This unannounced comprehensive inspection took place over three days on the 30 May, 05 June and 06 June 2018.

Peter House provides residential accommodation and personal care for up to 11 people who have a learning disability or autistic spectrum disorder and mental health needs. Accommodation is provided in one single dwelling as well as care and support provided to people living in nine supported living settings across Essex. This is so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. Other than the inspection of the care home where we did look at the safety of the premises, for the supported living settings, this inspection looked at people’s personal care and support. At the time of our inspection there were nine people living in the residential care home and 20 people supported in the community including supported living units.

The supported living settings had 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.

A registered manager was in post who was also the provider of this and other services but did not have day to day oversight of the service. 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.

At our last inspection in December 2016 the rating for this service was requires improvement. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safe care and treatment of people, a lack of action to lawfully obtain consent and ineffective governance and oversight of the service. We also found staff had not been provided with the training and skills required to meet the complex needs of people who used the service.

Following the last inspection, we asked the provider to complete an improvement action plan to show us what they would do and by when to improve the key questions; Is the service safe?, Is the service effective?, Is the service responsive? And Is the service well-led? to at least good.

At this inspection we found some improvements had been made to meet the relevant requirements, however there were still some areas which required further work. Action was taken by the registered provider during our inspection to rectify the potential risk of scalding from unprotected radiators and the risk of falling of un-restricted windows. However, whilst we acknowledge the registered provider has responded to rectify these shortfalls, these risks to people’s safety had not been previously identified and mitigated prior to our bringing these to the attention of the registered provider.

We recommended that risk assessments in place contain a date scheduled for review to ensure the current arrangements in place continued to meet people’s health, welfare and safety needs.

Not everyone had an up to date care plan which reflected their health, welfare and safety needs. This meant that the current arrangements for identifying people current care needs including risks to people’s welfare and safety were not as robust as they should be and improvements were required.

There were systems in place to monitor people’s level of dependency and to assess the number of staff needed to provide people’s care. However, when cover for staff absences was required there were not always sufficient staff available. This sometimes impact

This comprehensive inspection took place on 07 and 12 December 2016 and was unannounced. Peterhouse is a residential care home that provides care and support for up to eleven people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were nine people using the service.

We last inspected this service on 05 April 2016 where a number of breaches were found. These related to a lack of oversight by the provider to ensure the service delivered was of good quality and safe. People's safety and welfare was compromised because effective quality assurance monitoring processes to identify issues that presented a potential risk to people were not in place. Necessary maintenance work to the environment, staffing numbers, cleanliness and measures to limit the risk of cross infection also required attention. Staff training was also insufficient to ensure staff could care for people with complex needs. At the previous inspection in April we had found five breaches of legal requirements in relation to Regulation 12, 15, 16, 17 and 18 of the Health and Social Care Act 2008. We issued a warning notice for regulation 12 which was to be met by 04 July 2016.

Following the inspection in April 2016, we received an action plan which set out what actions were to be taken to achieve compliance. A subsequent inspection on 09 August 2016 was then undertaken to follow up on the progress the provider had made in meeting the warning notice. At this time we noted that the provider had met the requirements of the warning notice and only the domain of safe was inspected in relation to the physical environment of the service which posed risks to people's health and safety. The inspection at this time did not change the current rating of the service. The overall rating and judgement from the inspection in April 2016 was inadequate and the service was therefore placed in special measures. Three domains of ‘Safe’, ‘Effective and ‘Well Led’ were rated as Inadequate at that time with two further domains of ‘Caring’ and ‘Responsive’ being rated as Requires Improvement.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection we found further improvements had been made to meet the relevant requirements, however there were still some areas which required improvement. The service still required further time to ensure improvements implemented were embedded fully and would be sustained.

Whilst we are clear improvements were evident at this inspection we found breaches in relation to regulation 11 with regard to consent and a few continued breaches in relation to regulation 12 with regard to health and safety, and infection control, regulation 17 and regard to continued sustainably, provider oversight of the service and effective auditing, and regulation 18 with regard to effectively trained staff.

The service had a registered manager in post who was also the provider. Since the last inspection the provider had appointed a new manager, who was to take over the day to day management of the service and had been in post since July 2016. We were told an application for registration was to be submitted and the provider was in the process of doing this. 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 and associated Regulations about how the service is run.

Systems were in place to reduce the risk of abu

This was an unannounced and focused inspection carried out on 9 August 2016.

Peterhouse is a residential care home that provides care and support for up to eleven people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were nine people using the service.

The service had a registered manager in post but they did not manage the service on a day to day basis. The registered manager was also a director of the company that provided the service. 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.

We carried out an unannounced comprehensive inspection of Peterhouse on 5 April 2016 and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was given an overall judgement rating of ‘inadequate’ and is therefore in Special Measures.

Services in Special Measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in Special Measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in Special Measures.

Following the comprehensive inspection on 5 April 2016 we served a warning notice on the provider in relation to the physical environment of the service which posed risks to people’s health and safety. The warning notice included a timescale by when compliance with the legal requirements must be achieved.

We undertook this focused inspection to check that the provider had made improvements to meet the legal requirements in the warning notice, within the given timescale. This report only covers our findings in relation to the warning notice and those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Peterhouse on our website at www.cqc.org.uk.

Measures had been put in place to reduce the risk of fire in the laundry and the risk of the spread of fire from the laundry. The laundry facilities had been refurbished which included fire safety precautions.

Actions had been taken to ensure the means of escape from the premises in the event of an emergency could be safely and effectively used. These included a secure ramp for people who use a wheelchair, new emergency lighting and the removal of rust and moss from the fire escape steps to minimise a slip and fall hazard.

The laundry facilities were fully refurbished and equipped to ena

This inspection was unannounced and carried out on 5 April 2016.

Peterhouse is a residential care home that provides care and support for up to eleven people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were nine people using the service.

The service had a registered manager in post but they did not manage the service on a day to day basis. The registered manager was also a director of the company that provided the service. 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 service had appointed a new manager who commenced in post in January 2016 to take over the day to day management but they were not yet registered with the Care Quality Commission to manage this service. They have been employed to manage Peterhouse and another service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. Services in Special Measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in Special Measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in Special Measures.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There had been a lack of oversight by the provider to ensure the service delivered was of good quality, safe and continued to improve. People’s safety and welfare were compromised because they did not have in place robust and effective quality and assurance monitoring processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried out routinely to identify risks in relation to people's health care needs, the physical environment and fire safety; necessary maintenance work and health and safety precautions had not been taken to protect people from risk of harm. Cleanliness and measures to limit the risk of cross infection had been neglected.

A system was not in place to ensure there were sufficient numbers of staff on duty to support people to follow interests and take part in social and therapeutic activity. There were not enough staff to enable people to go out and to support those who remained at home. People were not supported to participate in meaningful activities and the se

The inspection took place on 18 December 2014 and was unannounced.

Peterhouse is a care service for up to 11 people who have a learning disability or autistic spectrum disorder. People who use the service may also be living with mental health needs, a physical disability or dementia. At the time of our inspection there were 10 people who lived at the service.

At the time of our inspection there was 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. The registered manager was supported in the day-to-day running of the service by an operations manager.

People were safe because staff understood their roles and responsibilities in managing risk and identifying abuse. People’s care needs were identified and they received safe care that met their assessed needs.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in ways they needed and preferred.

The provider understood their responsibilities to provide a safe environment that met people’s individual needs.

People’s health needs were well managed by staff with guidance from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs.

People were treated with kindness and respect by staff who knew them well. When people were unable to make their views known verbally, staff understood their individual ways of communicating what they needed or how they felt.

People were encouraged to take part in activities that they enjoyed and were supported to maintain relationships with friends and family so that they could enjoy social activities outside the service.

There was an open culture and the management team demonstrated good leadership skills. Staff morale was high, they were enthusiastic about their roles and they felt valued.

The management team had systems in place to check and audit the quality of the service. The views of people, their relatives and health or social care professionals were sought and feedback was used to make improvements and develop the service.

Some people spoke with us in general terms but others had complex needs and were unable to discuss their care with us which meant they could not tell us their experiences. Where people communicated with gestures, facial expressions or Makaton signing we saw that they were happy.

Relatives who completed surveys as part of the home’s quality monitoring process were complimentary about the care provided at Peterhouse. One relative said: “We have always found the service very good.” Another relative said: “Fantastic. Really improved and person centred.”

Staff knew people well and we saw that there were respectful and caring interactions between members of staff and people living in the home. We saw that staff listened to people and treated them with consideration.

People received care and support that met their needs and took into account their individual preferences. Staff were able to demonstrate that they understood people's specific needs and they provided care in a person-centred manner.

Staff understood their responsibilities to safeguard people and ensured they received their prescribed medication safely.

There were robust systems in place to recruit staff safely and provide training to ensure they had the skills and knowledge to support people safely.

Peterhouse was well managed and there were effective processes to monitor the quality of the service. They consulted with people and took their views into account to make improvements.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

People living at Peterhouse had complex needs and some were not able to speak with us. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home. One person was able to communicate with us and used some signing to show us what they liked. Another person spoke with us generally and they were looking forward to Christmas and visiting relatives. We could see that they were confident and happy.

During our inspection we saw that people received good care and that staff treated them with respect.

Some of the people living at Peterhouse were unable to talk with us or had limited verbal communication. Several people shared their views through gestures, facial expressions or signs. Through these ways of communicating we were able to see that people were well cared for and happy.

People living in the home told us they were happy.

People who completed surveys as part of the home's own quality assurance process, including health and social care professionals, made positive comments about staff, the improved environment, the quality of people’s lifestyle and the atmosphere in the home.

All the staff spoken with said that they felt people living in the home enjoyed a better lifestyle now.