The inspection took place on 23 and 24 May 2017 and the first day of the inspection was unannounced. We told the registered manager that we would be coming back the following day. At our previous inspection on 14 and 18 August 2015 we found the provider was in breach of two regulations relating to safe care and treatment and notifications, and the service was rated ‘Requires Improvement’.

Nonoy Capina is a residential care home that provides support for five adults with learning disabilities. The home is privately owned and is located in a residential area. At the time of our inspection four people were living in the service.

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 (CQC) 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 received care and support from staff who had worked with them for a long period of time and were aware of how to meet their needs.

We observed positive interactions between people and staff, including the registered manager, throughout the inspection. People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. All staff showed concern for people’s health and welfare in a caring and compassionate manner.

People were spoken with and treated in a respectful and kind way and staff respected their privacy and dignity, and promoted their independence.

Relatives told us they felt their family members were safe and staff had a good understanding of how to protect people from abuse. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with.

People’s risks were managed and care plans contained appropriate risk assessments with input from health and social care professionals, which were updated regularly when people’s needs changed. Staff worked closely with people and had a detailed understanding of how they could be aware and meet their needs.

People who required support with their medicines received them safely from staff who had completed training in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked by staff and audited by the pharmacy to minimise medicines errors.

The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Sufficient numbers of staff were employed to keep people safe and meet their needs.

Staff members were knowledgeable about their jobs as they had worked with people for over 15 years. They completed training on an annual basis to support them in meeting people’s needs effectively. Staff received regular supervision from management and told us they felt supported and were happy with their input during the supervision they received.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider had worked closely with the relevant health and social care professionals to ensure people’s liberty was not restricted in any way.

Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent.

People had regular access to healthcare services and staff made appropriate referrals if people’s needs changed. Staff worked closely with other health and social care professionals, such as the community learning disability team, occupational therapists and speech and language therapists .

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We looked at out five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were treated with dignity and respect. Their views and the views of their family were included as part of their care planning.

Any risks to people were taken into account to ensure the safety and welfare of people. Risk assessments outlined the nature of risk, triggers and prevention plans. Care workers were knowledgeable about how to manage identified risks when caring for particular individuals.

Is the service effective?

Staff were knowledgeable about people’s needs and how to meet them and how best to communicate with people. Staff also followed guidelines for how best to communicate with particular individuals.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider worked in co-operation with other professionals to promote the health and wellbeing of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People who lived in the home and their families were overall positive about the caring approach staff took with people.

Staff encouraged people to maintain their independent living skills and gave support with personal and domestic care activities only when assistance was needed.

People’s diversity, values and human rights were respected. The provider consulted people and their families about individual needs and wishes, including cultural and religious needs. Their individual preferences were taken into account as part of their care planning.

Is the service responsive?

People’s care needs were reviewed and their plans updated to ensure the service was responsive to meeting people’s current needs.

Key workers advocated on behalf of people with other professionals to ensure their needs were appropriately assessed when their needs changed. Staff used assessment tools to monitor the health and wellbeing of people. Staff responded appropriately to support people with their emotional and behavioural needs.

Is the service well led?

The service had an ongoing system of audits to check the quality of service. The management team had identified ongoing areas for improvement, for example, in staff training needs to ensure staff were able to meet the changing needs of people who used the service.

Staff told us they were well supported and received appropriate professional development. This meant they were familiar with their roles and responsibilities and carried these out with confidence.

We found that the provider had taken steps to protect people living at Nonoy Capina against the risk associated with the unsafe use or management of medicines.

We spoke with three people living at Nonoy Capina. People spoke positively about the home and the care they received. There were a number of ways people living in the home were involved in decisions about how services were delivered.

People told us they felt comfortable, happy and safe living at the home. We spoke with relatives of people living in the home. One person told us, “the care is good we couldn’t wish for a better place.”

Staff we spoke with received appropriate training and told us they were supported to carry out their roles.

We found that the provider had not taken steps to protect service users against the risks associated with the unsafe use or management of medicines. The storage, use, safekeeping and safe administration of medicines is importnant to ensure that people using the services are not at risk of harm.

We spoke with five people who used the service who were longstanding residents at the home. All five people had learning disabilities. Two people used hand signals to communicate and the other three had limited verbal communication. Each gave positive responses when asked if they liked living in the home. They said staff supported them well, their needs were being met and they felt safe.

The inspection took place on 14 and 18 August 2015. The first day of the inspection was unannounced; the provider knew that we would be returning for a second day. At our last inspection on 8 April 2014 we found that the provider was meeting all of the requirements of the regulations we checked.

Nonoy Capina is a residential care home for five adults with learning disabilities. The home is privately owned and is located in a residential area.

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.

People were not always protected from risks to their health and wellbeing because the quality of risk assessments was inconsistent and they were not always up-to-date. Furthermore, people were not always protected from environmental risks.

The provider had not always discharged their duty to inform the Care Quality Commission of significant events at the service.

We found that the provider’s approach to protecting people from avoidable harm and potential abuse was inconsistent. Care staff were aware of how to report potential abuse, however guidelines for reporting abuse were not always followed.

There were sufficient staff deployed at the service and the provider was in the process of recruiting a waking night member of staff to provide extra support to a person whose needs had recently increased.

A thorough recruitment system meant people were supported by staff who were suitable for work in the caring profession. The staff developed caring relationships with people using the service and people appeared happy and relaxed. Staff promoted people’s independence.

Medicines were stored, administered and disposed of properly. Staff had received training in medicines and completed accurate records. Staff received training relevant to their roles and staff felt confident requesting additional training to help them better support the people they worked with.

The provider followed the latest guidance and legal developments when obtaining consent to care. Staff used a range of communication methods to support people to express their views about their care. There was evidence that people and their relatives were involved in planning their care. In the event of a change in someone’s needs staff were informed of the changes and we observed these changes had been implemented.

People had good access to healthcare because the provider made prompt referrals. Staff supported people to eat and drink enough and followed recommendations made by healthcare professionals.

There was an open and positive culture at the service and people, relatives and staff were able to feedback about the quality of care. The provider demonstrated that they acted on feedback to make improvements in the service.

We found two breaches of regulations relating to safe care and treatment and notification of other incidents. You can see what action we told the provider to take at the back of the full version of the report.