This unannounced inspection took place on 10 January 2017. This meant the registered provider and staff did not know that we would be attending.

We previously inspected the service on 26 October, 10 November and 11 December 2015 and found that the service was not meeting all of the regulations which we inspected. We found the service was not meeting the regulations for safe care and treatment and good governance. We found that risk assessments were incomplete and care records had not been updated when people’s needs had changed or when they had been recommendations from health professionals involved in people’s care. People had missed healthcare appointments. There were significant gaps in all records looked at during inspection and audits had not highlighted these gaps. We also found that the registered provider had not been regularly visiting the service to monitor the quality of the service. We asked the registered provider to take action to improve the quality of the service and issued a warning notice for the quality of record keeping at the service.

Real Life Options: 58 Ormesby Road is a service for people living with a learning disability. The service is registered to provide accommodation for up to six people who require personal care. At the time of inspection there were six people using the service. The service was located in a residential area within its own grounds and had on-site parking. The service was located close to local amenities.

The previous registered manager had been registered with the Commission since 13 January 2013; however they had left the service in December 2016. 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. A new manager was in place at the time of inspection; they had been employed by the registered provider for many years. They had started the application process to become the registered manager.

At this inspection, we found that the registered provider had listened to our concerns and had taken action to improve the quality of the service. Significant improvements had been made to all records which meant that staff had the most accurate and up to date information to provide care and support to people which reflected their needs, wishes and preferences. Good systems were now in place to make sure people’s health and well-being needs were regularly reviewed. They now visited the service each month and carried out a comprehensive review of the service and provided action plans and feedback to the manager.

Staff showed they understood the procedures which they needed to follow if they suspected someone was a risk of abuse. Staff were able to discuss the types of abuse which people could be at risk from and how they could help to minimise these risks. All staff spoken with told us they would not hesitate to whistle blow (tell someone) if they suspected abuse had occurred.

Detailed risk assessments were in place which were individual to people and demonstrated the action taken to reduce the risks to people. These had been regularly reviewed. Staff recognised that people were vulnerable to harm because they did not always recognise risks to themselves.

Health and safety certificates were up to date and showed that the service was safe for people and staff.

All staff had a Disclosure and Barring Service check in place. DBS checks help employers make safer decisions and prevent unsuitable people from working with vulnerable client groups.

There were enough staff on duty to provide care and support to people. Staffing levels changed throughout the day to meet people’s needs and to provide one-to-one activities to people out in the community.

Good procedures were in place to manage people’s medicines.

This inspection took place on 26 October 2015, 10 November 2015 and 11 December 2015. 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 and third day of inspection.

Fifty eight Ormesby Road is a large detached house situated in a residential area of Normanby which can provide accommodation for up to six people who live with a learning disability 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 five 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 58 Ormesby Road on 9 February 2015. We found that checks of the emergency lighting for the service had been overdue and some policies such as quality assurance, Deprivation of Liberties Safeguards (DoL’s) and health and safety had not been reviewed for some time. There were no records to show that applications to deprive a person of their liberty had been made or reasons for this decision making. Records such as training and recruitment, weight charts, key worker reports and cleanliness were not up to date.

At this inspection we could see that all staff were aware of safeguarding procedures and training was up to date. The service had dealt with safeguarding alerts appropriately. All staff told us they felt confident discussing any concerns they may have had.

Risk assessments were in place for people and had been reviewed. Risk assessments for the day to day running of the service had also been regularly reviewed. Certificates relating to the day to day running of the service were up to date.

Each person who used the service had detailed personal emergency evacuation plans in place. This meant people involved in the emergency situation could provide people with the most appropriate support.

There were enough staff on duty to provide care and support to people and staffing levels changed according to people’s activities each day. People who used the service were involved in the interviews of potential staff members.

Medicines were managed appropriately. There were sufficient stocks of medicines in place for people. We highlighted some gaps in medicine records which were rectified during inspection.

People lived in an adapted house with bedrooms available on the ground and first floor. People had access to a variety of communal spaces on the ground floor and also had a large garden which they could access.

We could see that staff knew people well. Staff told us about people’s likes and dislikes as well as their daily routines. People, their relatives and staff had good relationships with each other.

Each person who used the service had deprivation of liberties safeguards in place to keep them safe. Although people could not always make their own decisions, staff did try to involve them where possible. Staff always sought people’s consent before any care and support was provided.

Staff told us that people’s relatives were involved in making decisions about people because they had safeguards in place to protect them however the records did not always show this.

People’s dignity and respect was maintained. People were not rushed when supported by staff and staff gave explanations when needed. Staff also supported people to access the local community and maintain relationships with the people important to them.

A complaints policy was available at the service. No complaints had been received at the service during 2015.

Meetings f

The inspection visit took place on the 9th February 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on 26 November 2013 and found the service was not in breach of any regulations at that time.

58 Ormesby Road provides care and support for up to six people who live with a learning disability. There were six people living at the service at the time of our inspection. The home does not provide nursing care. The detached house is situated in North Ormesby, close to all amenities and transport links.

There is a registered manager in post, although they manage additional services run by the provider so are not at Ormesby Road full-time. 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. On the day of our inspection the registered manager was at the service.

One person told us; “I like it here” when we spoke with them but other people using the service were not able to communicate with us so we observed staff interaction with them which was positive and caring.

We observed that people were encouraged to participate in activities that were meaningful to them. For example, one person had been out bowling with a support worker. We observed a good handover between staff members both before and after the activity so that staff were aware of whether this person had enjoyed the activity or not.

The registered manager told us that everyone at the service had an application for a Deprivation of Liberty Safeguard with the authorising body but there was no documentation to confirm if these had been approved or not at this stage and there was no evidence of applications being submitted in the care files that we viewed.. We also stated to the manager that the Care Quality Commission (CQC) should have been notified of the applications being submitted.

We were told that staff were recruited safely and were given appropriate training before they commenced employment. Some records from the provider’s Human Resources department could not be located in staff files as to their suitability to commence employment. We had to verify this information after the inspection with staff from the HR division. Staff had also received more specific training in managing the needs of people who used the service such as the management of epilepsy and positively supporting people when they displayed behaviour that challenged. Training records were not complete which meant that a record of exactly what training staff had completed at the service were not available.

There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the registered manager and of each other. Medicines were also stored and administered in a safe manner.

There was a programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify and support their personal and professional development.

We saw people’s care plans were person centred and had been well assessed. The home had developed care plans and communication aids to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from going to day services to helping to make their lunch. One person had very recently transitioned into the home and we saw this had been planned and assessed so it was as smooth as possible.

The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible and were supported to independently use public transport and accessing regular facilities such as the local G.P, shops and leisure facilities.

Although there were regular medicines audits there was not a system in place for checking the quality and safety of the service being provided. Policies were not up to date and the last quality check on the service had been carried out in August 2014 and there was no record of any actions required or completed after this check.

Records within the service that related to incomplete staff recruitment files, policies being out of date, training records not reflecting what had been provided and aspects of person centred review action plans not being carried forward into care plan for monitoring and other documents such as cleaning charts not being fully completed meant that the service was not keeping records up to date.

We saw a regular programme of staff meetings where issues where shared and raised and staff told us they were able to raise comments on where the service could improve. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people.

We found the provider was breaching a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.

The inspection visit took place on the 9th February 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on 26 November 2013 and found the service was not in breach of any regulations at that time.

58 Ormesby Road provides care and support for up to six people who live with a learning disability. There were six people living at the service at the time of our inspection. The home does not provide nursing care. The detached house is situated in North Ormesby, close to all amenities and transport links.

There is a registered manager in post, although they manage additional services run by the provider so are not at Ormesby Road full-time. 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. On the day of our inspection the registered manager was at the service.

One person told us; “I like it here” when we spoke with them but other people using the service were not able to communicate with us so we observed staff interaction with them which was positive and caring.

We observed that people were encouraged to participate in activities that were meaningful to them. For example, one person had been out bowling with a support worker. We observed a good handover between staff members both before and after the activity so that staff were aware of whether this person had enjoyed the activity or not.

The registered manager told us that everyone at the service had an application for a Deprivation of Liberty Safeguard with the authorising body but there was no documentation to confirm if these had been approved or not at this stage and there was no evidence of applications being submitted in the care files that we viewed.. We also stated to the manager that the Care Quality Commission (CQC) should have been notified of the applications being submitted.

We were told that staff were recruited safely and were given appropriate training before they commenced employment. Some records from the provider’s Human Resources department could not be located in staff files as to their suitability to commence employment. We had to verify this information after the inspection with staff from the HR division. Staff had also received more specific training in managing the needs of people who used the service such as the management of epilepsy and positively supporting people when they displayed behaviour that challenged. Training records were not complete which meant that a record of exactly what training staff had completed at the service were not available.

There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the registered manager and of each other. Medicines were also stored and administered in a safe manner.

There was a programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify and support their personal and professional development.

We saw people’s care plans were person centred and had been well assessed. The home had developed care plans and communication aids to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from going to day services to helping to make their lunch. One person had very recently transitioned into the home and we saw this had been planned and assessed so it was as smooth as possible.

The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible and were supported to independently use public transport and accessing regular facilities such as the local G.P, shops and leisure facilities.

Although there were regular medicines audits there was not a system in place for checking the quality and safety of the service being provided. Policies were not up to date and the last quality check on the service had been carried out in August 2014 and there was no record of any actions required or completed after this check.

Records within the service that related to incomplete staff recruitment files, policies being out of date, training records not reflecting what had been provided and aspects of person centred review action plans not being carried forward into care plan for monitoring and other documents such as cleaning charts not being fully completed meant that the service was not keeping records up to date.

We saw a regular programme of staff meetings where issues where shared and raised and staff told us they were able to raise comments on where the service could improve. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people.

We found the provider was breaching a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.

During this inspection we observed that people were treated with respect and that their needs were well understood by staff. We were only able to speak with one person due to limited verbal communication skills and with the support of staff, we were able to have some communication with other people who lived at the service. We saw that staff communicated with people sensitively and there was a warm and welcoming atmosphere in the home. We saw that people who lived in the home were involved in different activties on a regular basis and were supported by staff to pursue their interests

We looked at three care plans which showed that a person centered planning approach was taken to assess needs and deliver appropriate care. We found that there were clear policies and procedures in place for the administration of medication and measures in place to reduce risks of drug errors.

We found that staff were supported to undertake training to enable them to deliver quality care, staff meetings were held and staff had regular supervision but we saw that staff had not had annual appraisals in the last eighteen months.

The home had a complaints procedures in place which was accessible to people and their relatives. Mechanisms were in place to undertake health and safety audits.

We found that there were care plans in place and these were regularly reviewed. We saw that records were not always signed and dated by staff and some decisions had not been formally recorded.

During this inspection only one person was able to speak with us due to limited verbal communication skills. With the support of key workers we were able to have some communication with other people. We spoke with the manager, deputy manager, key worker and a support worker from another care agency.

We observed people living in the home and returning from activities. 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. A relative told us, “I am happy with things here, I am very involved with the care plan and they keep us involved in everything with regular meetings. “

We observed people returning from activities with support workers from other agencies. The staff were attentive and encouraging when interacting with people. We found evidence of good communication with other agencies.

We found the premises that people, staff and visitors used were safe and suitable.

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.

We were able to have some communication with people with assistance from their key workers. They had both enjoyed their day and had favourite activities. During our inspection visit we observed care, talked to staff and reviewed the care records.