We completed an unannounced inspection at 20 Oulton Road on 22 November 2018. At our previous inspection on 08 December 2016 we found that improvements were needed to ensure systems were in place to safeguard people from abuse. We asked the provider to send us an action plan to show how the improvements were to be made and when these would be completed. The service was rated as Requires Improvement overall. At this inspection we found the required improvements had been made.

20 Oulton Road 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.

20 Oulton Road accommodates a maximum of five people. At the time of the inspection there were five people using the service. 20 Oulton Road followed 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.

There was a registered manager at 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 registered manager was visible, approachable and acted as a role model for staff. There was a strong focus of person centred care within the service, which staff followed in practice to ensure people led a full and varied life. Staff were encouraged to create and develop ways to increase community links which achieved positive outcomes for people. Feedback was welcomed to drive improvements in people’s support which had made a positive difference to people's quality of life.

People were empowered to have choice and control over their lives and had been actively involved in community projects and consultations which affected the local area they lived in, this meant people experienced an improved quality of life because they were supported to explore new opportunities and were proud of the achievements they had made. Complaints systems were in place and people were supported to understand and make decisions about their end of life.

People received safe care and we found there were enough staff to provide support to people that met their needs. We found that people’s risks were assessed and managed to protect them from the risk of harm and people received their medicines safely. The provider had safe recruitment procedures in place to ensure that staff were of a good character and suitable to support people who used the service. People were protected from infection and cross contamination risks.

People were supported to make decisions about their care and staff sought people’s consent before they carried out support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s nutritional needs were met and people had positive mealtime experiences. People had access to health care services and advice sought was followed by staff to ensure people’s health and wellbeing was maintained. Staff received training to enable them to support people effectively. The environment was designed and adapted to meet people’s needs and promote independence.

People were treated with dignity and staff were caring and kind. People’s privacy was respected an upheld, people chose to have time to themselves in their private rooms and staff respected their wishes. Staff understood people’s individual communication needs. Staff supported people to maintain relationships with relatives/friends.

This unannounced inspection took place on 24 October 2017. At our previous inspection in November 2015 we found no concerns and the service was rated as good. At this inspection we found that the service was not consistently safe or well led and there was one breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

20 Oulton Road provides accommodation and personal care for up to five people with a learning disability. At the time of the inspection there were five people using the service.

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 2008 and associated Regulations about how the service is run.’

People were not always safeguarded from the risk of abuse as action was not always taken to report or investigate incidents of abuse. The systems the provider had in place to ensure that incidents of abuse were reported were not always effective.

There were sufficient numbers of staff available to support people.

Risks of harm were assessed and people were supported to remain safe and independent through the effective use of risk assessments.

People's medicines were stored and administered safely and staff received support and supervision to remain effective in their roles.

The principles of the Mental Capacity Act 2005 were followed to ensure people's capacity to consent to their care was assessed. When people lacked the capacity they were supported to consent by their legal representatives.

People were supported to eat and drink sufficient amounts of food and drink of their liking. When people became unwell or their health needs changed, health care advice and support was gained.

People were treated with dignity and respect and were encouraged to be as independent as they were able. People's right to privacy was upheld and their relationships respected.

People's support was delivered based on their individual assessed needs and preferences. There was a complaints procedure and people knew how and who to raise concerns with. The registered manager and providers were responsive to concerns and were liked and respected by the staff and relatives.

This inspection took place on the 4 February 2016 and was unannounced. At our previous inspection in 2013 we found no concerns in the areas we looked at.

20 Oulton Road provided accommodation and personal care for up to five people with a learning disability. Five people were using the service at the time of the inspection.

The registered manager supported us throughout the 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 2008 and associated Regulations about how the service is run.

People were protected from abuse as staff knew what constituted abuse and who to report it to if they suspected it had taken place. There were sufficient staff to keep people safe and to support people to follow their hobbies and interests.

People's medicines were managed safely. Risks to people were minimised to encourage and promote people's independence. Staff were clear how to support people to maintain their safety when they put themselves at risk.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the principles of the MCA by ensuring that people consented to their care or were supported by representatives to make decisions.

Staff were supported to fulfil their role effectively. There was a regular programme of applicable training.

People's nutritional needs were met. People were supported to eat and drink sufficient to maintain a healthy lifestyle.

People were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

Staff were observed to be kind and caring and they told us that were well supported by the registered manager.

Care was personalised and met people's individual needs and preferences. The provider had a complaints procedure and people knew how to use it.

The provider had systems in place to monitor the quality of the service. When improvements were required these were made in a timely manner.

We inspected The Cottage as part of our scheduled inspections to check on the care and welfare of people who used this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with people who used the service. People told us they were happy living at 21 Oulton Road and there were plenty of things to do. Some people who used the service had gone out for the day. Other people were getting ready and preparing for their daily activities.

We spoke with staff about the care and support they provided each day. They gave a detailed account of the specific individual needs of people. We saw staff supported people in a caring and compassionate way.

We looked at the care plans of people who used the service and found they were up to date and documented the specific care needs of people.

We looked to see if people's medication was being managed properly. We found the service had systems in place to ensure medication was handled safely and securely.

The service had a complaints procedure which detailed how to deal with any comments and complaints made by people who used the service or their relatives. Staff told us they had not received any complaints recently.

We found that 20 Oulton Road was compliant in the five outcome areas we looked at.

The people who use the service have autonomy over their weekly activities and lifestyle choices. Staff all work in a person centred manner to ensure that support is personalised and that individual needs are met. The provider ensures that all documentation is completed thoroughly to ensure that needs are identified and met by the team. The team have a thorough knowledge of safeguarding vulnerable adults and this reflects in their knowledge. The team are long standing and well supported by the provider. We also saw that there was a system in place for monitoring the quality of service provision and how the information gathered helps to shape future provision.