We carried out this unannounced inspection on 31 August 2018. Earlswood House is a care home without nursing. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this 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.” Registering the Right Support CQC policy.

Earlswood House accommodates up to eight people in one building. At the time of our inspection seven people lived at the home. At our last inspection on 09 November 2016, we rated the service as ‘Requires improvement’ in the key questions of safe and well-led and ‘Good’ in the key questions of effective, caring and responsive. We rated the service as ‘Requires improvement overall’.

During our most recent inspection we found improvements had been made and we rated the service as ‘Good’.

A registered manager was 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.

People were protected from the risk of harm or abuse because staff were aware of the actions they should take to escalate any concerns for people’s safety. Effective systems were in place to assess, monitor and manage people’s known risks. There were sufficient numbers of staff available to meet people’s needs. People received their medicines safely. The home environment was clean and systems were in place to audit infection control practices.

People were supported by staff who had the skills and knowledge to care for people effectively. People were asked for consent before care was provided. Where people’s rights were restricted this had been done lawfully. People received sufficient food and drink. People were supported to access healthcare professionals when required.

People were supported by staff who were kind and caring. People were supported to maintain their independence as much as possible. People were supported to make their own decisions and staff respected their dignity and privacy. Staff understood people’s needs, preferences and communication styles.

People were involved as much as possible in the planning of their care. Staff supported people to follow their interests and hobbies. The provider had a system in place to monitor and manage complaints.

Staff felt supported by the registered manager and were aware of their roles and responsibilities. There was a system in place to monitor the quality of the service provided to people and people had been asked to feedback about the service. The registered manager had submitted notifications to CQC of specific events as required by law

Earlswood House is registered to provide accommodation and support for up to eight people with a learning disability. There were eight people living at the home when we inspected. We last inspected this service in October 2015 and found that improvements were needed in all of the five key question areas. We also identified that the provider was in breach of the regulations as quality monitoring systems had not been effective. We had received an action plan from the provider and this inspection found that improvements had been made and there were no breaches of regulation.

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.

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 people looking relaxed and showing happiness with their facial expressions and body language. Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse.

Additional staff had been recruited so that the use of agency staff had been reduced and people were usually supported by staff who knew them well. Some improvement was needed to the deployment of staff to make sure people had the required level of supervision to keep them and others safe. New staff that had commenced had been provided with an in-house induction and had also attended the providers own induction on how to care for people and work safely. Staff told us that they were given the opportunity to develop their knowledge and skills in order to carry out their roles effectively.

People told us, or indicated by gestures, 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's changing health and wellbeing needs were responded to and people had regular access to health care professionals to maintain their health. People were usually given a choice of foods and staff knew what people liked to eat. Meals were prepared according to people's specific dietary needs.

Systems to monitor and develop the quality of the service people received had been improved but not all incidents had been investigated and used to learn lessons to prevent similar occurrences in future.

The service had a registered manager. Staff said the manager was approachable and available to speak with if they had any concerns. The provider and registered manager had used feedback from the last inspection to make some improvements to the service.

Earlswood House is registered to provide accommodation and support for up to eight people with a learning disability. There were eight people living at the home when we inspected. We last inspected this service in November 2013.

At the time of this inspection there was a manager in post but they were not registered. 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. There had been no registered manager since June 2014.

People who were able to speak with us confirmed that they did feel safe living in the home. Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse.

There was not enough suitably competent and experienced staff to accompany people to go out from the home or to undertake activities in the local or wider community, and this restricted people’s choices. Agency staff were being used to cover staffing vacancies and we were informed that additional staff had been recruited but had not yet commenced in the home as checks were pending to make sure they were suitable to work with people.

New staff that had commenced had been provided with an in-house induction and had also attended the providers own induction on how to care for people and work safely. Staff had been provided with some, but not all of the training they required or in some instances had not received regular supervision.

People told us, or indicated by gestures, 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. We saw staff treating people with respect but the way in which staff had managed one person’s behaviour had a daily impact on other people living at the home.

Whilst we received positive feedback from staff about the manager it was evident that they had insufficient time to carry out all of their responsibilities to ensure that people received the support and care they needed. The manager was also responsible for the management of three other services.

We saw that attention was needed to the environment. Décor was in poor condition and some carpets and furnishings needed replacement. There was no evidence that work to address these issues had been scheduled by the provider.

It was not evident that arrangements for checking the safety and quality of the service by the registered provider were effective. We found the provider was in breach of Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We visited the home on a weekday. We met most of the people who lived there and several members of staff. We spoke with some people who lived in the home. Due to the specific needs and preferences of some of the people in the home, our interaction with people was limited, but we observed staff interacting with people.

We saw that people’s needs had been assessed. Care and support was provided according to people’s plans. Work was taking place to involve people in re-writing their plans so that they better reflected their current needs and preferences.

People were involved in a range of activities in the home and the community. Staff encouraged people to make choices about how they spent their time. People told us they were happy and provided examples of how staff supported them to do the things they wanted to do. We saw staff communicating well with people and providing reassurance.

There were enough staff with sufficient skills to meet the needs of people living in the home. However, although the home was not providing nursing care, it was registered to provide nursing and for the treatment of disease, disorder or injury. These activities need suitably qualified staff and the rotas showed that they were not always available. The manager assured us that an application would be made to remove these activities from the home’s registration.

We found that staff were well supported in their roles. Staff told us that they had very good access to training in addition to staff meetings and supervision.

There were good arrangements for the storage, administration and recording of people’s medication.

There were good systems for monitoring the performance of the home. These had been used to identify some shortfalls in relation to the environment and the records. Action was being taken to improve these areas.

At the time of our visit in February 2013, there were eight people living in the home in two units of four, one person had gone on an overnight family visit. Most people had lived at the home since it opened in 2001 and had transferred from another home where they had lived together for many years previously. Most people living at the home were unable to communicate verbally and as such we observed practice and saw that staff interacted well with people, ensuring they were treated with dignity and respect. People were observed being involved in managing the daily activities of the home and some people were observed going out with staff. This ensured that they maintained both their independence and physical need to be active.

Evidence of verbal encouragement was noted to good effect and staff demonstrated their detailed knowledge of people by responding appropriately to gestures, tones or other expressions. During the course of the inspection, staff were heard to be offering people choices, ensuring person centred care, and to be responding appropriately to the more physical and tactile affections of some people living at the home.