We inspected Nutley Hall on 19 and 23 June 2017 and the inspection was unannounced. Nutley Hall is a care home which provides personal care and accommodation for up to 33 adults who have a learning disability. On the day of our inspection there were 32 people living at Nutley Hall. Nutley Hall is made up of a number of small group homes in a community setting and offers therapeutic approaches based on the ideas of the philosopher Rudolf Steiner, which includes the recognition of each individual’s unique path in life. Nutley Hall is a living and working community providing residential care & support and employs nearly 50 members of staff, some of whom are also resident on site. Nutley Hall has a craft centre, bakery, woodwork room, classroom, candle making and weaving workshops, kitchen gardens, communal hall and a lively cultural & social environment. There are six distinct homes within the community of Nutley Hall and each home has a house co-ordinator. The registered manager oversees the whole Nutley Hall community.

The service 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.

The registered manager had not consistently notified us of events that had occurred within the service so that we could have awareness and oversight of these to ensure that appropriate actions had been taken. We have made a recommendation about this in our report.

People were kept safe at Nutley Hall. Staff told us they understood the importance of people's safety and knew how to report any concerns Risks to people's health, safety and wellbeing had been assessed and plans were in place, which instructed staff how to minimise any identified risks to keep people safe from harm or injury. Some food safety checks were not being recorded. We have made a recommendation about this in our report.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

There were sufficient numbers of staff employed to meet people’s needs and staff knew people well and had built up good relationships with people. The registered provider had effective and safe recruitment procedures in place.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff treated people as individuals and with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. People’s privacy was respected by staff who valued peoples’ unique characters.

Peoples' health was monitored and referrals were made to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples' care plans.

Staff were kind and caring: good interactions were seen throughout our inspection, such as staff sitting and talking with people as equals. People could have visits from family and friends whenever they wanted.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. There were a range of varied and meaningful activities that engaged people and gave people a sense of belonging in their community.

Complaints were used as a means of improving the service and people felt confident that they could make a complaint that any concerns would be taken seriously.

There was an open, transparent culture and good communication within the staff team. Staff

People at the home had complex needs and were not all able to tell us about their experiences at the home. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with the manager and six members of staff. We sat in on two workshop groups and spoke with some of the people who used the service.

At the time of the inspection there were 32 people who lived at the service.

Our inspection team was made up of one adult social care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. Risks to people who used the service had been identified and there was information on how to manage and minimise risks.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Some medication was not clearly labelled and there was not an effective system to ensure that medicines were disposed of appropriately. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found that a lack of appropriate employment checks meant that the provider could not be certain that people were cared for, or supported by, suitably qualified, skilled and experienced staff. There were gaps in the background checks for the recruitment of staff which included inadequate references and insufficient proof of identity. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. Some records relating to the people who used the service were not clear and there was no consistent approach to the management of records.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. People were able to take part in activities of their choice. The activities on offer supported people in developing their skills and independence.

We found that the staff understood the requirements of the Mental Capacity Act 2005 and carried out decision specific mental capacity assessments and best interest meetings when needed.

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the service and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. We observed that people were treated with respect and dignity. The people we spoke with told us they liked living at Nutley Hall. One person said "I am well looked after".

Is the service responsive?

People’s needs were continually assessed and reviewed. Records confirmed people’s preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people’s wishes. People's needs were reviewed to make sure that changes in needs were identified and action taken.

Is the service well-led?

The manager had been in post for two months and was still becoming familiar with the management systems of the service. There were a number of senior staff responsible for different areas of the service such as medication, training and recruitment. We found that there was no clear oversight of these systems which meant there was a lack of consistency. We spoke with the manager about this who agreed that this needed to be improved.

We looked at the care records relating to people's care and support and saw that people's wishes had been taken into account in planning their care, with support from health professionals and relatives if necessary. Risks to people's health had been assessed and documented. However at the time of our visit there was no effective system in place to demonstrate that people were cared for and supported by staff effectively at all times.

We looked at the procedures for administering medicines to people and found that whilst these were administered safely, they were not always stored and maintained correctly.

Due to people's complex needs they were not able to tell us fully about their experiences of living at Nutley Hall. One person told us they were "happy here" and another told us the staff "were nice". We spoke with one relative who told us they were "very happy with the care here". They said they had never needed to make a complaint and added that the staff were "always very friendly". We spoke with four members of staff, one of whom told us people "have lots of opportunities".

We used a number of different methods to help us understand the experiences of people who used the service because people's complex needs meant they were not fully able to tell us about their experiences. One person told us "I am happy here". Two people we spoke with both said that they liked it there. Throughout the day we observed that people appeared happy, relaxed and comfortable with whatever they were doing.

We found that people were treated with respect by the staff and that they were involved in the running of the service. People were encouraged to have their say and were listened to.

People received the support they needed to meet their identified needs. Care plan information was up to date and contained detailed information about people's needs and how these should be met. Staff were knowledgeable about the people they supported. Up to date risk assessments encouraged people to be independent whilst maintaining their well being.

We found that staff were aware of how to protect people and what to do if they suspected any abuse. There were clear guidelines in place about what action should be taken if staff had any concerns.

Staff were supported in their roles and had the skills needed to carry out their work effectively. One staff member told us "I feel supported" and that they were "Happy" working there. Staff had opportunities to receive specialist training and regular team meetings meant that staff were able to discuss any concerns or issues.

We inspected Nutley Hall on 24 February and 4 March 2015. Nutley Hall provides accommodation and support for up to 33 people. Accommodation is provided from six individual houses, each with its own identity. Two houses are contained within the main building and the four remaining houses are located within the extensive grounds. Nutley Hall refers to itself as a ‘living and working community’ and as such some staff live on site. The service, although not a school, adheres to the general rhythm and routines of the academic calendar. Some people chose to visit their relatives during the holiday periods.

The age range of people living at Nutley Hall is 24 – 85. The service provides care and support to people living with a range of learning disabilities and a variety of longer term healthcare needs. Several people have been living at Nutley Hall for over thirty years. There were 33 people living at the service on the day of our inspection. The home is located in a rural setting and has built good links within local community.

We last inspected Nutley Hall on 2 July 2014. We found the provider was not meeting all the regulations we inspected against. People were not protected against risks associated with medicines. There was a lack of appropriate employment checks and a lack of accurate and appropriate records. The provider submitted an action plan which stated all the required improvements would be made by February 2015.

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 and associated Regulations about how the service is run.

People were happy and relaxed with staff. There were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place.

It was clear staff and the registered manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and care plans developed. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

The service had good links with the local community. Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working at Nutley Hall. The registered manager undertook regular quality assurance reviews to monitor the standard of the service and drive improvement.