This inspection took place on 22 November, 1, 6 and 14 December 2016. The first day of the inspection was unannounced which meant the registered provider and staff did not know we would be visiting. The following two days of inspection was announced.

At the last comprehensive inspection on 4 February 2015, we identified a breach regulation. The registered provider had failed to ensure people with capacity were not subject to Deprivation of Liberty Safeguards authorisations and that mental capacity assessments and Best Interests decisions were undertaken and recorded. A further inspection in August 2015showed that although we could see that improvements had been made, further improvements were needed. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation.

At this inspection we found the registered provider had followed their plan and legal requirements had been met.

New Stead House provides care and accommodation for up to 17 people who are on the autistic spectrum and may have an associated learning disability. Accommodation is provided via a main house and an annex with self-contained apartments. The home is close to shops, pubs and public transport. At the time of inspection, the service provided support to 15 people.

The service had a registered manager who has been registered with the Care Quality Commission since 23 February 2016. 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.

Where risks had been identified, individual risk assessments had been completed and care plans had been produced with written guidance to help reduce the risks. These were specific to the individual and person-centred. Staff understood the risks to people. Risk assessments were also in place associated with the day-to-day running of the service.

Good procedures were in place for the management of medicines, which staff understood and followed. We highlighted gaps in the recording of topical cream records and these were addressed on the day of inspection by the registered manager.

Safeguarding alerts, accidents and incidents had been recorded and were analysed to identify any patterns and trends. This information was also used to identify any triggers that may have caused an episode of behaviour that challenges. Staff understood the procedure that they needed to follow when reporting a safeguarding concern, accident or incident.

Emergency procedures were in place for staff to follow in the event of an emergency and emergency plans were in place for people who needed them.

There was sufficient staff on duty to support people and the rotas we looked at corresponded with staffing levels on the day of inspection. People were supported by a regular team of staff. Safe recruitment processes had been followed.

Staff told us they felt supported by the management team and received regular supervision, appraisal and training and we saw records to confirm this. Staff had received up to date mandatory training, as well as training in specialist areas.

People were supported to make independent decisions regarding food and fluid including meal options, shopping lists and menu choices. Staff understood the procedure they needed to follow if people became at risk of malnutrition or dehydration.

Referrals to other professionals had been made in a timely manner and people’s cultural needs had been taken into account. People were supported by staff to make and attend routine appointments and when they experienced deterioration in their health, appropriate professionals were contacted.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Saf

At the last unannounced, comprehensive inspection on 4 February 2015, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11. We asked the provider to take action to make improvements to ensure people with capacity were not subject to Deprivation of Liberty Safeguards authorisations and that Mental Capacity Assessments and Best Interests decisions were undertaken and recorded .

This inspection visit took place on the 17 August 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The service was newly registered with the Care Quality Commission in November 2014. The service had been subject to the Serious Concerns Protocol process undertaken by the local authority for the last three months. This was in relation to concerns about medicines administration and the healthcare requirements of people with diabetes. The service had been subject to daily monitoring in relation to these concerns and it was recognised that New Stead House had prioritised these areas and staff training and recruitment to ensure people were kept safe at the service.

New Stead House provides care and accommodation for up to 12 people who are on the autistic spectrum and may have an associated learning disability. Accommodation is provided via a main house and an annex with self-contained apartments. The home is close to shops, pubs and public transport.

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.

We undertook this focussed inspection to check that the registered provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the previously identified breach of regulation.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The service had applied the MCA, but some care records needed clarification to ensure people with capacity were not subjected to the DoLS process and that where decisions had been made in people’s best interests these were clearly recorded.

We found the provider was still breaching Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11 although they had undertaken considerable steps towards achieving compliance. We also took into consideration other priorities the service had been asked to address by the local authority as part of the Serious Concerns Protocol process that New Stead House had been subject to for the last three months. We decided to continue with the requirement for the service to meet this regulation promptly rather than take further enforcement action. You can see what action we took at the back of the full version of this report.

The inspection visit took place on the 23 February 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The service was newly registered with the Care Quality Commission in November 2014.

New Stead House provides care and accommodation for up to 12 people who are on the autistic spectrum and may have an associated learning disability. Accommodation is provided via a main house and an annex with self-contained apartments. The home is close to shops, pubs and public transport.

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.

Two people who used the service told us they felt safe at New Stead House and we observed care and support for people who were not able to communicate with us. This support was provided in a caring and dignified manner. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse, including the actions to take to raise concerns with external agencies.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager and deputies had applied the MCA, but some care records needed clarification to ensure people with capacity were not subjected to the DoLS process.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene, as well as condition specific training, such as working with people who had an autistic spectrum disorder and behaviour that may challenge. We found that the staff had the skills and knowledge to provide support to the people who lived at the service. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that seven staff routinely provided support to 7 people and other senior staff were also available.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development. Many staff were new to the service and spoke to us about their induction and support which they said was good. We also saw a regular programme of staff meetings where issues where shared and raised.

The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible. People were supported to independently use public transport and in accessing local amenities such as the local G.P, shops and leisure facilities, as well as to use the facilities in the service such as their kitchens for cooking meals. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. People went out routinely with staff and accessed the community. One person told us that they made their own choices and decisions and these were respected.

There was a system in place for dealing with people’s concerns and complaints. Two people we spoke with told us that they knew how to complain and felt confident that the registered manager would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service. There were other mechanisms in place for keyworkers to seek the views of people living at the service and their families or carers on a monthly basis.

People told us they were involved in planning their meals and were encouraged to help prepare food with staff support if they wished. We saw people had nutritional assessments in place and people with specific dietary needs were supported. Specialist advice was sought quickly where necessary. We observed the lunchtime meal and saw people had a wide variety of choice and were encouraged to take healthy options by staff.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. Two people we spoke with discussed their support plans and how they had worked with staff to develop and review them. Some work was required to ensure plans were reviewed on a regular basis and that clear guidelines were in place for any physical intervention.

We reviewed the systems for the management of medicines and found that people received their medicines safely and there were clear guidelines in place for staff to follow.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the service and there was plenty of personal protective equipment to reduce the risk of cross infection. We saw that audits of infection control practices were completed.

We saw that the manager utilised a range of quality audits and used them to critically review the service. They also sought the views of people using the service and their families on a regular basis and used any information to improve the service provided. This had led to the systems being effective and the service being well-led.

We found the provider was breaching one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report. The provider responded immediately after this visit and shared with us measures they had taken to address the outstanding issues.