We carried out this inspection on 25 and 26 July 2018. The inspection was unannounced on the first day, which meant the nobody knew we were visiting. On the second day of the inspection, we told the registered manager we would be coming. Our last inspection took place on 15 March 2016 and the service was rated as good. You can read the report from our last inspections, by selecting the 'all reports' link for 'Quarryfields Health Care Limited' on our website at www.cqc.org.uk. Quarryfields Health Care Limited is a 'care home'. 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.

Quarryfields is a purpose-built home on the outskirts of Doncaster close to local facilities and transport links. It accommodates up to 25 people with a learning disability or autistic spectrum disorder, who require personal and/or nursing care. The home comprises of a four-bedroomed house, a one-bedroomed house, two eight bedded bungalows, a two-bedded flat and two-single occupancy flat. 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.

The service had 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 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.

Since our last inspection the service has not sustained the rating of good in all areas. The registered manager acknowledged that the service needed to make improvements in some areas. The registered manager and registered provider had commenced an action plan to capture and address the shortfalls that had been identified during the inspection.

People were not always protected from risks of harm or abuse. We looked at a sample of people’s daily records and saw incidents had not always been referred to the local authority, or escalated to senior staff so appropriate actions could be taken. Staff told us they did know how to report safeguarding concerns. Staff had been trained in safeguarding although we saw that a significant proportion of safeguarding training had expired. This meant staff’s knowledge may not have been up to date.

There was enough staff on duty to meet people's needs and we saw staff were effectively deployed. There was a recruitment system in place that helped the employer make safe recruitment decisions when employing new staff.

New staff told us they received a structured induction and training at the beginning of their employment. A significant number of staff had not received refresher training to update their knowledge and skills. Where this had not taken place, the registered manager said they had identified these shortfalls. However, refresher training had not been arranged in a timely way and some staff had not received training updates since 2017. Formal supervision did not always take place. However, staff told us they were supported and able to speak to the manager.

We saw there were systems in place to make sure the premises and equipment was maintained and serviced as required. Records we looked at showed gas and electrical safety tests were carried out at the correct intervals. Records also showed that fire equipment had been serviced. Fire exits were clear and staff understood what to do to support people in the event of an emergency evacuation.

Risks to people’s health and welfare had been identified. These had been regularly re

The inspection took place on 15 March 2016 and was unannounced. We last inspected the service in August 2014 when it was found to be meeting with the regulations we assessed.

Quarryfields is a purpose built home on the outskirts of Doncaster close to local facilities and transport links. It accommodates up to 24 people with a learning disability or autistic spectrum disorder, who require personal and/or nursing care. The home comprises of a four bedroom house, a one bedroom house, two eight bed bungalows, a two bed flat and a single occupancy flat.

The service had 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 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 we spoke with told us they felt safe living in the home. Throughout our inspection we saw staff encouraged people to be as independent as possible while taking into consideration their wishes and any risks associated with their care. People’s comments, and our observations, indicated people using the service received appropriate support from staff who knew them well.

People received their medicines in a safe and timely way from staff who had been trained to carry out this role.

There was enough skilled and experienced staff on duty to meet people’s needs. There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. New staff had received a structured induction and essential training at the beginning of their employment. The majority of staff had received timely refresher training to update their knowledge and skills. Where this had not taken place the registered manager had identified shortfalls and was arranging further training.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

The Deprivation of Liberty Safeguards were only used when it was considered to be in the person’s best interest. This legislation is used to protect people who might not be able to make informed decisions on their own. The registered manager demonstrated a good awareness of their role in protecting people’s rights and recording decisions made in their best interest.

We saw people received a well-balanced diet and were involved in choosing, shopping for and helping to prepare what they ate. People’s comments indicated they were happy with the meals provided. We saw specialist dietary needs had been assessed and catered for.

We found people’s needs had been assessed before they moved into the home and they had been involved in formulating support plans. Records reflected people’s needs and preferences so staff had clear guidance about how to support them. Support plans and risk assessments had been regularly evaluated to ensure they were meeting each person’s needs, while supporting them to reach their aims and objectives in a safe way.

A varied programme of activities and education took place both in-house and in the community which was tailored to each person’s individual needs and interests. People told us they enjoyed the activities they took part in, which they felt enhanced and improved their lives and abilities.

The provider had a complaints policy to guide people on how to raise concerns and there was a structured system in place for recording the detail and outcome of any concerns raised.

There was a system in p

Our inspection looked at 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. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

The home was clean and fresh throughout. We saw there were effective systems in place to reduce the risk and spread of infection.

The provider had systems in place to ensure the service was safely run. For example we saw regular audits were carried out on topics such as housekeeping and medication practices.

Records, and people’s comments, indicated there were enough qualified, skilled and experienced staff on duty to meet their needs in a timely way.

The company had policies and procedures in place to help protect people who used the service from abuse. We found staff had received training in relation to safeguarding vulnerable people from abuse and update sessions took place annually.

Is the service effective?

People’s health and care needs were assessed on a regular basis and care plans updated to reflect their changing needs. People who used the service, and the visitors we spoke with, said they were involved in writing and reviewing care plans.

People told us they were encouraged to be involved in social activities, attend day centres and carry out day to day living skills, such as cooking and doing their laundry. One person described how they were involved in growing vegetables and maintaining the garden. Another person said they enjoyed horse riding, undertaking educational courses and going to community discos.

We saw staff had access to a varied training programme that helped them meet the needs of the people they supported.

Is the service caring?

People were supported by enthusiastic, caring staff who were knowledgeable about their needs and preferences. During our visit we saw staff interacting with people positively. They encouraged them to be as independent as they were able to be, while providing support as needed.

We saw people looked well-presented and cared for. We spoke with five people who used the service and two visitors. They said they were happy with the care provided and raised no concerns. One person told us, “They (staff) help me make meals and keep my room tidy.”

Care records contained good information about people’s needs and preferences. This included the people important in their lives and their personal aims, as well as their aspirations and goals.

Is the service responsive?

Care records demonstrated that when there had been changes in people’s needs, outside agencies had been involved to make sure they received the correct care and support. For example, we saw staff had monitored some people’s behaviour, and if additional support was needed timely referrals had been made to GPs or other healthcare professionals.

The home had a complaints procedure which was available to people using and visiting the service. We saw when issues had been raised action had been taken to address them.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People’s comments indicated they were mainly happy with how the service operated and the home’s facilities.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included in-house and company audits as well as various surveys. The deputy manager told us action plans were put in place to address any shortfalls and these were monitored by the company management team.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

The Expert by Experience spoke with five people who used the service and one staff member. Overall, people told the Expert by Experience that they were very happy living at Quarryfields.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

There was an effective complaints system available, although no one had made any complaints.

We spoke with four people who used the service and were able to speak with three people in private. People who used the service told us they were happy living at Quarryfields. One person said, "I like the staff, they help me."

People who used the service said staff were, “Helpful.” and “Supportive.”

One person said they were, “Absolutely brilliant.”

They said that staff listened to them. Everyone said they felt safe in the service. Some people said they would tell the manager if they were worried about anything. Others said they would talk to their named nurse. People told us they were happy with the care provided and were involved in decisions about their care. All of the people we spoke told us they had lots of choices about things. Two people told us they attended their review meetings. One person said, "They listen to what I say."

Another person said, "We have meetings to talk about things, like activities we want to do."

One person told us that they chose how the house they lived in was decorated.