This inspection took place on 22 February 2019. At our last inspection of 25, McRae Lane in January 2018, the service was rated as 'Requires Improvement'. Following that inspection the provider sent us an action plan detailing how improvements would be made. At this inspection we found the provider had made significant progress in all areas and we rated the service as 'Good'.

25, McRae Lane is a 'care home'. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

25, McRae Lane accommodates up to five people with a learning disability and / or physical disability in one single-story purpose-built building which is wheelchair accessible throughout. 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. There were four people living in the service at the time of our inspection.

The service had 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.

At the last inspection in January 2018 we saw safe medicines management processes were not consistently followed with regards to checking stocks of medicines and medicines recording processes. Appropriate action was taken following that inspection, and at this inspection medicines procedures were found to be safe. Fire exits were alarmed and this has helped to minimise the risk to people’s safety. Assessments and clear procedures were in place and understood by staff to respond to fire emergencies.

At the inspection in January 2018 we also found two staff members were not up to date with the provider's mandatory training, which included first aid and medicines management. At this inspection we saw certificated evidence that confirmed all staff had completed their mandatory training in all the areas deemed necessary by the provider including first aid and the safe administration of medicines and medicines management.

People's care and support was planned and delivered safely. Staff understood the provider's safeguarding procedures and their role in keeping people safe. The risks associated with people's care were assessed and managed to reduce the possibility of them experiencing foreseeable harm. There were enough suitable staff to meet people's needs and people's medicines were administered as prescribed. Staff followed appropriate health, hygiene and fire safety practices within the care home.

People had detailed assessments of their needs in place. These had input from health and social care professionals and were regularly reviewed. People's needs were met by trained and supervised staff.

People’s dietary and nutritional needs were met. They ate well and were supported to do so in line with their assessments. The provider made sure people only received care that was in their best interests and they had timely access to healthcare services. The layout of the service and the equipment therein met the needs presented by people's physical disabilities.

People and staff shared warm relationships that had spanned many years. Staff supported people to maintain friendships and contact with relatives. People's privacy was maintained and staff promoted people's independence. Where people chose to, they were supported around their spiritual needs and to participate in the wider activities of church groups.

The service continued to be responsive to

25 McRae Lane provides accommodation, care and support to up to five people with a learning disability and/or physical disability. At the time of our inspection five people were using the service.

At our last inspection in December 2015 the service was rated good. At this inspection on 4 January 2018 we identified some errors and areas requiring improvement. The rating for the three questions, “Is the service safe?”, “Is the effective?” and “Is the service well-led” had deteriorated from ‘good’ to ‘requires improvement’ meaning the service was now rated ‘requires improvement’ overall.

Risks to people’s safety posed by the environment had not always been considered. The fire exits were not alarmed meaning there was a risk that people could leave the service without staff’s knowledge. We identified some errors regarding medicines records and stock control. Some staff had not adhered to the provider’s mandatory training requirements and formal supervision was not held in line with the provider’s policy. We also identified that some areas of the service required redecoration and refurbishment. The registered manager had systems in place which had identified the majority of these concerns and action was planned in response to them, however, this had not been implemented at the time of our inspection.

Despite the evidence above and staff not receiving regular formal supervision, staff felt well supported and there was regular informal supervision and support delivered that at the time was not being captured. Whilst some staff had not completed their required training, they were not left on shift on their own and other staff were on duty who had completed the required training and refreshed their knowledge and skills. Some medicines management errors were identified, however, people had received their medicines as prescribed and there was no current adverse impact on people’s health or welfare.

Staffing levels had been increased in response to changes in people’s needs and there were appropriate staffing levels in place in order to provide people with prompt support. Staff were aware of safeguarding adults procedures and action was taken in response to any safeguarding concerns raised. Staff adhered to good practice in order to prevent and control the spread of infection.

Staff adhered to the principles of the Mental Capacity Act 2005 and the restrictions authorised through the Deprivation of Liberty Safeguards (DoLS). Staff supported people with their dietary requirements and their health needs. Staff liaised with healthcare professionals to obtain advice about how to support people with their health and social care needs and implement best practice guidance. The environment was accessible, clean and free from malodours.

Staff continued to have caring relationships with people. They were aware of how people communicated and what people were communicating through changes in their behaviour. Staff empowered people to make as many choices as they were able to and to experience new things. Staff respected people’s privacy and maintained their dignity.

People’s needs were regularly reviewed and care records were updated in line with any changes in their support needs. Care plans provided detailed information about the level of support people required and how this was to be delivered. A vehicle had been purchased which gave people greater opportunity to access local amenities. Staff provided people with activities which provided sensory stimulation.

A complaints process remained in place. No complaints had been received, instead we saw the staff had received many compliments. Staff felt well supported by the registered manager and able to have open and honest conversations with them. The registered manager had built working relationships with the local authority and clinical commissioning group. They adhered to the requirements of their CQC registration.

We undertook an unannounced inspection of this service on 17 December 2015. At our previous comprehensive inspection on 11 December 2014 the service was in breach of a legal requirement relating to medicines management. The service continued to be in breach of this requirement during a focussed inspection on 21 May 2015. We checked whether the service was meeting this requirement during this inspection.

MCCH Society Limited – 25 McRae Lane is a care home which provides personal care and support for up to five people with profound learning and physical disabilities and sensory impairments. At the time of our inspection four people were using the service.

The service did not have a registered manager since May 2015 and a new manager had been appointed. They were in the process of applying to be the registered manager. 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.

Improvements had been made in regards to medicines management and people received their medicines as prescribed. Medicines management processes were checked daily and ensured people received their medicines on time, medicine administration records were complete and stock balances were accurate.

Staffing levels had increased since our last inspection and there were sufficient staff to keep people safe and meet their needs. Staff had the knowledge and skills to support people. There was a stable staff team and they had worked with the people using the service for a number of years. Staff received regular training and updated their knowledge and skills in line with people’s needs and changes in their diagnoses.

Staff were aware of people’s preferences and routines and this enabled personalised care to be provided. People were unable to communicate verbally. Staff were aware of people’s different communication methods. They were aware of what behaviour people displayed to express their emotions and this enabled staff to provide the support people required. Staff were aware of how people expressed they were in pain and provided them with the comfort and pain relief they required. Staff were familiar with people’s non-verbal communication and we observed staff using touch and objects of reference to communicate with people in a way they understood.

Staff supported people in line with the Mental Capacity Act 2005. People using the service were unable to make decisions about their care. Best interests decisions were made for them, and these were regularly reviewed to ensure they reflected what was best for the person. The manager had arranged for an advocate to work with people and to be involved in decisions about people’s care.

People’s care records were up to date and contained detailed information about people’s support needs. Staff were aware of what support people required and provided them with this. People were encouraged and supported to be independent, whilst still maintaining their safety. Staff were aware of the risks to people’s safety and followed management plans to minimise those risks.

People were supported to engage in activities. People using the service enjoyed activities that involved sensory stimulation. Staff provided one to one activities with people and supported them to access the community. Staff continued to look for other activities and engagement that people may enjoy, to widen people’s experiences.

Staff supported people’s nutritional needs. They liaised with healthcare professionals to ensure people received the specialist care they required with risks associated with choking and in regards to individual dietary requirements. Staff supported people to access healthcare services and accompanied people to appointments.

Staff used their knowledg

This inspection took place on 11 December 2014 and was unannounced. At the last inspection on 30 September 2013 we found the service to be meeting the regulations we looked at.

MCCH Society Limited – 25 McRae Lane provides accommodation and personal care for up to five people who have severe to profound learning disabilities, visual impairments and other disabilities. On the day of our visit there were four people living in the home.

The home had a registered manager. 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.

Medicines management was not safe as people did not always receive their medicines as prescribed.

The service was not meeting their requirements in relation to the Deprivation of Liberty Safeguards (DoLS) as applications for authorisations to deprive people of liberties had not been made. This meant that people may have been unlawfully deprived of their liberty. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Care plans and risk assessments were in place and information was available to staff to understand people’s needs and about the best ways to support them, including their preferences and personal histories. Staff treated people with kindness, dignity and respect.

The premises and equipment used to support people were safe as they were well maintained, with a range of safety checks in place.

The manager and staff had a good understanding of how to recognise abuse and how to respond if they suspected abuse was taking place.

There were enough staff employed to meet people’s needs, although more staff were being recruited to increase the level of social activities on offer. People were not always able to do activities they were interested in regularly due to staffing levels and lack of resources.

Recruitment procedures were robust and only applicants who were found to be suitable worked in the home. The induction, training and ongoing support provided to staff helped them to meet the needs of people using the service.

People were provided with choice and support to eat and drink. Staff supported people with their healthcare needs in accessing necessary healthcare services.

There were arrangements to support people in relation to their disabilities, for example environmental adaptations had been made to the home. Staff had developed close relationships with people and could detect the subtle changes in people’s mood, posture or sounds, knowing what they were trying to communicate.

For people who did not have relatives to support them in making decisions about their care, there were no advocates. This meant that they might not have been fully supported to make decisions or decisions might have been made without consideration of their best interests.

A range of audits to monitor the quality of the service were in place, although these had not been effective in identifying areas for improvement such as those we identified.

The organisation had a clear vision and values which staff were aware of. The manager and staff understood their responsibilities and staff found the manager supportive. Resources were available to support the team and drive improvement.

At this inspection, there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to medicines management and consent to care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

On the day of our inspection there were four people residing at 25 McRae Lane. We met all four people living at the home, although due to their needs and sensory impairments they were unable to share direct views about their care. We therefore used a number of different methods to gather evidence of people's experiences. These included observing care practices; interactions with staff and reviewing records. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

On the day of our inspection we observed how staff supported and cared for individuals. We saw that the registered manager and other staff members respected people's privacy and dignity, and took account of what people expressed in relation to the way their care and support was provided.

We spoke with visiting professionals to the home. One person told us “Working relationships with members of staff is excellent. The environment is always clean and tidy, it’s like home”.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people’s family members or representatives fully involved.

At the time that we visited there were four people living at the home. We used a number of different methods to help us understand the experiences of people who use the service because not everyone was able to talk with us.

We found that people received effective and safe care and support from suitably trained and experienced staff that were familiar with people’s individual needs and preferences. We saw staff always treated people who use the service with the utmost respect and dignity. During a tour of the premises we saw the physical layout of the home meant people lived in a safe and accessible environment. We also found the provider had effective systems in place to routinely assess and monitor the quality of service that people received.

This inspection took place on 21 May 2015 and was unannounced. At the last inspection on 11 December 2014 we found the provider was breaching regulations in relation to medicines and consent.

MCCH Society Limited – 25 McRae Lane provides accommodation and personal care for up to five people who have severe to profound learning disabilities, visual impairments and other disabilities. On the day of our visit there were four people living in the home.

The home did not have a registered manager as they resigned, leaving the service in March 2015. 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 temporary manager had covered the scheme with a new manager starting around a week before our inspection. The new manager had started the application process to become registered with the CQC.

We found the provider had put in new systems in relation to medicines management, including a daily audit and improved recording of medicines received by the home. However, staff did not always carry out the daily audit correctly and had not identified an omission a few days before our inspection. This meant a person may have not received their medicine as prescribed. In addition, the provider could not evidence they were administering a person enough nutritional supplement to keep them healthy. We also found that appropriate guidelines for staff to follow for ‘as required’ medicines were not in place, including how staff should recognise when people were in pain or discomfort but were unable to express this verbally.

The provider had taken sufficient action to meet their requirements in relation to DoLS. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. They had made the necessary applications to deprive people of their liberty lawfully and had retrained staff so they understood DoLS.