The inspection took place on the 5 October 2018 and was announced.

At our last inspection on 29 August 2017 the service received an overall rating of 'Requires Improvement'. We identified four breaches of the regulations relating to safe care and treatment, fit and proper persons employed, staffing and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well- Led to at least good. At this inspection we found the provider had made the necessary improvements to meet the standards required of them.

Nimrod House provides care and support to people living in a supported living setting. Each person’s flat had a living area, separate bathroom and kitchen. People live in their own flats so they can live as independently as possible. People's care and housing are provided under separate contractual agreements. The Care Quality Commission does not regulate the premises used for supported living; this inspection looked at people’s personal care and support.

The service had a registered manager. 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 had risk assessments in place and now clearly stated how to mitigate against risk. Staff supported people to take risks in a safe way so that their freedoms were respected. Relatives told us their family members were kept safe at the service by staff.

Staff understood the different types of abuse and how to report abuse if they suspected it. Staff also knew when to whistleblow if they witnessed poor practice.

Staff were recruited safely and relevant checks were performed to check for suitability before staff could work with people at the service.

People’s medicines were managed safely and the registered manager regularly checked staff competency in medicine administration to ensure safe practice.

The risk of infection was minimised as staff were provided with personal protective equipment and they kept people’s living areas clean and tidy.

People’s needs were assessed before they began to use the service and people were involved in the care planning process along with their relatives and health professionals. People’s care plans were person centred and people were given the opportunity to speak with their key worker each month to discuss their care.

Staff received mandatory training and specialist training in Autism and diabetes, specifically related to the people they supported which ensured they received good care from staff who understood their health needs. Staff were supported by management and received regular supervision and an annual appraisal where appropriate.

People were offered choices and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) Where needed the registered manager had made appropriate applications to the Court of Protection where people’s liberty was being deprived.

People’s dietary and food preferences were now clearly recorded, people were supported to eat and drink well. People were supported to access health services to maintain good health.

People were supported by staff who were kind and patient. We observed people laughing and dancing with their key worker. People’s privacy and dignity was respected. People were supported to explore personal relationships.

People took part in a number of activities of their choice and records showed people suggested new activities they wanted to try.

The registered manager had an open-door policy and staff felt well supported by management and other staff at the service.

The registered manager had a variety of monitoring tools they used to check the quality

The inspection took place on 29 August 2017 and was announced. The provider was given 48 hours' notice as they are a small supported living service and we needed to be sure someone would be in.

This was the service’s first inspection since being registered with us.

Nimrod House is a building containing five one bedroom flats. The provider has two registered locations at the address. Up to three of the flats can be registered care, and the remaining are supported living flats for adults with learning disabilities. This inspection related only to the supported living aspects of the service. At the time of our inspection two people were receiving personal care in supported living flats.

The service had a registered manager. 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 receiving a service presented with a range of behaviours and needs that could put themselves and others at risk of harm. Although the risks had been clearly identified, the measures in place to mitigate risks were unclear and lacked detail.

Staff were knowledgeable about the different types of abuse people might be vulnerable to and knew what action to take to safeguard people from harm. Staff looked after money for people and there were effective systems to protect people from financial abuse.

People received support from a consistent staff team and records showed staffing levels matched the hours of support people were entitled to receive. However, recruitment records did not demonstrate safe recruitment practice had been followed.

People were supported to take medicines by staff. Records showed this was managed in a safe way and staff were confident in how to respond to a medicines error.

Staff did not always receive the training and support they needed to perform their roles. None of the staff had received training in supporting people with autistic spectrum conditions despite the fact that everyone receiving a service had an autistic spectrum condition.

People were supported and encouraged to make day to day choices in their lives. However, records regarding the application of the Mental Capacity Act 2005 were inconsistent and were not always in line with best practice.

People were supported by staff to prepare and eat a varied diet. However, information about people’s dietary preferences was not clearly recorded in their care plans. This meant there was a risk people were not always supported to prepare meals that reflected their preferences.

People receiving a service experienced a range of physical and mental health conditions. People had health related care plans and records and were supported to access relevant healthcare professionals. However, records were not clear that the advice from healthcare professionals was implemented by the service.

People and staff were able to develop positive relationships as they were paired to work together gradually. The service had information profiles about staff interests to ensure they were a match to people they were supporting.

The service used assistive technology to ensure people were given private time. Assistive technology was used to monitor people to ensure they were safe while alone in their flats.

People were supported to maintain relationships and to develop new relationships. Staff supported people to practice their religious faith where they wished to do so.

Care plans were large documents contained in various folders with information in different places. It was difficult to locate the most up to date information within the folders. Instructions for staff about how to meet people’s needs were not detailed enough to ensure people’s needs were met. Staff told us they relied on verbal handover fr