We carried out this unannounced inspection on the 20 August 2018.

At our last inspection carried out on 24 August 2016 we judged this service as ‘requires improvement’ in the key questions of safe and well led and rated the service as ‘requires improvement’ overall. At this inspection we found that the provider had not made the required improvements we identified at our previous inspection. We found that the provider had failed to make sufficient improvements to the efficiency of their quality assurance systems. This meant that this was the second consecutive inspection whereby the provider had failed to achieve a ‘good’ rating in the well led area of our inspection. As a result of our finding we found that the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what further action we have taken at the end of this report.

21 Elvetham 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. 21 Elvetham Road provides care and support for a maximum of five people who are living with a learning disability. There were three people living at the home at the time of the inspection.

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.

There was 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 2008 and associated Regulations about how the service is run.

The provider’s quality monitoring systems had either not identified some of the areas for improvement that we found during our inspection or when identified by their own system had then not been followed up on in a timely way.

People’s needs had been assessed and care plans developed to inform staff how to support people. However, care records did not fully reflect the detail of specific health care conditions. Some risks to people were not well managed.

Staff had not received all the training they needed. However, the registered manager took action to address this and a training plan was put in place following our inspection.

People were supported for by staff who were trained in recognising and understanding how to report potential abuse. People’s dignity was maintained and people were communicated with in their preferred way.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The provider was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS).

People were supported to take part in activities and were involved in their day to day care and chose how to spend their day. People were encouraged to maintain their independence and were supported to meet religious and cultural needs.

People spoke positively about the care staff .Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them. There was a friendly and calm atmosphere within the home.

People were supported to maintain a healthy diet that met their cultural and dietary needs. Systems were in place to ask people their views about the home and to listen to concerns and complaints.

This inspection took place on 24 August 2016 and was unannounced. We last inspected the service in June 2014 and found it was compliant with all the regulations we looked at.

The home had 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 is registered to provide care for up to five people who have a learning disability. Five people were living there when we inspected, but we did not meet with one person as they were in hospital.

Our visit found that some records were not up to date. This included people’s care plans and some sampled records contained conflicting information. We also found that records of healthcare appointments attended by people were disorganised and made it difficult to locate information about when people had last attended routine health checks. Some of the records we requested to look at were not available.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff we spoke with were knowledgeable about how to protect people from the risks associated with their specific conditions and took prompt action when they thought a person was at risk of harm. People’s care records did not always reflect the detailed knowledge about people’s conditions that staff expressed to us.

People who used the service and people important to them told us that the home was safe. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice. There were sufficient staff to meet people’s needs. Staff told us that they were given the opportunity to develop their knowledge and skills in order to carry out their roles effectively.

People were protected from possible errors in relation to their medication because the arrangements for the administration and recording of medication were good. There were robust systems for checking that medication had been administered in the correct way.

The registered manager had approached the appropriate authority when it was felt there was a risk that people were being supported in a way which could restrict their freedom. Staff had been provided with training about the Mental Capacity Act 2005 (MCA) and were aware that applications had been submitted to restrict people’s liberty.

People were kept safe from malnutrition because they were offered a choice of foods and drinks they liked. Staff knew how to support people to eat and drink enough to keep them well. People were supported to have their mental and physical healthcare needs met. The registered manager sought and took advice from relevant health professionals when needed.

People told us that they were happy at this home. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting. People and, where appropriate, their relatives, were consulted about their preferences and people were treated with dignity and respect.

Records that were required to be maintained were not always well maintained or available. The registered manager had a good level of understanding in relation to the requirements of the law and the responsibilities of his role. They had been in post under six months before our visit and were in the process of identifying what needed to improve and taking actions to achieve this.

There were good arrangements for making sure that people were asked for their consent in relation to their care and treatment. Where people were unable to give consent, staff had received suitable training and there was guidance to make sure that decisions were made by appropriate people.

People told us that they were happy at this home. One person said, “I can do what I want to”. People told us about their favourite hobbies and interests and their plans for holidays and days out. Staff told us about the changes in their work patterns so that people could be better supported to do the things they chose to do.

Staff made sure that people were provided with choices in relation to food and drink, whilst making sure that their nutritional needs were met. Staff made use of the services of relevant health professionals when people had specific needs in this area. Staff enabled people to prepare items of food for themselves when possible. Mealtimes were social occasions when staff joined the people in the home at a large table.

There were appropriate arrangements for making sure that medicines were stored, administered and recorded properly so that people were protected.

There were enough staff, with relevant experience and qualifications to meet the needs of the people in the home.

We met three people who lived in this home. They told us that they liked living there. They showed us their bedrooms and the items which they had chosen to personalise them.

People told us that the staff supported them to live the lives they wanted to live. They said that they chose what to do each day, when they got up and went to bed, what they ate and what they wore.

People told us about the activities they undertook on a regular basis, such as knitting, shopping and baking. They also described outings to places of interest and courses which they had taken part in including flower arranging, puppetry and music. They said that staff would support them to go wherever they wanted to go.

All three people confirmed that they felt safe in this home.

We spent time observing staff as they provided support to people who lived in the home. We saw people making choices about what they wanted to do, where they wanted to go and what they preferred to eat. They looked relaxed in the company of staff.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found –

Is the service safe?

People told us and indicated that they felt safe in this home. They looked relaxed and content in the company of staff. One person said, “It is safe here, the staff are kind.”

There were good systems for checking that the environment was safe.

Staff had received training in safeguarding people and there were good arrangements for staff to report colleagues should they suspect that their practice could lead to people being harmed.

CQC monitors the operation of the Deprivation of Liberty Safeguards, (DoLS), which applies to care homes. We found that proper policies and procedures were in place and the manager demonstrated a good level of awareness of this area. Staff had also received training in the Mental Capacity Act and DoLS.

Is the service effective?

People indicated that they were happy with the care and support and their needs were being met.

It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. The staff team was settled.

Staff had received relevant training to meet the needs of the people living at the home.

Staff were well supported and they told us that they enjoyed their job.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience when communicating with people, offering them choices, waiting for them to respond and respecting the decisions which they had made.

People told us that they liked the staff and found them helpful. One person said, “They all look after me well.”

Staff demonstrated that they knew people’s needs and preferences and showed that they took these into account when supporting people.

Is the service responsive?

People’s needs had been assessed before care plans had been drawn up. We saw that people’s plans took account of their needs and choices and had been updated when these had changed.

Records confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded. Staff showed that they were aware of the contents of people's plans. Care and support had been provided in accordance with people’s wishes.

People had access to a range of activities in the community and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

There were good systems for quality assurance.

People in the home and their relatives were consulted about the service.

Staff and relatives told us that the manager was accessible and took account of their comments.

The manager demonstrated a good level of knowledge about the people in the home, the staff and the systems used in the home.