The inspection took place on 9 and 16 August 2017 and was unannounced. When we last inspected the service on 31 March 2016 we found breaches with regulations 11, 12 17 & 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to manage people’s medicines safely and people were placed at risk due to staff not having a full understanding or knowledge with regard to how to obtain consent from people. We also found there was a lack of effective leadership and governance and deficiencies in the monitoring and auditing of the service placed people at risk of not receiving proper care and treatment. The staffing levels on the day of the inspection were also found to be inadequate to ensure people’s health and safety were maintained.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements and therefore improved the quality of the service provided at Milehouse Lane.

Milehouse Lane provides accommodation and personal care for up to seven people who have a learning disability and the home was fully occupied on the day we inspected.

Accommodation is provided over two floors. All bedrooms are for single occupancy and there are separate toilets and bathroom/shower facilities. There is a kitchen, communal areas, including a dining room, a lounge and a conservatory for people and their visitors to use.

There was a new manager in post who was in the process of applying to become the registered manager of the service. 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 and associated Regulations about how the service is run.

The majority of people who lived at the home were unable to communicate verbally but we observed staff supporting people with a range of communication aids, which included signing and interpreting people’s body language with regards to meeting their needs and wishes. People welcomed us into their home and told us they felt safe and happy living at Milehouse Lane.

We found that people were supported to take their medicines by trained staff. We saw that staff followed safe practices and medicines were accurately documented and stock levels checked were correct.

People felt safe living at Milehouse lane. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated a thorough recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so.

We found that staff received regular one to one supervision and felt supported and valued. People received the support they needed to eat and drink sufficient quantities and their health needs were catered for with appropriate referrals made to external health professionals when needed.

Relatives complimented the staff team for being kind and caring. Staffs were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The manager had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. There was an effective system in place for people to raise complaints about the service they received.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the manager if they had a conce

Milehouse Lane provides accommodation and personal care for up to seven people who have a learning disability and the home was fully occupied on the day we inspected.

Accommodation is provided over two floors. All bedrooms are for single occupancy and there are separate toilets and bathroom/shower facilities. There is a kitchen, communal areas, including a dining room, a lounge and a conservatory for people and their visitors to use.

The inspection took place on 31 March 2016 and was unannounced. The home had a registered manager in post, a registered manager is a person who has registered with the Care Quality Commission (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.

Although we found sufficient numbers of staff were deployed to provide care and support to people living at Milehouse Lane, on occasions we saw from the staff rotas that people were required to work, excessive hours in order to cover vacancies. Risk assessments had not always been developed to positively manage risks to people.

People’s wellbeing was not always supported by staff who met their individual needs and preferences by ensuring people’s social needs and nutritional needs were met.

Medicines were not always managed effectively or safely.

People were supported by staff who had undergone a recruitment process that ensured they were of sufficiently good character to provide care to people.

Staff felt supported by the manager to enable them to carry out their role sufficiently although staff had not been provided with regular supervision. Staff had received training relevant to their role.

We saw that people had access to a range of health professionals, and records demonstrated they were referred to other professionals appropriately when their needs changed.

Staff spoke to people in a kind, patient and friendly way, however we observed staff, on occasions spoke to people in an ’Infantile’ manner.

People did not always receive high quality care that was well led. The systems in place to assess and monitor the service had failed to identify errors in medicines and infection control which placed people at risk of harm.

We found that people were not offered the opportunity to offer their views or opinions on the service provided due to information being provided in a format that not everyone at the home could comprehend.

We found four 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.

We visited Voyager 1 Ltd on 10 May 2013, we saw that people using the service were well cared for in a clean environment and staff were available to assist them with their care. We were unable to speak with the people using the service. Staff we spoke with told us that there were “enough staff to take care of the different needs” of the people that use the service and relatives we spoke with said that although the home had experienced a high turnover of management and staff in the past ‘things have now settled down’.

During our site visit, on 14 June 2012, we met all seven people using the service. People were not able to communicate verbally, and therefore were not able to answer our questions directly, but indicated to us through signs and gestures that they were content with the service.

The people we spoke with during our visits on 13 July 2011, 16 August 2011 and 15 September 2011 did not express an opinion about this service. Only three of the people using the service are able to communicate verbally and those we spoke with did not respond to our questions about their care.