This inspection took place on the 28 and 29 November 2017. It was an unannounced visit to the service.

Reach Vale 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.

Reach Vale Road accommodates six people in one adapted building. It is registered for people with a learning disability. At the time of this inspection five people were living there.

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.’

At the previous inspection on the 17 November 2016 the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to act in accordance with the Mental Capacity Act 2005. Records were not up to date, accessible and fit for purpose and effective systems were not in place to audit and monitor the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions effective and well-led to at least good. At this inspection we found the provider had made improvements to comply with those regulations.

People and their relatives were happy with the care provided. They felt their family members received safe care from staff members who were well supported by the registered manager. They described Reach Vale Road as “home from home.”

We found the home provided safe, effective, caring, responsive care to people in a service that was well-led.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had care plans in place which provided detailed guidance to staff on the support people required. People’s records were suitably maintained. Further improvements to records were identified and planned.

Systems were in place to safeguard people. People were provided with the information and opportunities to raise concerns. Risks to people were identified and managed. Accident and incidents were appropriately responded to and reported on which enabled trends and reoccurrences to be picked up and addressed.

People’s health and nutritional needs were met. They had access to other health professionals and were supported to take their medicines. Safe medicine practices were promoted.

People had access to activities and whilst there had been a decline in people accessing community activities this was recognised and being addressed.

Staff were kind, caring and had a positive relationship with people. They had a good understanding of people’s needs. Staff were developing communication with people by use of signs and pictures to further promote people’s understanding and involvement.

The home had a number of staff vacancies which they were attempting to recruit into. The required staffing levels were maintained and regular agency staff were used to cover shifts to promote continuity of care for people.

The home was clean and suitably maintained. Systems were in place to ensure equipment was safe to use and that infection control risks were minimised. People were provided with equipment to promote their safety and independence.

Staff were suitably recruited, inducted and trained to fulfil their roles. They received support from the registered manager and one to one supervision meetings with staff took place. The registered manager recognised this was not at the frequency outlined by the provider and was looking to improve the frequ

This inspection took place on 17 November 2016. It was an announced visit to the service. This meant the service was given 24 hour notice of our inspection. This was to ensure staff were available to facilitate the inspection and the home was accessible.

Vale Road is a care home which provides accommodation and personal care for up to six people with learning disabilities. At the time of our inspection there were six people living in the home.

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.

The home was previously inspected in July 2014. It was compliant with regulations in place at that time.

At this inspection we found people were provided with staff who were caring, responsive and people’s safety was promoted. However, improvements were required to the effectiveness, management and monitoring of the service.

Decisions around people’s care and treatment were not made within a best interest meeting and in line with the Mental Capacity Act 2005.

People’s records were not effectively maintained or fit for purpose. An assessment document was not in use. Care plans were disorganised, not detailed and specific as to the care required. Information in relation to handovers, activities and meals eaten was not accessible.

The provider carried out quality monitoring visits and some quality audits were being introduced. However, all aspects of care and practice were not being audited and monitored.

The registered manager was accessible, approachable and actively involved in people’s day to day care. Relatives and staff were very complimentary about the registered manager and the positive changes they had brought about since being in post.

People were provided with pictorial menus, however props, aids and objects of reference were not routinely used to promote people’s involvement in all aspects of their care. Information for people was not available in a user friendly, accessible format and therefore their involvement within the home was limited. This was being developed.

Systems were in place to safeguard people. Their medicines were given as prescribed. Risks to people were identified and managed.

Staff were kind, caring and had a good relationship with people. They promoted people’s privacy, dignity and respect.

The home was clean and maintained. People had access to activities and their health and nutritional needs were met.

Staff were suitably recruited, inducted, trained, supervised and supported. Staffing levels were sufficient and flexible to meet people’s needs.

The provider was in breach of two regulations and was not meeting the requirements of the law.

You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

We found staff were knowledge around safeguarding issues and were able to tell us how they would raise their concerns and escalate them further if required. Where safeguarding incidents had occurred, the provider had taken appropriate steps to ensure the relevant authorities where contacted. We saw contact numbers for the local authority were readily available to people who used the service. We spoke with three people who used the service. One person told us “I feel safe here, if I didn’t I would talk to X (staff member).” Another person told us they also felt safe. We found risk assessments and care plans were thorough and concise and detailed how potential risks should be reduced.

We found people were protected against the risk of harm in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Where people were assessed as lacking capacity, appropriate procedures were followed to ensure arrangements were in people’s best interests and in line with the correct legal framework.

This meant the service was safe.

Is the service effective?

We found regular audits where undertaken and highlighted actions where improvements were needed. We saw evidence that these were acted upon accordingly and learning was implemented. We saw the provider worked closely with other professionals to ensure people’s care and welfare, for example community learning disability teams, GP’s and speech and language therapists. We saw care plans and risk assessments were reviewed annually and updated accordingly to reflect people’s current needs.

This meant the service was effective.

Is the service caring?

We saw positive interactions between staff and people who used the service and found the home to have a calm atmosphere. Staff supported people to access the community and during the morning, were asked if they wanted to participate in music and dancing. Staff promoted conversations with people who used the service and met their needs in a timely and professional manner. We observed lunch time and saw staff supported people with their meals with minimal disruption. We saw one person did not want their lunch and they were offered an alternative.

This meant the service was caring.

Is the service responsive?

We saw care plans and risk assessments were updated where changes had occurred around their care and treatment. We saw the provider had robust systems in place to deal with foreseeable emergencies, for example an on call person. This meant if a person had to attend hospital, they could be accompanied by a member of staff. We found people’s requests were met in a timely manner and people were supported to undertake activities of their choice on that day. Health appointments were recorded clearly and we saw evidence of follow up appointments where required. We saw the provider welcomed compliments and complaints and acted upon them appropriately.

This meant the service was responsive.

Is the service well-led?

Regular quality monitoring visits where undertaken by the provider which highlighted areas for improvement. People were involved in regular reviews of their care including professional input, family input and the person themselves. The manager undertook yearly audits of the service which included looking at principles of care such as dignity, privacy and respect. We saw accidents and incidents were analysed to identify trends and patterns. One staff member told us “The management are great. They listen to us and are always open to us bringing new ideas on how to make improvements.”

This meant the service was well-led.

The people we met were happy and said they felt well looked after; people were relaxed and told us they enjoyed living at the home. These people also told us that they regularly went out on shopping trips, out to the cinema and attended a variety of local social clubs of their choice. We looked at a range of people’s weekly activity plans and we noted that a broad range of weekday, evenings and weekend activities were promoted. We spoke with one person who told us, “I am going home for the weekend but I like it here and I am going with my key worker next week to have my hair cut.”

We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal leisure activities or social goals. We looked at four care files that demonstrated the personalised approach in place to support the staff’s comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training and support that enabled them to provide a high quality of care.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who used the service. We observed staff assessing people’s needs and ensuring that care was provided in line with individual care plans. We were able to see that people were comfortable and that there was adequate numbers of staff available to provide the individualised support needed.

We spoke with relatives of two people using the service. Both expressed a high level of satisfaction with the service. One person said they were “Very, very pleased”. They told us their relative participated in a lot of activities and was very happy living there. They said their relative seemed to get particular benefit from the ‘intensive interaction’ (a therapeutic approach towards communication with people with severe learning difficulties) which was practiced in the service. They told us the home kept them informed of developments. Overall, they described the care as “Excellent”. Another person expressed similar views. They said they were happy with all aspects of the service. Their relative was very well looked after, they got out and about with staff and participated in activities in the service as well. Both relatives said the present staff group were particularly good, they described them as enthusiastic, caring and supportive. Both told us they were confident they were being well looked after.

We found the service had arrangements in place to provide the care and support people required. The service involved people in decisions about their care. It had procedures to protect people from the risk of abuse. People were looked after by staff who were appropriately trained and supported. The provider had arrangements for monitoring the quality of the service provided to people.