This inspection took place on 13 December 2017 and was unannounced.

65A Newtown provides care and support for three people who have autistic spectrum disorder and 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.

“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.” Registering the Right Support CQC policy.

A registered manager was 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.

There were people that used non-verbal language. While their communication plans stated they used pictures and object of reference to communicate, their care plans and information was not in their preferred method. For example pictures. The registered manager said equipment was now available to provide information in picture format.

Quality assurance systems were in place and where shortfalls were identified action plans were developed to meet the set standards. While audits had identified people’s views were not formally gathered action had not been taken to introduced on how to gain feedback about the service. processes.

We observed the people at the service accepted staff support and approached staff for attention. The staff we spoke with said they had attended safeguarding training. They knew how to identify abuse and the procedures for reporting their concerns.

Risk assessments were in place for people with medical conditions such as epilepsy and for people that showed anxiety through verbal and physical aggression. Action plans gave staff guidance on the actions to take to ensure people were protected from harm and were able to take risks safely. Staff were aware of the actions needed to minimise risks to people.

Incident and accidents reports were completed and analysed for patterns and trends.

Staff told us there was some lone working but mainly two staff were on duty. The rota showed that two staff were on duty during the day and at night there was one waking staff. The registered manager said two staff were mainly on duty to allow for people to go out during the day and evening.

Medicines were audited which included the stocks held and medicines ordered. We saw medicine administration records (MAR) were signed to indicate medicines administered. Some people were prescribed ‘as and when required’ (PRN) medicines for pain and to reduce agitation. We saw for one person the medicine care plan stated that the person may not tell staff when they were in pain and staff needed to look for changes in behaviour as the person may be in pain. The member of staff took immediate action and included how staff were to identify the person was in pain into the support plan.

Staff told us the training was good. There was mandatory training which staff we spoke with said they had attended. One to one supervision was with the line manager. The member of staff on duty had not had regular supervision although the line manager had made attempts to organise them. The registered manager said this was to be addressed. Discussions with the member of staff were to take place.

Staff knew the day to day decisions people were able to make. We saw people’s capacity to make decisions about their care and treatment was assessed. Where people lacked capacity best interest decisions were taken.

The pe

This inspection took place on 24 January 2016 and was unannounced. The last inspection took place on 21 May 2013 and no breaches of legal requirements were found at that time.

Newtown 65a provides care and accommodation for up to three people with a learning disability. At the time of our inspection there were two people using the service.

There was a registered manager in place 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.

The service was safe in most aspects; however more needed to be done to ensure that the risks associated with infection control and health and safety were minimised.

Staffing levels were assessed to meet the needs of the people living in the home to provide one member of staff at all times in the home and one to one support, when people accessed their community. However we noted the rota on the day of the inspection, failed to demonstrate the correct staff numbers for the day.

Procedures were in place to manage and dispense people’s medicines safely. Medicines audits were also undertaken. Stock levels that we checked were correct.

There were risk assessments in place to ensure that staff received guidance in how to support people safely. These were reviewed and updated accordingly when necessary.

People received effective care that met their health needs. Staff worked with healthcare professionals to ensure that professional advice was sought when necessary.

People’s rights were protected in line with the Mental Capacity Act 2005. This is legislation that protects the rights of people’s who are unable to make decisions about their own care and treatment. Where appropriate, applications to deprive a person of their liberty were made to the relevant authority.

People were supported by staff who were kind and caring and treated people with respect. People were encouraged to maintain relationships with people that were important to them. People were involved in planning their own care where possible.

Staff understood and were responsive to people’s individual needs and preferences. People were able to follow their own preferred routines during the day, for example by getting up and going to bed when they wished.

The service was well led by the registered manager. Staff reported feeling well supported and able to raise any concerns or issues. There were systems in place to monitor the quality and safety of the service. This included a programme of audits that included: medicines, the environment and people’s care plans.

At this inspection we did not speak with people who used the service. This was because some were out taking part in community activities and those who were at home could not communicate verbally. Instead we spent time observing how staff communicated and supported people to see people’s experiences of care in the home.

Staff we spoke with were knowledgeable about the people they cared for. They emphasised the importance of understanding people’s routines, non verbal communication and behaviour to anticipate need. Staff had received the appropriate training to care for people safely and effectively. People were relaxed in their home. They had an activity programme which promoted their independence and reflected their personal interests.

We found people had the appropriate support to make decisions and consent to care.

The provider had an effective system in place to ensure people received appropriate support and care provided by other health and social care services.

People's records were up to date, were regularly reviewed and were an accurate reflection of the care and support need and received.

One person told us: “it’s good living here. I like going to the farm.” Another person said “ok!” and gave the thumbs up.

People’s privacy and dignity were respected. Their independence and involvement in the community was promoted by regular social activities and responsibilities within the home.

Staff were knowledgeable about people’s lives. We observed staff understood people’s individual routines and the impact on behaviour if routines were disrupted.

We saw risk assessments and support plans had not been updated regularly. Monthly keyworker reviews had not been completed for some months.

People were involved in choosing the menu. One person told us "the food is great." Food looked tasty and a well balanced menu was offered.

Staff were confident in their understanding of what constituted abuse and their role and responsibilities in the reporting process.

During the visit we saw there were enough staff on duty to take people out for their regular activities and provide the care needed.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.