This unannounced inspection took place on 1 August 2018. New Redvers is a residential care home for people with a learning disability. At the time of the inspection there were 13 people living at the 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.

At our last inspection in May 2017, we found two breaches of regulation and the home was rated overall as ‘Requires Improvement’. Following that inspection, the provider contacted us outlining the steps they would take to meet the relevant legal requirements. At this inspection, we found improvements had been made.

New Redvers had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published; we found it followed some of these values and principles. These values relate to people with learning disabilities being able to live an ordinary life.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

New Redvers is set over two floors. The home was clean, tidy and people's bedrooms were decorated with their own furniture and items of importance. However, some areas of the home needed redecoration. For example, some carpets were worn and stained, paintwork and walls were marked and some radiator covers were damaged. The outside garden area was quite extensive, but poorly equipped with seating etc, which limited the opportunities for people to spend time outside. The registered manager and the provider’s representative were aware of our observations about the environment and assured us there was an on-going refurbishment programme in place. We asked the registered manager for a copy of the home’s refurbishment plan but this was not provided.

We have made a recommendation in relation to the environment and outside space.

People told us they felt safe and were happy living at the home. One person said; “I like living here, I do feel safe.” Another person said, “I feel quite safe here.” A relative said, “I do not have any concerns about [person’s name] safety.”

People receive care and support from sufficient numbers of staff to meet their needs and checks were carried out on staff before they started work to assess their suitability. Staffing levels were organised around each person’s specific support needs. For example, were people required 1:1 or 2:1 staff support, this was being provided. At the time of the inspection there were four members of staff on duty in addition to the registered manager. At night people were supported by one waking night staff member and one sleep-in staff member who could be woken if needed.

People received their medicines when they needed them and in a safe way. People were cared for and supported by staff who knew them well. Staff were kind, caring, treated people with respect and maintained their dignity. The manager and staff understood their roles and responsibilities to keep people safe from harm; protect people from discrimination and ensure people's rights were protected.

People's care records reflected their needs, were regularly reviewed and updated. We looked at the care and support records for four people living at the home. These were developed using a range of formats including symbols, pictures and words. They described what was important to people, what people could do for themselves and how staff should offer support. People told us they were actively involved in developing their care and support. Each person had a copy of their support plan, which some choose to keep in their bedroo

New Redvers is a care home for people with learning disabilities located in Torquay. It is registered to provide accommodation and personal care for up to 19 people. On the day of inspection there were 12 people living at the home. The inspection was unannounced and took place on the 30 May and 2 June 2017.

The home had 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.

People were not always safe because there were not enough staff on duty, and on the premises, at night. We raised our concerns with the provider and the nominated Individual, who took immediate action and increased the staffing levels at night. A nominated individual is the providers representative and responsible for supervising the management of the regulated activity. Following the inspection, we shared our concerns about people’s safety with the local authority’s quality assurance and improvement and safeguarding teams.

We looked at home’s quality assurance and governance systems and found these were not all effective. There were a variety of systems to monitor the home. These included a range of audits and spot checks, for instance, checks of the environment, medicines, care records, accidents and incidents, finances and people’s wellbeing. Although some systems were working well, others were not effective, as they had not identified a number of concerns we found at this inspection. For example, the home’s policies and procedures for fire safety at night, medical emergencies and missing persons were not accurate, up to date or being regularly reviewed.

We discussed these findings with the nominated individual who assured us this had been an oversight and gave us assurances this had not placed people at unnecessary risk. Staff we spoke with were clear about the action they should take in the event of an emergency.

People told us they felt safe and were happy living at New Redvers, comments included “I feel very safe here,” “If I have worries I would talk to my keyworker” and “I’m happy living here with my friends.” Relatives told us they did not have any concerns about people's safety. People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. This included safeguarding, first aid, infection control, moving and handling, and food hygiene.

People were encouraged to make choices and were involved in the care and support they received. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how to support people within their best interests. People told us staff treated them with respect and maintained their dignity. Throughout the inspection, there was a relaxed and friendly atmosphere within the home and staff spoke about people with kindness and compassion.

People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care.

People received their prescribed medicines when they needed them and in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. Staff had received training in the safe administration of medicines.

People were encouraged to lead active lives and were supported to participate in community life where possible. People were empowered to access support from a range of services, such as dentists, opticians, chiropodists, and G

New Redvers is a care home for people with learning disabilities, located in Torquay. It is registered to provide accommodation and personal care for up to 19 people. There were 11 people living at the service at the time of our inspection.

The service did have 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 inspection took place on 12 March 2015 and was unannounced. It was undertaken in response to concerns raised to us about the quality of the care and safety of people living in the home, and to follow up on actions we asked the provider to take at our previous inspection on 19 August 2014.

People told us they were happy and said they enjoyed living at New Redvers. We saw people and staff relaxing together and enjoying a variety of activities throughout our inspection.

People’s care needs were clearly documented and risks were managed well and monitored. People were encouraged to live full and active lives and were supported to participate in community life. Activities were varied and reflected people’s interests and individual hobbies. On the day of our inspection people went into Torquay, either by themselves to go shopping, or in a small group with staff to go bowling. We observed staff actively engaging with and encouraging people to complete activities, such as painting, making cards and assisting with the decorating preparation in the hallway.

People had their medicines managed safely. People received their medicines as prescribed and on time. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, occupational therapist and district nurses.

People told us they felt safe. Comments included, “Yes, I’m safe”, “I like it here” and “the staff are nice.” Staff understood how to protect people’s human and legal rights by using the principles of assessment within the Mental Capacity Act 2005 and through best interest meetings. Applications were made to the local authority to authorise the deprivation of people’s liberty where this was required to keep them safe. All staff had undertaken training on safeguarding adults from abuse. Staff displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

Staff described the management to be very open, supportive and approachable. People told us the registered manager was “efficient and friendly” and “(name of registered manager) is very nice, I like her.” The registered manager was seen in conversation with people throughout the inspection: it was obvious through smiles, and physical contact they had a respectful and caring relationship. Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate.

Staff recruitment processes were thorough and new staff received a comprehensive induction programme. One staff member said, “My induction included fire training, health and safety, reading client files, I was shown around and staff were supportive.” Staff were appropriately trained and had the correct skills to carry out their roles effectively. There were sufficient staff to meet people’s needs.

There were effective quality assurance systems in place. Incidents were appropriately recorded, investigated and action taken to reduce the likelihood of reoccurrence. Feedback from people, friends, relatives and staff was encouraged and positive. Learning from incidents and concerns raised were used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the home.

We found the home to be clean and tidy with no offensive odours.

We found no evidence to support the concerns raised with us prior to the inspection.

We carried out this inspection on19 August 2014 to follow up on concerns identified at our last inspection of 24 and 28 April 2014. We also decided we would look at how the home managed people’s medication. This was because we had received information from the review team that they had identified a concern over medication practice at the home. This had been looked at as a part of a review carried out by the local authority in relation to concerns about the service.

This inspection was carried out by an adult social care inspector. During the inspection we looked at the evidence to answer the key questions:

Is the service safe?

Is the service well led?

New Redvers is a care home without nursing providing care and support for up to 19 people with a learning disability. Some of the people who lived there also had physical disabilities.

We, the Care Quality Commission (CQC) inspected New Redvers on 11 June 2013, and again on 25 November 2013. At these inspections we had continuing concerns in relation to consent to care and treatment, assessing the quality of the service and records. We issued the provider with warning notices in relation to assessing and monitoring the quality of the service and records.

On 3 February 2014 we again inspected the home as we still had concerns over how they assessed the quality of the service and records management. We carried out a provider level review and looked at whether the issues were shared across other homes operated by the provider.

We inspected the home again on 24 and 28 April 2014 and found that although improvements had been made the provider was still not fully compliant. As a result we served compliance actions in relation to assessing and monitoring the quality of service and records management. On the inspection of 24 and 28 April 2014 we also identified new concerns in relation to safeguarding practices at the home. The provider sent us an action plan telling us what they were doing to put this right. We met with the provider on 14 May 2014 to discuss our concerns with them and the actions we would consider taking if the home did not improve. We saw that the provider had employed a specialist management consultancy service and had clarified the management structure.

On this inspection we looked at what had changed.

We spoke with and spent time with six of the eleven people who lived at the home. We also spoke with four members of staff and two members of the management team. We reviewed records relating to the management of the home which included three care plans in detail and observed the care and support people received.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People we spoke with told us they were happy at the home and felt safe there. We saw that systems for protecting people from abuse had improved. For example we saw that there were more robust and transparent systems for supporting people with their personal finances. Concerns about safeguarding issues were being reported appropriately by the provider to external organisations for investigation.

We found that people’s medication was being managed safely.

However we found that some recording systems were still not robust enough and some internal audits were still not being completed, for example for infection control. This could leave people at risk of unsafe or inappropriate care.

Is the service well led?

We found that there had been improvements within the home. The manager who had been in post for nearly a year told us they had developed more confidence in their role. Staff we spoke with told us that things were getting better at the home.

However we still had concerns that people who lived at the home did not benefit from safe quality care, treatment and support due to a lack of effective decision making and unclear leadership within the provider organisation.

The employment status of the Registered Manager for the purposes of CQC was unclear. The Registered Manager had not been working at the home for around a year. The current manager in post was not yet registered. They are referred to throughout this report as the manager. The nominated individual, who is the person nominated by the provider company to oversee the operation of the organisation had sought a meeting with the Director of the company. This was to discuss a lack of clarity in roles and accountability within the organisation. This told us that there was still poor communication and understanding of people’s roles at times within the organisation.

We found that some areas of the provider’s action plan were incomplete or inaccurate. This did not give us confidence that the plan was being implemented effectively. We found that sufficient changes had not taken place for the service to become compliant.

This was a responsive inspection to follow up concerns from inspections in June and November 2013. We considered how people's consent was obtained and acted upon and how information about people's care was recorded. We also considered if the service had effective quality assurance in place.

The registered manager was not present or running the service at the time of this inspection. A manager had been appointed to run the service and had been in post since September 2013. They were not a registered manager. We were told they were supported by the provider's wider management team.

We found that people were not always consulted about daily decisions or supported to express their views or consent. Some steps had been taken to contact advocates for people. However, the principles of the Mental Capacity Act 2005 were not put into practice or understood.

Records at the service were lacking in some information and instructions on record keeping were not followed by all staff. There were no verifiable records for some important monitoring checks on some people's health. There was a risk of inconsistent, unsafe or inappropriate care.

There was an on-going failure to operate effective quality assurance systems. It was not always clear who had responsibility for completing specific tasks. There was insufficient monitoring of completion of tasks. The service was not well led and the provider's management team did not work effectively to improve the service.

A previous inspection on 11 June 2013 had identified that improvements were needed at New Redvers with regard to consent, care of individuals, quality assurance and record keeping. During this latest inspection on 25 November 2013 we found that although improvements had been made in relation to care delivery and planning there were still concerns in the other areas.

A specialist learning disability advisor accompanied us on this inspection. We spoke with seven people who lived at the home. Most people were positive about life at New Redvers. Comments included, “I like my room and I like going out to the café”. Where people were unable to communicate with us we used observations to help us understand their experiences of living at New Redvers. Most of the interactions we observed were friendly and respectful.

We found that staff and management at the service did not demonstrate full understanding of their responsibilities in relation to the Mental Capacity Act (2005) and issues of consent. We also found that some records at the service were not fit for purpose and some personal records were not stored securely.

People and their relatives told us that the service was improving. Comments included, "They are doing more with all the residents, the management is better". However, we found that quality assurance systems were not effective.

We had received specific concerns about fire safety prior to our visit. Those concerns were not substantiated.

We spoke with six of the eleven people who lived at New Redvers. People told us that they liked living at the home. One person said, "I like my room and the house". Some people were unable to communicate with us verbally to tell us their experiences. We observed that people were treated with respect by care workers. People told us that they felt safe at the home.

We observed people being supported to make choices about daily living, such as whether to go an outing or what to eat. However, we found that records showed that some people had not been supported to go out into the community regularly. We observed staff asking people for consent. We found that Mental Capacity Act (2005) assessments had not been undertaken for people who might not have been able to make some decisions about their care. This meant that there was a risk that their rights might not be protected and decisions taken on their behalf might not be in their best interests.

We found that there had been efforts to improve the organisation of care plans. However, care plans had insufficient or out of date information. This meant there was risk of unsafe or inappropriate care being delivered. Some records were not fit for purpose.

The provider had identified staff training needs and we saw records which showed that further training and refresher training was underway for care workers. However, we found that the interim management team had not provided effective management or quality assurance.

We carried out an unannounced inspection at New Redvers on 6 August 2012.

We brought forward the date of this planned inspection because we received information that some people being who lived at the home were sent to their rooms for long periods. We also received information that other people were not allowed to go to their rooms when they wished to. No evidence to support this information was seen during the inspection.

We spoke to four people who live at New Redvers who were able to communicate with us. We also spoke on the telephone with relatives of two people who lived at the home.

People who used the service told us that they liked living at New Redvers and that they could express choices. They said that people who worked there were kind to them. People told us that the staff knew what they liked and disliked.

People we spoke with during the inspection told us that they could do a range of activities, but that they could choose not to do things if they did not want to. One person told us, “We go to skittles; I love it. We do lots of things.”Another person told us that they chose not to take part in activities, “I don’t want to go out, I like to be on my own. I like to watch my favourite films here.” People told us that they liked their rooms one person said “I like my room; it’s got all my pictures and things that I like.”

When we the Care Quality Commission (CQC) had inspected New Redvers on 11 June 2013 we had identified concerns in relation to consent to care and treatment, care and welfare, assessing and monitoring the quality of service provision and records being kept by the home. The home was issued with compliance actions and we asked them to send us a report telling us what actions they were going to take to meet the standards. We inspected the service again on 25 November 2013 and found we still had concerns in relation to consent to care and treatment, assessing the quality of the service and records. On 19 December we issued the provider with warning notices in relation to assessing the quality of the service and records. This told the provider they needed to become compliant by 8 January 2014.

We inspected the home again on 3 February 2014. We found that we still had some concerns over consent to care and treatment, assessing and monitoring the quality of service and records.

We held a provider level review looking to see if the issues we had found were identified at other homes operated by the same provider. We found that there was not a co-ordinated quality assurance policy and that the management team did not work effectively together to improve the service across all the locations we inspected. However we found the impact of this had varied between locations. The provider sent us an action plan in relation to the February inspection on 17 April 2014.

On this inspection of the 24 and 28 April 2014 we inspected the home to monitor the progress that had been made in relation to the warning notices we had issued. We identified that improvements had taken place in relation to the specific actions in the warning notices for the management of records and quality assurance systems. We also identified some new concerns in relation to safeguarding. We have decided as a result to downgrade the warning notices to compliance actions to reflect the fact that improvements have taken place. However these are not yet sufficient to become compliant with the whole of the regulation. We found progress had been made on the compliance action regarding consent to care and treatment.

We considered our inspection findings to answer 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?

Although some improvements had been made to the systems for care planning and assessing of people’s needs we found there were still inconsistencies. For example we had concerns that staff were not using guidance in the care plans consistently to help keep people safe and reduce risks. The home’s management were not using management tools to learn and prevent re-occurrence of incidents that presented risks. Incidents had not always been reported to external agencies. This meant that people were at increased risk of unsafe or inappropriate care.

We identified concerns in relation to the way in which people’s personal finances were used or accounted for. We found that the lack of robust and detailed systems for the management of people’s money and supported decision making left people at risk of financial abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that although no-one at the home was the subject of an authorisation to deprive them of their liberty this was being reviewed by the local authority as a part of a review of all the people they funded at the home.

We found that records relating to the maintenance and upkeep of the environment and risk assessments had improved. This helped to ensure people lived in an attractive and safe environment.

Is the service effective?

We found that the home manager and staff had an increased understanding of decision making in relation to people’s capacity, best interest decisions and acting upon people’s wishes with regard to their care and treatment. We saw people being supported to take part in activities of their choice.

Improvements had been made with regard to protecting people’s rights to make decisions where they were able to do so. Where people had lost this capacity the provider had taken steps to ensure that best interest decisions had been or were being made when required. We saw records of recent best interest decisions in relation to people’s health and welfare which described the rationale behind decisions and who had been involved. This demonstrated the home protected the rights of individuals in these instances.

Is the service caring?

People told us they were positive about living at New Redvers. One person said, “Yes, I like it here. I get on with people I do” another said “I am alright. I like to go out into town and I do.”

We saw people interacted well with staff and sought them out for re-assurance or guidance. We saw staff spoke respectfully to people. We asked one person about their key worker. They told us “She’s very nice. She helps us a lot. She goes out with us.”

We spoke with staff to see how they ensured people exercised choice in their lives. We spoke with one member of staff who told us how they were careful not to present a whole range of options at once, as this caused one person to become anxious. They explained how the person was better equipped to make a decision if they were presented with options one at a time and could consider and discount each option. We spoke with the person who confirmed that they like to hear, “not lots, just one thing to choose” and that this helped them decide what they wanted to do. This told us that staff were aware of presenting information and choices in a way that suited individual needs.

Is the service responsive?

People who used the service were asked for their views about their care and treatment. However we did not see evidence that these had been acted upon. For example we saw that there had been two residents’ meetings in the last two months. The minutes of those meetings showed that these were largely focussed on food and outings. There were no actions points from the meetings. For example, where people expressed a wish to do a particular activity there was no indication of how that wish would be considered or progressed and whether people’s key care workers had been informed. This meant that there was a risk that when people raised issues they would not be fully addressed.

We also found that staff concerns had not always been directed appropriately, or responded to in a timely way.

Is the service well-led?

The Registered Manager was no longer working at the home, and had not been since 2013. A new manager was in post, but was still in their probationary period. They are referred to throughout the report as the manager. We have not yet received an application from the previous manager to de-register.

The management of the home was working through action plans set for the CQC or by the CQC, the commissioning authority and by a care management company. None of the plans had yet been completed, however progress could be identified.

We found there was a lack of clarity over people’s roles and responsibilities at the home and in the higher management structure of the provider organisation. For example we were told that decisions had been made by an area manager about a person’s care without reference to the manager of the home.

Clear and effective systems were not in place to make sure the manager and staff learned from events such as incidents, complaints or concerns. This meant that people were not benefitting from learning to prevent incidents re-occurring.

We found that audits had not always identified issues, or if completed had not led to clear action where identified. This had the potential to put people at risk.