At the last inspection on 27 September 2017, we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 good governance. We asked the provider to take action to make improvements in their auditing procedures.

Following the inspection, the provider wrote to us, to tell us the action they would take to meet legal requirements. At this inspection we found improvements had been made.

67a St Georges Road is a ‘care home’ registered to provide accommodation and personal care for up to three people with learning disabilities. 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. At the time of the inspection three people were living at the service.

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

The home manager was in the registration process. 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 safe. Staff understood their responsibilities to safeguard people and to report any concerns. Staff had received training to ensure they remained up to date with recognising the signs of abuse and what to do about it.

People were protected from risks. Where risks had been identified, risk assessments were in place with guidance for staff on action to take to manage the risks. Medicines were administered, stored and managed safely. Protocols were in place to manage ‘as required’ PRN medicines.

Staff had a good understanding of the Mental Capacity Act (2005) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions.

People were treated as individuals by staff who respected people’s diverse needs and individual preferences. Care plans were personalised and reviewed or updated when people’s needs changed.

The home requested and gained feedback, all of which was positive. There was a complaints procedure in place and no complaints had been received in the 12 months prior to the inspection.

The staff spoke positively about the provider and the management team. The home manager felt supported by senior managers and the values of the service were evident throughout the staff team.

At the last inspection on 27 July and 3 August 2016, we found breaches of legal requirements. We asked the provider to take action to make improvements on developing person centred care plans and to assess people’s mental capacity to make complex decisions. After the comprehensive inspection, the provider wrote to us to say the action they would take to meet legal requirements in relation to Regulations 9 and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvements were made.

67a St George’s Road is registered to provide accommodation and personal care for up to three people with learning disabilities. At the time of the inspection three people were living at the service.

This inspection was unannounced and took place on 27 September 2017

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.

Quality assurance systems were in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. Monthly self-assessments audits were undertaken by the registered manager which senior manager’s reviewed. However, the internal self- assessment was not consistent with the findings of this inspection. For example, findings from the care planning and medicine self-assessments had not identified any shortfalls.

Some people were prescribed with when required medicines (PRN) for pain relief including topical creams and to reduce agitation. Medicine procedures gave staff direction to develop protocols on the administration of PRN medicines. However, protocols were not always in place for medicines to be administered when required. This meant staff were making decisions on when to administer PRN medicines instead of having clear guidance on administering PRN medicines consistently.

Where people used non-verbal language to communicate, a pain assessment tools was used by staff to assess the person’s level of pain. The pain scale ensured staff were able to identify the level of pain the person was experiencing and take appropriate action. For example, administer pain relief.

People were able to follow their own preferred routines during the day. Care plans were variable and some were more people centred than others. Although the care plans had been reviewed, the dates and the progress made were not included. Staff said the quality of the care plans had improved. One person told us where their care plan was kept and told us staff had read their care plan to them.

One person told us they felt safe living at the service. Other people living at the service were not able to tell us what feeling safe meant to them. The staff we spoke with said they had attended safeguarding of abuse training. They knew how to identify the signs of abuse and were knowledgeable about the procedures for reporting their concerns.

We saw good interactions between people and staff. We saw staff use humour with one person and a gentle approach to help another person who became distressed. Arrangements were in place for people to have in-house activities, one to one outings and trips in the local community

Staff were aware of the individual’s risks which included supporting people with mobility needs and for people at risk of choking. Intervention charts were completed for repositioning, food and fluid intake and for weight monitoring. This meant preventative measures were taken to ensure risks were minimised.

Staff were supported to develop their skills and to meet the responsibilities of their role. One to one supervision was with the registered manager. Staff said during their one to ones they discussed their concerns, the people at the service and performance.

When pe

This inspection took place on the 27 July and 3 August 2016 and was unannounced. At the previous inspection visit which occurred on 12 June 2014 we found breaches of regulations. The provider took action to meet the requirements of the regulations made at the previous inspection. This included adapting the environment to provide people with suitable bathing facilities.

This service is registered to provide accommodation and personal care for up to three people with learning disabilities. At the time of the inspection there were three people living at the service.

A registered manager was in post on the first afternoon of the inspection but on the second day we were informed the registered manager was no longer in post. We were told the registered manager was leaving their post on 31 August 2016. The provider had made arrangements to cover the day to day management of 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.

There was a lack understanding from staff on the principles of the Mental Capacity Act 2005 (MCA). MCA assessments were not always carried out for specific decisions such as bed rails and administering covert medicines. Staff had asked relatives without legal powers to give their consent for male staff to deliver personal care.

Support plans lacked detail and were not person centred. Support plans were inconsistent with Person Centred Plans (PCP) and risk assessments. Guidance from healthcare professionals was not used to develop detailed support plans. This included helping people to develop meaningful activities and for eating and drinking. While support plans were dated to indicate a review had taken place for some people, the plans had not been updated for a significant period of time. Action plans were not developed. This meant support plans described how people liked their care to be delivered but they did not incorporate guidance from healthcare professionals and the effectiveness of the support plans was not evident.

Assessments were developed to ensure people were able to take risk safely and to minimise the risks to people’s health and welfare. Staff knew the actions needed to minimise the identified risks. However, some assessments were inconsistent with people’s support and PCP plans.

Quality assurance systems were in place. However, the internal self- assessment was not consistent with the findings of this inspection. For example, all standards assessed were shown as met including care planning and MCA.

The person we asked said they felt safe with staff. Members of staff we spoke with were aware of the safeguarding of vulnerable adults from abuse procedures. These staff knew the expectations placed on them to report allegations of abuse.

Two staff were on duty on both days of the inspection. Staff said two staff were needed to assist with moving and handling manoeuvres. The rotas in place confirmed there was a minimum of two staff during the day. We saw there were three staff on duty during the week to enable people to go out. For example, shopping, swimming and for meals out. At night one member of staff was awake in the premises.

People were supported with their ongoing healthcare needs. Reports from healthcare professionals showed people had input from specialists and they had regular check-ups for example dentists.

People told us they approached staff with concerns. One person said the staff were kind and caring. This person also told us their rights were respected by staff.

Medicine systems were safe. The person we asked said the staff administered their medicines. They said at times they refused to take their medicines and the staff gave them time and returned to check they had changed t

We considered our inspection findings to answer questions we always ask: 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. The summary is based on our observations during the inspection, speaking with people using the service, the feedback care staff gave and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

Staff spoke to people in a caring, friendly and respectful manner. There were many positive interactions between staff and people who used the service. Staff spent time with people and encouraged people’s involvement in conversations and decision making. Staff supported people in an attentive and sensitive way.

Is the service responsive?

Staff were attentive to people’s needs and responded positively to people without delay. People were regularly asked what they wanted to eat and drink and what they wanted to do. Staff responded appropriately and fully involved people in any interventions undertaken.

The environment had not been updated to meet people’s changing needs. Due to this, not all people were able to access the bathroom to have a bath or a shower. This significantly compromised people’s rights.

Is the service safe?

Systems were in place to ensure the safety of the environment. Equipment had been checked to ensure it was safe to use.

Clear systems were in place to administer people’s medicines. People had medicine profiles which detailed how they liked to take their medicines. Staff had received training in the safe handling of medicines and policies and procedures were in the process of being reviewed.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications from this home had been required. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People had detailed support plans in place, which provided staff with the information they required, to meet individual needs.

Training was given priority to ensure staff had the knowledge and skills to undertake their role effectively. Staff felt well supported and used both formal and informal supervision to discuss and review their practice.

Is the service well led?

The manager worked as part of the staffing roster and knew people well. There were regular meetings to ensure information was shared and views could be given. The systems in place enabled good communication within the staff team.

Whilst senior managers undertook audits as part of their monthly visits, the manager checked practice on a day to day basis. These checks were not recorded and formal audits were not undertaken.

During our visit we were able to meet with two of the three people who lived at the home. The other person was unwell so we did not disturb them. One of the people we met told us they were happy living at the home. The other person was unable to verbally communicate with us but we observed positive interactions between them and the staff on duty.

All of the staff had attended training on the Mental Capacity Act 2005. Evidence in care records demonstrated the provider had considered people’s capacity to make decisions about their health and welfare. We saw where people were unable to make major decisions best interest meetings had been held within a multi-disciplinary team.

We saw people’s likes and dislikes had been considered when the menu was compiled.

We toured the home and found it to be clean and tidy throughout. There was a cleaning schedule completed by members of staff.

We looked at the recruitment records of the most recently recruited member of staff and saw all appropriate information had been gathered and recorded. A member of staff we spoke with described their induction period and the training they had completed.

Arrangements were in place to ensure people could raise any concerns if they needed to. The manager told us there were no current complaints. We saw many visiting health care professionals had made compliments about the service and the care received for people.

There were three people living at this service. We looked at records, met and talked with two people and made observations throughout the visit. One person said they were ‘treated well’. Another person said they 'feel respected' and 'well cared for' by the staff.

We observed staff caring in a polite and professional manner throughout the visit. People in the service were respected.

The care records were an accurate reflection of people's support needs and described how those needs were to be met. Information was clearly recorded in order to provide good continuity of support at all times.

People said they were listened to and their opinions were respected. One person told us that they were given time to make their own decisions and that they were able to talk to staff if they had concerns.

People commented that they were happy to live at St George’s Road. One person said ‘I really like it here.’

The person we spoke with told us people got up and went to bed when they chose. People had their own interests and links in the community, which they were supported to maintain. We heard about people going out and about in the home’s car. People often experienced being with staff one-to-one. All the staff knew people well and treated them as individuals. People were supported to make choices, such as when and where they wished to eat

The person told us about their health action plan. We could see from health action plans that people had been very involved with staff in putting them together in ways they could understand.

The person told us they valued feeling safe in the home, or when they went out, which was always with their key worker.

We found all the home was clean and looked after. People living in the home chose how their own rooms and the shared rooms were decorated. We saw new furniture some people had been supported to get, to make their lives easier.