Miles House, 4 Hentland is registered to provide accommodation and personal care for people for five people. The inspection took place on 11 and 16 January 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.

People felt safe when they were receiving care and support from staff. Staff knew how to keep people safe and what risks people could be subjected to. Staff had received training on what abuse was and the action they needed to take. Risk assessments and care plans were in place and staff were seen to take appropriate action to keep people safe while they ensured people’s right to make decisions was maintained.

People were treated kindly and had their privacy and dignity maintained. There were sufficient staff available to meet people’s needs and to ensure people had the opportunity to go out and enjoy things away from the home. Checks were made on potential staff members prior to them starting work to ensure their suitability. People’s medicines were administered as prescribed and when people needed them to maintain their wellbeing.

Staff received training to enable them to provide care and support to people. Specialist training was provided to ensure specific needs were able to be met. Staff enjoyed their work and felt supported by the management. They were able to attend handover sessions and regular staff meetings to ensure they were up to date and aware of people’s care and support needs.

Staff provided people’s care with their consent and agreement recognising the importance of this. Best interest decisions were in place where people were unable to make an informed decision on their own. People were supported with their eating and drinking and received these in accordance with their specific needs and requirements. People had access to healthcare professionals and specialists when needed to ensure their healthcare needs where met

People and their family member’s views were listened to. Relatives felt involved and consulted on the care and support their family member received and were confident any concerns would be listened to and suitable action taken.

Systems to ensure action appropriate checks on the care people received were in place. The registered manager undertook to develop these checks.

We were unable to speak with all of the people who lived at Miles House due to their level of complex health needs. Therefore we looked at some people’s care plans which provided information on the needs of each person. We looked at how staff cared for the people who used the service. We also spoke with four staff.

We observed that people appeared relaxed and comfortable. They were being cared for in a way that they preferred.

We found that the provider had held best interests meetings to support decisions about care where people had been unable to consent, or where decisions needed to be made on their behalf.

We saw that people who lived at Miles House were protected from the risk of abuse.

Appropriate checks were carried out before staff commenced employment.

During this inspection we spoke with three relatives and five staff.

We also looked at how staff cared for the people who used the service. We saw that people were being given choices around what they wanted to do. We observed that people were receiving care that was meeting their heath and welfare needs.

The relatives of people who used the service gave us positive feedback about the standards of care and support that the staff provided. One person said that the staff were always, "On top of care". Another said that they would give them, "10 out of 10".

However there were some areas of intimate care where consent from the people who used the service had not been gained. The provider had not made adequate arrangements to identify where consent or a best interests meeting was needed.

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said they had, "Good supervision". Another said, "I get good support in my role". This meant that staff had the support and knowledge to meet the care and welfare needs of people who used the service.

There were regular review meetings for the people who used the service, the families and staff. Also there were regular audits of areas of care. This meant that the provider was able to review the quality of the service and to ensure appropriate care was being provided.

This inspection took place on 25 and 30 September 2015 and was unannounced.

Miles House provides accommodation and personal care for up to five people who have a learning disability. At the time of our inspection five people were living there. The home comprised of five single bedrooms, a bathroom, a quite lounge and a conservatory. The conservatory was used as both a seating area and dining area.

There was a registered manager in place at the time of our inspection. 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 body language and gestures of people who lived at the home demonstrated they were at ease with staff members. Relatives told us they were happy with the care and support provided at the home for their family member and felt people’s individual needs were met. Staff we spoke with were able to demonstrate an awareness of potential abuse and were able to tell us about the action they would take in the event of an abusive situation or if they had concerns about people’s welfare.

We found people were at risk of not always receiving their prescribed medicines. This was as a result of a lack of suitable managements systems and over view of the system. We found times when people had not received their medicines as they were not available to them. Risk assessments were in place but staff were not always fully aware of how some risks were managed and described people’s care needs differently.

Sufficient staff were available to meet people’s needs. Staff received regular training and support to make sure they had suitable knowledge to care and support people. Staff treated people with respect and knew how they were able to maintain people’s privacy and dignity. Staff were seen to be kind, caring and respectful when attending to people’s individual needs.

People had a choice of food and drink and were supported with these when they needed them. People’s consent was obtained on a day to day basis. Best interests decision had at times been taken by the registered manager and staff when it was believed people lacked the capacity to make these specific decisions. The manager had knowledge about the Deprivation of Liberty Safeguards (DoL'S) and the people whose liberty was potentially restricted but they had not submitted applications to the supervisory body. This meant the required standards of the law related to the MCA and DoL'S were not being met so that the decision to restrict somebody’s liberty is only made by people who had suitable authority to do so.

People had access to health care professionals as required to maintain their well-being. Relatives felt involved in people’s care and were regularly up dated by staff of any changes. Relatives were confident they could raise concerns about their family member’s care if needed. Everyone we spoke with felt the registered manager was approachable and encouraged them to be involved in the home.

Systems to monitor and improve the quality of the service provision were in need of improvement to identify shortfalls and make changes to the delivery of the service to ensure people were not placed at risk.

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