This inspection took place on 10 and 11 October 2017. It was an unannounced visit to the service. This meant the service did not know we were coming.

Micholl's house is a care home which provides accommodation and personal care for up to twenty people with a learning disability. The home had been purpose built and is made up of four individual units. Each unit accommodates five people. There are two units on the ground floor and two units on the first floor. At the time of our inspection there were twenty people living there.

The service 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.

The home was previously inspected in September 2016. At that inspection they were found to be in breach of two Regulations of the Health and Social Care Act 2009 and got an overall “Requires Improvement” rating. At this inspection we found those regulations had been met and the service had made good progress in improving the service which resulted in an overall good rating.

People were happy with the care provided and had positive relationships with staff. The majority of relatives spoken with were happy with the care provided. They felt thankful to staff. One relative described it as “Home from home where my family member is happy”. People had access to activities. Two relatives were unhappy with their family members care in relation to their access to activities. Another relative was unhappy with many aspects of their family members care and was considering if this was the right placement for their family member. This was fed back to the registered manager to address.

Systems were in place to safeguard people. Risks to people were identified and managed which promoted people’s independence. People had support plans in place which provided guidance to staff on the support required. Care plans were updated and reviewed as people’s needs changed.

The home had a higher than expected number of medicine errors reported over the course of the year. Measures were put in place to address those errors. The medicines records viewed showed medicines were safely managed.

People were consulted with on their care and the service worked to the principles of the Mental Capacity Act 2005. Their health and nutritional needs were met.

Staff were suitably recruited, inducted, trained, supervised and supported. This enabled them to have the right skills and training to support people effectively. The home had a number of staff vacancies and used bank and agency staff to cover the vacancies. Staff felt the staffing levels were sufficient. Some relatives felt the staffing levels were not always sufficient and that one to one observation of their family member was not consistently maintained and impacted on community activities people had access to. This was fed back to the manager to follow up on.

People’s privacy and dignity was promoted. Staff were kind, caring and had a good knowledge of the people they were supporting. They were aware of people’s needs, risks and the support required to promote their safety. People were provided with information in a format suitable to their needs and staff used symbols and pictures to communicate with people.

People and their relatives knew who to contact to raise a concern or complaint. Monthly resident's meetings took place which enabled people to raise issues which affected them as a group. An annual survey was undertaken to enable the provider to get feedback on the service. Systems were in place to audit the service to enable the provider to satisfy themselves the service was running effectively. Where issues were identified action was taken to make improvements.

People who used the service,

This inspection took place on 14 and 15 September 2016. It was an unannounced visit to the service.

Micholl’s house is a care home which provides accommodation and personal care for up to twenty people. The home had been purpose built and is made up of four individual units. Each unit accommodates five people. There are two units on the ground floor and two units on the first floor. At the time of our inspection there were twenty people living there.

The service 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.’

We previously inspected the service on the 8 May 2014. The service was assessed against five outcome areas at that time and found to be compliant.

At this inspection we found systems in place to safeguard people had not been followed and the provider failed to notify the Commission of a safeguarding incident.

All risks to people were not identified and managed. Care staff roles included cooking, cleaning and laundry which took them away from providing care to people. Staff were observed to be kind and caring but they did not always respond to people in a timely manner. This did not promote people’s privacy and dignity. We have made recommendations for the provider to address these shortfalls.

Safe recruitment procedures ensured people were supported by staff with the appropriate experience and character. Staff were suitably inducted, trained and supervised in their roles to ensure they had the required skills and knowledge to meet people’s needs.

Systems were in place to promote safe medicines practices. Staff were trained to administer medicines and daily audits took place to pick up on any discrepancies. The home had a high number of medicine errors and had put measures in place to address those.

The home was clean, suitably maintained and systems were in place to promote a safe environment. People were provided with a varied diet. Their health needs were met and they had access to a range of health professionals to promote their health and well-being. People were consulted and involved in their care. Mental capacity assessments and deprivation of liberty safeguards were in place for people who required them. People had individual programmes of activities. Staff recognised access to activities could be improved to enable people to have better access to community based activities.

Systems were in place to enable people to raise concerns and give feedback on the service. The provider audited the service and action was taken to make improvements. The management team were accessible. They had a visible presence on the units. We received mixed feedback from staff on the level of support received from management. We have asked the provider to explore that further with staff.

People and their relatives were happy with the care provided. Relatives felt confident their family members received safe care.

The provider was in breach of two regulations and was not meeting the requirements of the law.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection visit was carried out by one inspector. We spoke with three people who lived at Micholl's house and a visiting relative. We spoke with the manager, deputy manager, an activities coordinator and five members of the care staff team. We observed the interactions between staff and people who lived at Micholl's house. We also carried out a SOFI observation on one of the units where people were unable to communicate verbally with us. This was to assess the quality of care those people received. We looked at some records, including people's care plans files, staff training and recruitment files.

We considered the evidence we had gathered under the outcomes we inspected. We used this information to answer the questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). The deputy manager told us at the time of our inspection there was no person with a DOLS application in place, but they did have previously and the appropriate arrangements were in place to safeguard that person. The manager was aware of the recent proposed changes to DOLS and was already considering how this impacted on the people they supported.

Where required, we saw best interest meetings took place, but who was present and the outcome of the meetings were not always recorded to confirm the decision that was made.

We looked at care plans and spoke with staff. We found there were risk assessments in place to identify and manage risks to people's health, safety and welfare. However we saw there were no risk assessments in place to identify and manage potential risks to staff and others. We saw staff manage challenging behaviours safely and in line with the guidance in care plans. This meant people's safety was promoted.

We looked at three staff recruitment files, induction and training records. We saw staff were suitably recruited and the required checks were carried out prior to staff commencing work within the home. We saw staff were suitably inducted and trained to ensure they delivered safe care to people.

Is the service effective?

We looked at four care plans. We saw that they were detailed, specific and informative as to how people were to be supported with all aspects of their care. Care plans contained detailed descriptions of people's seizures and protocols for managing seizures. These provided clear guidance for staff on how they supported people.

We saw people's health needs were identified and met and people's medication was appropriately managed to ensure people got their prescribed medication.

The home had a wide range of individual and group activities available seven days a week. The activities were person centred and focused on developing people's communication skills. Objects of reference and visual aids such as pictures and textures were used to promote that. Staff used a therapy called "intensive therapy" to engage with people. This was where a staff member mirrored the person's actions, sounds and behaviours to engage with the person. We watched a video of the therapy and saw the positive responses of the person to the interactions.

Is the service caring?

We spoke with three people who lived in Micholl's house. People told us they were happy there. One person commented " I am well looked after and staff treat me well ". Another person told us "There are lots of things for them to do".

Throughout our visit we observed positive interactions between staff and the people who used the service. Staff were kind, caring, gentle and reassuring. We saw staff maintained good eye contact with people whilst providing reassurance throughout the task they were assisting them with.

Is the service responsive?

A relative told us the staff were responsive to their relatives needs and their relative seemed happy there. They commented "Staff are professional, caring and knowledgeable, they are simply brilliant and are X's life saver". They also told us how their relative had been swimming and horse riding since been at the home and how responsive and happy that had made the person who used the service.

We saw for one person recently admitted to the home, visits and assessments from other professionals had been carried out but an assessment document was not completed to evidence the person had been assessed.

Is the service well led?

Staff told us they felt suitably supported. They said the manager, deputy and seniors were always available, approachable and accessible.

We saw that relatives were asked to give feedback on the service provided. This indicated people were happy with the service and included comments such as "The staff are helpful, kind and competent", "A very well run service ".

We saw that a range of audits took place and issues highlighted in the audits were actioned. We saw that complaints were logged and investigated. They were reported to the provider each month and a central record was maintained.

We saw accidents, incidents and the number of seizures were logged on a computer programme. This allowed the manager to produce graphs and analyse trends in accidents, incidents and seizures. The manager told us the results had been used to review people's epilepsy medication which had resulted in a reduction in the number of seizures some people had. This meant accidents and incidents were being analysed and action taken to reduce risks to people.

Micholl's House consists of four flats spread over two units. At the time of our visit there were 17 people in residence. We spoke with three people and one relative. One person told us "Staff always ask me what I want to eat and what activity I like to do." Another person told us "They take my permission before they help out." The relative we spoke with told us they were pleased with their loved ones care and could visit them when they wanted to. They told us “Staff do a very good job with (X), they are very kind, I couldn’t fault them. All (X) needs are met here..."

We found the home had processes in place to ensure consent was sought from people and where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We found individualised care plans and risk assessments were in place, however people's care was not always delivered as it was planned.

We found sufficient recruitment checks had not taken place putting people at risk of receiving a service from staff who may be unsuitable to work with them.

Quality of the service provided by the home was monitored by various methods. This included; feedback surveys, quality assurance audits, staff handovers, staff supervision and quarterly quality assurance check. Resident and relatives meetings took place regularly. A relative told us "I always give them feedback during my visits."

People told us they were given choices in relation to food, activities, times for getting and going to bed. They said they were involved in meetings and made decisions about their day to day care. Two people told us they were involved in planning their care. Staff supported them with their care. They commented that they were well looked after and were happy with the activities made available. People told us that they felt safe living at the home and knew who to talk to if they had any concerns. People told us that the staff were helpful and were available when they needed support.

People told us that they liked living at the home. They told us that on admission to the home they were given a choice of room.

People told us that they were well looked after and one person commented that “staff were very nice and that the food was good”.