We carried out this unannounced inspection on the 21 August 2018.

At our last inspection carried out on 09 February 2017 we judged this service as ‘requires improvement’ in the key questions of safe, responsive 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.

21a 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. 21a Elvetham Road provides care and support for a maximum of five people who are living with a learning disability. There were five 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 always 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 9 February 2017 and was unannounced. We last inspected the service in June 2016 where we identified that improvements were needed to make sure the service was responsive and well led. Activities on offer to people needed to be improved and care plans needed to be updated. Quality monitoring systems were not always effective and there was not a registered manager in post. This inspection found that some improvements were still needed.

21A Elvetham Road is registered to provide care for up to five people who have a learning disability. Five people were living there when we inspected.

Since our last inspection the manager had registered with us and they were available throughout our inspection visit. 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.

One incident between two people at the home had not been responded to in line with local safeguarding procedures and risk assessments had not been reviewed following the incident. This meant that not all possible action had been taken to keep people safe from the risk of future incidents. People who were able to speak with us confirmed that they did feel safe living in the home. Some people we met found verbal communication difficult, we observed these people looking relaxed and showing happiness with their facial expressions and body language. 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 who received opportunities to further develop their skills. People received the correct medication at the correct times. All medication was administered by staff who were trained and competent to do so.

People had care plans in place, but some of these were not current. Action to ensure the care plans were updated was in progress. People were supported to engage in activities but further development was needed to promote opportunities for activities in the community.

People were supported by staff who had been trained and were aware of people’s needs. The registered manager had in most instances approached the appropriate authority when it was felt there was a risk people were being supported in a way which could restrict their freedom. For one person, this had been delayed but had been done a few days before our inspection visit. 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 supported to maintain good health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs.

People told us or indicated by gestures and their body language 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.

The registered manager had a good level of understanding in relation to the requirements of the law and the responsibilities of his role but in some instances had not made expected referrals to the local authority. The systems in place to review and improve the quality and safety of the service were not always effective.

This inspection took place on 23 June 2016 and was unannounced. We last inspected the service in June 2013 and found it was compliant with all the regulations we looked at.

The home did not have a registered manager in post. A new manager had been appointed who had recently applied for registration. 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. Three of these people had moved to the home the week of our visit.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Some of the staff we spoke with told us that they had not yet had the time to read people’s care plans or risk assessments and they were relying on verbal information from other staff who knew people’s needs. People who lived at the home were not consistently offered opportunities to participate in activities they enjoyed.

Whilst the staff provided positive feedback about the manager of the home they had concerns about the process that had been followed in moving three new people into the home in the same week. The manager had a good level of understanding in relation to the requirements of the law and the responsibilities of his role. They had only been in post for a short time before our visit but were already in the process of identifying what needed to improve and taking actions to achieve this. There were some areas of practice where audits had not been completed or had identified that improvement was needed.

People who used the service and their relatives 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 who received opportunities to further develop their skills.

People were protected from possible errors in relation to their medication because the arrangements for the storage, administration and recording of medication were good and 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 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) but not all staff were aware that applications had been submitted to restrict peoples liberty.

People were supported to maintain good health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs.

People told us or indicated by gestures and their body language 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.

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 indicated they were happy at this home. They showed that they were relaxed in staff company and were able to communicate their choices. 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 when they wanted to do them.

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 took care to prepare people’s food in specific ways so that it was easy to eat and tasty. 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. People were always supported by people they knew and with whom they were able to communicate.

We met the five people who lived in this home. They all had visual impairment and other complex needs. Some were not able to talk with us about their care. Those who were able told us that they were happy and had no complaints. People showed us their bedrooms, which contained items which they had chosen to personalise them.

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 contacted the relatives of two people who lived in the home. They told us that they were pleased with the standard of care. One told us that their relative, “seems really happy” and “overall, everything’s fine”.

A health professional who visits the home on a regular basis expressed satisfaction with the care and said staff always followed any instructions which she left after her visits.