This unannounced inspection took place on 8th and 12th June 2017.

Milverton Road is a home for six people with learning disabilities and physical disabilities, the home had currently one vacancy. The home is managed by Voyage, a large national provider for people with learning disabilities.

A new registered manager had recently started at Milverton Road. 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.

During our last inspection in March 2015 we rated Milverton Road good.

People who used the service were safe and staff knew whom and how to report allegations of abuse.

Risk to people who used the service was minimised, by assessing people’s risk and providing detailed risk management plans.

The provider had robust recruitment procedures in place, which ensured that only appropriately vetted staff worked with vulnerable people. .

Staffing levels were based on people’s dependency levels and assessment by the provider.

Medicines administration was mostly safe, however the registered manager acknowledged that recording of some medicines and the storage of some medicines needs to be improved.

Staff received a wide range of mandatory training and also had access to specialist training and further development. A new system to ensure planned supervisions will be provided six times per year had been introduced and staff started to receive their supervisions regularly.

Appropriate requirements and regulations had been followed when people lacked the capacity to make independent and safe decisions in regards to the treatment or care provided.

People were provided with a healthy and well balanced diet. Their dietary needs had been met and support to eat was provided where required.

People’s changing health care needs were attended to and health care professionals had been contacted when required.

People and staff had positive professional relationships with people. Staff had good knowledge and understanding of people’s needs.

People’s care plans were of a good standard and based on information obtained during assessment. When people were unable to communicate their needs appropriate advocacy services and/or people’s relatives were invited to contribute to the care planning and care plan review process.

Complaints were responded to appropriately, and the format of complaints systems and procedures reflected that people were unable to read, by the inclusion of visually appropriate documents.

Care staff we spoke with were clear about the organisational aims and vision. The senior management were visible and the executive team engaged regularly with people who used the service and staff.

The management of the home had recently changed and positive feedback was received in regards to the transparency, visibility and support the new registered manager was providing.

Quality assurance systems were in place; however on some occasions in particular recording of topical medicines required some attention. We saw that the new registered manager had made an impact since staring and the changes were reflected in this report. The registered manager demonstrated awareness and provided reassurance that further changes will be introduced to ensure the quality of treatment or care provided will continue to improve. You can see what changes had been made or planned at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 12 March 2015 and the service was rated good overall. In May 2016 we received information of concern, these included staffing deployed to be insufficient to meet people’s needs; infection control procedures not being adhered to; as well as people who used the service not being involved in making decisions about whom they want to live with and inadequate management of the service. As a result we undertook a focused inspection on 26 May 2016 to look into these concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Milverton Road on our website at www.cqc.org.uk.

Milverton Road is a home for six people with learning disabilities and physical disabilities. The home is managed by Voyage, a large national provider for people with learning disabilities. The registered manager had recently left the service. 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 saw that the service had put risk assessments in place to protect people from others and themselves and care staff spoken with were clear regarding how to follow risk management plans and we observed them being used in practice.

While currently the home was staffed mainly by agency staff, bank staff and only a small number of permanent staff, we saw that the provider had taken action to recruit more permanent staff and was working hard to have a full staff compliment in place. Agency staff spoken with demonstrated a good understanding of people’s needs and how to respond to behaviours that challenge the service.

During our visit the home was free of offensive odours and overall it was clean. We observed staff following infection control procedures to ensure that people were not put at risk from an unhygienic environment.

People who used the service were not able to express themselves verbally, but families had been informed of the most recent admission and were able to voice their opinions.

During the day of our inspection the home was well staffed and a temporary manager and deputy manager were put into place until a new manager and deputy had been recruited.

We carried out this inspection on 12 March 2015. This inspection was unannounced.

The previous inspection of the service took place on 7 February 2014 when it was found to meet all the assessed regulations.

Milverton Road is a home for six people with learning disabilities and physical disabilities. The home is managed by Voyage, a large national provider for people with learning disabilities. A registered manager was in place on the day 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.

People’s relatives told us they felt people were safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The registered manager had been trained to understand when applications for Deprivation of Liberty Safeguards (DoLS) authorisations should be made, and how to submit one. We found the location to be meeting the requirements of the DoLS. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests.

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Medicines were managed safely and staff received training in the safe administration of medicines.

Suitable arrangements were in place and people were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Care and support was tailored to meet people’s individual needs and staff knew people well. The support plans included risk assessments. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. People were supported to attend meetings where they could express their views about the home.

A range of activities were provided both in-house and in the community. We saw people were involved and consulted about all aspects of the service including what improvements they would like to see and suggestions for activities. Staff told us people were encouraged to maintain contact with friends and family.

The registered manager investigated and responded to people’s complaints in accordance with the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager which included action planning. Staff were supported to challenge when they felt there could be improvements and there was an open and honest culture in the home.