The inspection took place on 31 August 2018 and was unannounced. At our last inspection on 5 July 2015, the service was found not to be meeting the required standards in the areas we looked at. They were rated requires improvement in Safe and Well-led.

At this inspection we found that the provider had made the improvements required. However, we have found other areas that require improvement and have spoken about this in the body of the report. The rating remains as Requires Improvement.

Quince House provides care for up to six young people with a learning difficulty. At the time of our inspection six people were living at Quince House. Quince House 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.

The care service has not 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. We found that peoples dignity was not always promoted, staff interaction did not always ensure a positive experience. People were not always supported to follow their activities due to staffing.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. However, staffing numbers were not always sufficient to meet people’s individual needs.

Infection control was not always managed appropriately by all staff.

Documentations had not always been completed appropriately.

Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Complaints were recorded and responded to in line with the service policy.

People, relatives and staff were complimentary about the registered manager and how the home was run and operated.

The inspection took place on 5 and 13 July and was unannounced. At our last inspection on 25 August 2015, the service was found to be meeting the required standards in the areas we looked at. Quince House provides care for up to six young people with a learning difficulty. At the time of our inspection six people were living at Quince House.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People were not consistently supported to maintain good health and have access to health and social care professionals when necessary. Staff had not followed the guidance detailed in care plans to ensure people were safe.

Safe and effective recruitment practices were not consistently followed to help ensure that all staff were suitably qualified and experienced.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service. We found that the registered manager had not reported a reportable incident to CQC.

Audits and care plan reviews were completed; however we found that these had not identified areas of concern.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Trained staff helped people to take their medicines safely and at the right time. Relatives were positive about the skills, experience and abilities of staff who worked at the home.

Staff received training and refresher updates relevant to their roles and had regular supervision to discuss and review their development and performance.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support provided.

The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

Complaints were recorded and responded to in line with the service policy.

This inspection was carried out on 20 August 2015 and was unannounced.

Quince House provides care for up to six young people with learning difficulties. On the day of our visit there were five people living at the home.

When we last inspected the service on 14 November 2014 we found them to not be meeting the required standards in relation to regulation 10 Health and Social Care Act 2008. At this inspection we found that they had met the required standards.

There was 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 and associated Regulations about how the service is run.

The provider failed to display the CQC ratings from the last inspection.

Care plans were personalised and included information about people’s history and interests. People’s individual needs were assessed and were specific to people as individuals. Staff were knowledgeable about how to manage people’s individual needs and assisted people to take part in appropriate daily activities.

Medicines for people was managed safely

People felt safe and staff were knowledgeable about how to protect people from the risk of abuse. Accidents and incidents were monitored to ensure the appropriate actions were put in place to prevent reoccurrence.

There were regular quality assurance checks carried out to assess and improve the quality of the service.

The provider used safe recruitment practices.

Staff received regular training and knew how to meet people’s individual needs. There were regular meetings held for staff to share information and keep up to date with changes in people`s needs.

The staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and the importance of giving people as much choice and freedom as possible. The CQC is required by law to monitor the operation of the MCA 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS were not always in place where required to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection not all applications had been made.

People were offered a choice of nutritious food in accordance with their needs and preferences.

Staff were kind and had positive relationships with people. Choices were given to people at all time’s people’s privacy and dignity was respected and all confidential information about them was held securely.

The manager promoted an open culture. They encouraged staff to take on more responsibilities and promoted their professional development. The manager also had regular supervisions to support staff.

Summary of findings

This unannounced inspection was carried out on the 12 November 2014.

Quince House provides accommodation, support and treatment for up to six people living with learning difficulties. At the time of the inspection there were five people living in the home.

The service has 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 provider had effective recruitment processes in place, and there were sufficient staff employed however they were not always deployed effectively on a day to day basis.

People’s needs had been assessed, and care plans took account of people’s individual care and treatment needs, preferences, and choices. However, people’s records were not always up to date with relevant information.

There were risk assessments in place that gave guidance to the staff on how risks could be minimised. However these were not always up to date. There were systems in place to safeguard people from the risk of abuse and medicines were managed safely.

The staff had appropriate training, supervision and support, however they did not fully understand their roles in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have sufficient food and drinks in a caring and respectful manner.

People were supported to access other health and social care professionals when required. However the home did not always use the services available in the community effectively. The people were supported to continue their relationships with their family members and friends.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to improve the quality of the service.

During this inspection we found the service to be in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the personal care or treatment records of people who use the service, carried out a visit on 5 August 2014, observed how people were being cared for and talked with staff.

What people told us and what we found

An inspector from the Care Quality Commission (CQC) conducted this inspection. We looked at care records and other records pertaining to the safe running of the home. The people who live at Quince House did not have verbal communicating skills, however we saw that they were able to make their needs and wishes know to the staff. We saw that the staff clearly understood them. We spoke with the staff on duty and they were able to tell us about the needs and wishes of the people who lived at Quince House.

We inspected this home on the 07 and 09 November 2013 and we found that they were not meeting the standards in relation to nutrition, management of medicines, premises, assessing and managing the quality of the service and the storage of records. We also had information of concern relating to the home. The purpose of this visit on 05 August 2104 was to ascertain if those standards were being met and to explore the information we received. We found the people who lived at Quince House were well cared for and that home compliant in all areas.

Is the service caring?

We observed three of the five people who lived in the home. We saw that they displayed signs of wellbeing and that care had been taken to prepare them for the day. We saw staff interact with the people in a kind and caring manner.

Is the service responsive?

We did not look at this aspect of care on this occasion. However we found at the last inspection that the care and welfare of the people was promoted.

Is the service safe?

At our last inspection on 07 and 09 November 2013 we found that the people who lived at Quince House could be at risk from hazards in the home and from the possible use of out of date food. On this occasion we found that all food was labelled and that the environment was clean and safe. We found that there were systems in place to ensure that medication was ordered, stored, administered and when not used returned to the pharmacist appropriately.

Is the service effective?

We did not look at this aspect of care on this occasion. However we found at the last inspection that the people had good physical health and were integrated in to the community.

Is the service well led?

At our last inspection we had concerns that the home did not have an auditing system in place. An auditing system in needed to ensure that all aspects of people’s care was reviewed on a regular basis. On this occasion we saw that the manager had introduced a system to audit the use of food supplies, the storage and administration of medication and a house keeping rota had been introduced. The people who lived at Quince House or their representative and the staff had been offered the opportunity to comment on the service offered to the people this ensured people’s needs were recognised and met.

We were unable to speak directly to the people who use the service. We watched the interaction between the staff and the people. We found that the staff were able to understand the non verbal communications of the people and we saw that their needs were recognised and met.

We spoke with the relative of one person who told us that they were very happy with the care provided to their relative. We saw correspondence from other relatives and found that they were complementary about the staff and the home manager.

People’s care needs were documented and were reviewed regularly. Risk assessments had been carried out to ensure the safety and to promote the independence of the people.

You can see our judgements on the front page of this report.

When we visited Quince House on the 17 November 2011, whilst we had limited verbal communication with the people living there, we were able to communicate non-verbally and to observe the way that choices were offered to them by care staff, the way that care and support was provided for them and the interaction between them.

All of the interactions and communication we observed, of whatever kind, were appropriate, respectful, unhurried and enabled the people living in Quince House to make their views clear and to influence when and how their care was provided and what activities they carried out on the day.

On this occasion we did not speak to people living in Quince House about assessing and monitoring the quality of service provision. We did however see copies of surveys, completed by people living in Quince House that enabled them to give their view of their experience of living there and the care they received.

We were unable to communicate directly with the people who lived at Quince house because they had limited verbal communication. We made observations around people’s interactions with staff and how they spent their time in the home. The manager showed us around the home and we raised a number of concerns about the upkeep of the home. Furthermore there were a number of safety issues in the home environment and we found that the surroundings did not promote peoples wellbeing.

We found that people had care plans in place which were detailed and appropriate to inform staff about the level of support people required. Consent had been obtained and the consent forms had in some cases been signed, new forms were being introduced and the manager told us that they were in the process of obtaining consent from family members or advocates.

We looked noted that food had not been properly maintained and some was out of date. The provider did not have appropriate arrangements in place for the safe administration of medication and we found some medication was out of date. The quality monitoring arrangements that were in place were inadequate and the limited information that was received was not evaluated or used as a means to improve the quality of care. We noted that Records were not stored and or disposed of in a way which protected people’s confidential information, or in accordance with the data protection act 1998