care and treatment as far as possible. One person we spoke to said "I am always happy" and "I like it here." Staff said that although they worked with people that were not able to verbalise their needs, they respected people's dignity by offering them options and did not make decisions for people where they could make their own.

One staff member said that where verbal communications were limited, they studied the person's care plan which detailed what the person liked and disliked. They also said that they used this information when giving choices to the person and obtaining consent to deliver care.

People had an individual care plan completed by the provider. This detailed peoples' needs and the care and support that would be given.

Staff we spoke with were able to identify the various types of abuse and the what they would look for to identify if this was taking place. We saw the company safeguarding policy and that staff had completed safeguarding training.

We saw evidence that staff had completed training on first aid, manual handling, fire safety and food hygiene. We saw evidence that staff had attained or were enrolled to undertake qualifications in health and social care.

The provider had systems in place to monitor the quality of the service provided. We saw that the provider sent out surveys asking for feedback on the service they had delivered.

People using the service spoke positively about the treatment or care provided, they told us that they "could choose when to go up" or "where to go". We observed staff demonstrating good understanding to people’s needs and showed sensitivity to people’s behaviour by exploring the underlying reasons why people behave in certain ways.

People using the service told us that they felt "safe".

Care plans were detailed and reviewed by and with people using the service, comments included "I had my review last week".

Staff were available in sufficient numbers, which ensured people’s complex needs were met and responded to. Staff told us that they felt supported by the manager and regular team-meetings enabled them to discuss people using the service, which led to their needs being met better.

Regular quality checks and surveys ensured that the quality of care was monitored and improvements were implemented if shortfalls were found.

This inspection took place on 10 August 2015 and was unannounced. We were unable to review staff records during this visit as the registered manager was away from the home, so we returned on 26 August to complete our inspection.

1 Milton Avenue is a care home registered for five people with a learning disability situated in Kenton. At the time of our inspection there were no vacancies at the home. The people who used the service had significant support needs because of their learning disabilities. The majority of people had additional needs such as autistic spectrum conditions, mental health conditions, and communication impairments.

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.

A person who lived at the service told us that they felt safe, and this view was confirmed by a family member whom we spoke with. We saw that people were comfortable and familiar with the staff supporting them.

People who lived at the service were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the service were well managed. People’s medicines were managed and given to them appropriately and records of medicines were well maintained.

We saw that staff at the service supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the needs of the people using the service.

Staff who worked at the service received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about capacity was included in people’s care plans. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made to the relevant local authority to ensure that people who were unable to make decisions were not inappropriately restricted. Staff members had received training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. Meals provided were varied and met guidance provided in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day.

Care plans and risk assessments were person centred and provided detailed guidance for staff around meeting people’s needs.

The service provided a range of activities for people to participate in throughout the week. Staff members supported people to participate in these activities. People’s cultural and religious needs were supported by the service and detailed information about these was contained in people’s care plans.

The service had a complaints procedure. A family member told us that they knew how to make a complaint, and we saw evidence that complaints were dealt with quickly and appropriately.

The care documentation that we saw showed that people’s health needs were regularly reviewed. The service liaised with health professionals to ensure that people received the support that they needed.

We saw that there were systems in place to review and monitor the quality of the service, and action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date.

People who used the service, their relatives and staff members spoke positively about the management of the service.