This inspection took place on 14 June 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

The service was last inspected in April 2016 and was rated good. However, at that inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. We found records had not always been fully completed and contained gaps. We took action by requiring the provider to send us an action plan setting out how they would improve the service. When we returned for this inspection, we found that records had improved, but the provider was still in breach of the regulation relating to good governance as their governance processes had not identified or acted on the issues we found during our visit.

At the 2016 inspection we also found that the provider was in breach of the Care Quality Commission (Registration) Regulations 2009 as they had not submitted all required notifications to CQC. We took action to address this outside of our inspection process by writing to the provider to remind them of their duties under the regulations.

Real Life Options – 12 Linden 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. It accommodates up to six people in one adapted building. At the time of our inspection six people were using the service.

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 manager. The manager had joined the service at the beginning of 2018 and was in the process of applying to become the 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.

The premises were not maintained in a way that was safe for people to use. Fire safety procedures were not always followed or in place.

Personal risks to people arising out of their health conditions and support needs were assessed and action taken to address them. Accidents and incidents were monitored to see if improvements could be made to help keep people safe. People were safeguarded from abuse. People’s medicines were managed safely. The manager and provider monitored staffing levels to ensure enough staff were deployed to support people safely. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively and were supported with regular supervision and appraisals. 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 at the service supported this practice. People were supported to maintain a healthy diet. People were supported to access external professionals to monitor and promote their health.

The building the service was based in had been adapted for the use of people living there. We made a recommendation that the provider reviews the accessibility of the garden to ensure it is accessible for people using the service.

Throughout the inspection we saw staff offering support in a kind and caring way. People were treated with dignity and respect and were encouraged to maintain their independence. People were supported to access advocacy services.

People received personalise

This inspection took place on 22 and 23 February 2016. The first day was unannounced which meant the staff and registered provider did not know we would be visiting. The registered provider knew we would be returning for the second of inspection.

Twelve Linden Road can provide accommodation for up to six people who live with a learning disability. It is a purpose built detached house in its own grounds within a residential area of Brotton. Care and support is provided to people on both floors of the service which can be accessed via stairs. At the time of our inspection there were six people living at the service.

The registered manager had been in place at the home for many years. 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 previously inspected this service on 17 January 2014 and found that the service was meeting all of the regulations we inspected on that occasion.

All safeguarding incidents had been logged on the local authority’s consideration log which the service updated every month. Separate safeguarding alerts had not been made.

Each person had a Deprivation of Liberties Safeguard in place to keep them safe from harm. We could see that these had been carefully considered to look at the least restrictive options.

Accidents and incidents had been reported and appropriately investigated.

People had risk assessments and personal emergency evacuation plans in place.

Staff told us they felt confident in dealing with an emergency situation and had received up to date first aid training.

There was enough staff on duty to provide care and support to people. Staff levels changed to accommodate people’s individual needs.

Staff had been appropriately recruited. Disclosure and Barring Service checks and references had been sought prior to employment.

Staff had been appropriately trained to dispense prescribed medicines which people received on time.

Most certificates for the day to day running of the service were up to date; where two had expired we saw that the registered manager had booked these in with the appropriate services.

Staff training was up to date. All staff received regular supervision and appraisals. Staff told us they felt supported to carry out their roles at the service.

A four week menu was in place, however alternatives were always available. People were supported at mealtimes and monitoring was in place to ensure people received appropriate nutrition and hydration.

People were regularly supported to attend appointments with a variety of health professionals including their GP, dentist and optician.

There was a communal living and dining room at the service; each person had their own bedroom which had been decorated to their individual wishes.

Staff showed kindness and compassion to people. They gave people the time they needed and were not rushed.

Staff involved people in any decisions made during their day. Staff gave explanation and used appropriate communication methods to interact with people.

People had been able to access an advocate to speak on their behalf when they had needed to.

Staff provided detailed examples about how they maintained and respected people’s privacy and dignity.

Staff supported and encouraged people to maintain contact with those important to them.

Care records were very detailed and reflected people’s wishes, preferences and daily routines. This meant staff could provide the most appropriate support to people when, and how they wanted it.

People were encouraged to give feedback generally and in reviews of their care. Staff made sure people’s care reflected their individual needs and choices.

There were some gaps in records looked at during inspe

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

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

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

During the inspection we observed the interactions between staff and people who were using the service. We heard people being offered choices and supported to make decisions.

We saw people treated with dignity and respect by staff. The three members of staff we spoke with told us they knew people’s likes dislikes and what made them happy.

The people using the service had limited verbal communication skills. We observed staff using other methods to communicate and engage with people. With the support of key workers we were able to have some communication with people in the home.

We observed people living in the home returning from activities. The staff were attentive and interacted well with people. We saw that people were made comfortable and offered drinks. We observed staff explain everything to people in a way that could be easily understood.

We were able to observe the experiences of people who used the service. The people we observed seemed happy and relaxed with staff.

The home had a safeguarding procedure in place; staff had received training and were knowledgeable about how to deal with safeguarding concerns.

There were appropriate arrangements in place for the recruitment of staff.

The home had a complaints procedure in place and this was accessible to people who used the service and their relatives.

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