About the service:

- The service is in a residential area of Syston, a suburb of Leicester.

- The service provides accommodation and personal care to people with learning disabilities and autism. The care home can accommodate 10 people in one building. At the time of our inspection there were seven people using the service.

People's experience of using this service:

• The service provided a safe service.

• People and relatives told us that people liked living at the service.

• There was a homely atmosphere for people.

• People were protected against abuse, neglect and discrimination. Staff members were aware of ensuring people's safety and acting when necessary to prevent any harm.

• Staff members knew people well and people appeared to enjoy the attention from them.

• People were assisted to have choice and control of their lives.

• People and their representatives had a say in how the service was operated and managed.

• People's care was personalised to their individual needs.

• Audit processes were in place to ensure quality care. Questionnaires had been supplied to people and their representatives for their views of the service. These were overwhelmingly positive about people’s satisfaction with the service.

• A registered manager was not in place. This will be monitored as it is a condition of registration, to ensure comprehensive governance of the service.

• The service met the characteristics for a rating of "good" in all key questions except well led, where it was rated Requires Improvement due to a registered manager not being in place.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated "good". Our last report was published for the inspection of 16 June 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

This was an unannounced comprehensive inspection that took place on 16 June 2016. At the last inspection completed on 14 May 2015, we found the provider had not met the regulations for four areas; notifications, safeguarding service users from abuse and improper treatment, need for consent, and good governance. At this inspection we found the provider had made the required improvements and the regulations were being met.

Pear Tree Grove is a care home registered to accommodate up to 10 people who have a learning disability or who are on the autistic spectrum. The home has 10 single bedrooms, two lounges and a dining room. The home has a large landscaped garden. At the time of the inspection eight people were using the service.

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 told us that they felt safe when staff supported them and that they enjoyed living at Pear Tree Grove.

Risk assessments were in place which described how to support people in a safe way. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

The provider carried out checks before staff started to work at the service to make sure that staff were suitable to work. There were enough staff on duty to meet the needs of the people who lived at the service.

People received their medicines as it had been prescribed by their doctor. Staff were trained and assessed as competent to administer medicines.

Staff were supported through training and supervision to be able to meet the needs of the people they were supporting. They undertook an induction programme when they started to work at the service.

Staff sought people’s consent before providing personal care. People’s capacity to make decisions had been considered in their care plans.

People were supported to maintain a balanced diet. People were supported to access healthcare services.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity. Staff understood people’s needs and preferences.

People were involved in decisions about their care. They told us that staff treated them with respect.

People were involved in the assessment of their needs. People and their relatives were involved in the review of their needs.

People were supported to take part in activities that they enjoyed.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

The service was well organised and led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

People were asked for their feedback on the service that they received. The provider carried out monitoring of the quality of the service.

This inspection took place on the 14 May 2015 and was unannounced.

At our last inspection carried out on 25 September 2013 the provider was meeting the regulations.

Holly Lodge Court provides accommodation for up to ten people who are aged over 18 and who have learning disabilities. The home has ten single bedrooms, two lounges and a dining room. The home has a large landscaped garden. There were nine people living at the service at the time of inspection.

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 living at the service were happy and felt able to speak to the manager about any concerns. They told us there were always enough staff and that the staff were kind.

There were policies in place to ensure that people’s medicines were safely managed but these policies had not always been followed to ensure that people were protected from the associated risks.

People told us they enjoyed the food and that they were able to choose what they had to eat, but there was a restriction placed on people’s choices of drinks at night. People told us that their privacy was respected, but we found that people were not able to lock the shower room door.

There were regular meetings held with people who used the service where discussions about events they would like to attend took place. There was an annual holiday to the seaside and an annual trip to London that took place.

People had care plans in place that identified their needs and provided information about how they could be met. People told us they were able to make decisions about their care and how they spent their time.

Staff were supported in their roles and they had a consistent understanding of the services vision and values. Staff felt that any concerns they raised with the registered manager would be addressed.

Decision specific mental capacity assessments had not been carried out where there had been a concern identified about a person’s capacity. The service had made a decision relating to a person’s care and treatment and not acted in accordance with the Mental Capacity Act.

Incidents of abuse and allegations of abuse had not been identified as safeguarding concerns and had not been reported and dealt with appropriately. This also meant the registered manager had failed to notify CQC of incidents that are required to do so by law in order to help protect people using services. Risks assessments had not been updated following incidents to keep people safe.

Quality assurance systems that were in place had failed to identify the concerns that we found did not identify or manage risks associated with the environment.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three people who used the service and looked at responses relatives had made to a recent questionnaire survey. People told us that they liked living at the home and were satisfied about how they had been supported by staff. One person told us, "I'm happy here. I go out most days. There is enough to keep me occupied." Another person told us, "The staff are good to me." Relatives had made favourable comments about the service. One relative expressed, "The staff seem very committed and caring and there is good continuity with the staff." Another relative said, "I cannot see how you can improve the care given."

The provider had involved residents and relatives in decisions about the care and support provided. The provider had listened to and acted upon people's feedback. Many activities, outings and holidays had been arranged in direct response to suggestions that people had made. People's choices about what they had at meal times and how they spent their time had been respected. An important factor was that the home had a well established work force with very little turnover. That meant that staff had developed a good understanding of the needs of the people they supported. The provider had ensured that staff had continued to attend relevant training.

We found that the service was safe, effective, responsive and caring.

The service did not have a registered manager at the time of our inspection but the provider was taking steps to appoint one.

We spoke with four of the ten people who used the service. All four people told us that they enjoyed living at the home. They told us that they liked that they were able to spend their time how they wanted and that they had enough to do that kept them occupied. One person told us that they liked their bedroom and the amount of space at the home. They added, "The staff are nice to talk to, I have good conversations with them. All of the residents fit in." Another person told us, "I have a lot to do." We saw people reading, doing puzzles, colouring books and conversing with people. Six people who lived at the home were at a local day centre on the day we visited the home.

We found that the service supported and encouraged people to make decisions about how they wanted to spend their time. People's health and welfare needs had been met because the service had supported people to attend appointments with health professionals or had arranged for health professionals to visit the home. People were supported by staff who had received relevant and appropriate training.

We spoke with all of the people who lived at the home. Each one told us that they liked living there and were happy. One person told us that he enjoyed the activities he took part in which included playing lawn green bowls, and arts and crafts. Another person told us that all the people living at the home got on well with each other and the people who supported them. She especially enjoyed having choices about how to spend her time.