We carried out this unannounced inspection on the 30 October and 07 November 2018.

We carried out this inspection because we had received concerns in relation to poor care, safeguarding concerns and staffing levels.

At our last inspection carried out on we judged this service as ‘requires improvement’ in the key questions of safe, responsive and well led and rated the service as ‘requires improvement’ overall. At this inspection we found that the provider had not made the required improvements we identified at our previous inspection and we identified additional concerns. We found that the provider had failed to make sufficient improvements to the efficiency of their quality assurance systems. This meant that this was the second consecutive inspection whereby the provider had failed to achieve a ‘good’ rating in the well led area of our inspection. As a result of our finding we found that the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We also found that the provider You can see what further action we have taken at the end of this report

Mr Adrian Lyttle- Erdington is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. provides care and support for a maximum of ten people who are living with a learning disability. There were 10 people living at the home at the time of the inspection.

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 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 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 provider’s quality monitoring systems had either not identified some of the areas for improvement that we found during our inspection or when identified by their own system had then not been followed up on in a timely way.

People’s needs had been assessed and care plans developed to inform staff how to support people. However, care records did not fully reflect the detail of specific health care conditions. Some risks to people were not always well managed.

The provider was not fully aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions, although records of this were not always maintained.

Staff had received training however this had not always been effective. Staff received supervision from managers and were support to carry out their role.

People were supported for by staff who were trained in recognising and understanding how to report potential abuse. People’s dignity was maintained and people were communicated with in their preferred way.

People were supported to take part in activities and were involved in their day to day care and chose how to spend their day. People were encouraged to maintain their independence and were supported to meet religious and cultural needs.

People spoke positively about the care staff .Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them. There was a friendly and calm atmosphere within the home.

People were supported to maintain a healthy diet

This inspection took place on 4 May 2017. This was an unannounced inspection.

At the last inspection in August 2016 the provider was rated as requires improvement in three out of the five areas we inspected against; whether the service was safe, effective and well- led. This was because the registered manager had not always fulfilled the responsibilities of their role by ensuring that the service was safe and effective for people living at the home. The registered manager had failed to implement safe recruitment processes and had not identified potential safeguarding concerns in order to protect people from the risk of abuse and avoidable harm. They had also failed to share information with us that they are required to notify us of, by law.

During this inspection, we found that some improvements had been made; however further improvements were required.

The home provides accommodation and personal care for up to 10 people who require specialist support relating to their learning and physical disabilities. At the time of our inspection, there were 10 people living at the home.

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. There was not a registered manager in post at the time of our inspection. The person who was registered to manage the service had recently left. The provider had arranged for a member of staff to deputise and manage the day to day running of the service in the absence of a registered manager. Arrangements were also being made for the registered manager of the provider’s other home in Sutton Coldfield, to apply for their registration with us to manage the service.

The service was not consistently safe, responsive or well-led because the management team had not always fulfilled the responsibilities of their role. The provider’s quality assurance systems had failed to identify the shortfalls found during the inspection and some of the improvements required at the time of our last inspection had not been made.

Accidents and/or incidents were not always recognised as potential safeguarding concerns and key processes had not been followed. The provider had also failed to ensure that there were sufficient staffing levels to support people to live active and fulfilling lives, particularly at evenings and weekends.

Relatives did not always feel involved in the planning or review of the care that was being provided to their loved ones. Relatives were concerned that staff did not always have sufficient information in order to keep people safe from the risks associated with their physical healthcare needs. The provider had not ensured that all of the information that was pertinent to people’s health and safety was readily available to new and/or temporary members of staff, such as person-centred care plans relating to their physical health needs, allergies or personal emergency evacuation plans. However, the acting manager was responsive to our feedback and improvements have been made since our inspection site visit.

People received care and support with their consent where possible and were offered choices on a daily basis which included meal preferences. This meant that people had food that they enjoyed and any risks associated with their diet were identified and managed safely within the home.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

People received care from staff who had the knowledge and skills they required to do their jobs. People were supported to have their medicines when they required them, from staff who had the relevant knowledge and skills they needed in order to promote safe medication management.

The servi

This inspection took place on 11 August 2016. This was an unannounced inspection.

Mr Adrian Lyttle Erdington was previously registered by a different provider and therefore this was their first inspection under the new provider.

The home provides accommodation and personal care for up to 10 people who require specialist support relating to their learning and physical disabilities. At the time of our inspection, there were 10 people living at the home.

There was 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.

The service was not consistently safe, effective or well-led because the registered manager had not always fulfilled the responsibilities of their role. For example, they had not sent an alert to the local safeguarding authority where required nor had they followed key processes to ensure that people were not unlawfully restricted. The provider had also failed to implement safe recruitment processes.

People received care and support with their consent where possible and were offered choices on a daily basis which included meal preferences. This meant that people had food that they enjoyed and any risks associated with their diet were identified and managed safely within the home.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

People received care from staff who had the knowledge and skills they required to do their jobs. People were supported to have their medicines when they required them, from staff that had the relevant knowledge and skills they required to promote safe medication management.

The service was caring because people were supported by staff that were nice, helpful and caring and who took the time to get to know them, including their personal histories, likes and dislikes. People were also cared for by staff that protected their privacy and dignity and respected them as individuals.

People were encouraged to be as independent as possible and were supported to express their views in all aspects of their lives including the care and support that was provided to them, as far as reasonably possible. People felt involved in the planning and review of their care because staff communicated with them in ways they could understand.

People were actively encouraged and supported to engage in activities that were meaningful to them and to maintain positive relationships with their friends and relatives.

Staff felt supported and appreciated in their work and reported the home to have an open and honest leadership culture. People were encouraged to offer feedback on the quality of the service and knew how to complain if they needed to.