Redehall Cottage is a residential care home accommodating up to six adults with learning disabilities, communication needs and autism. There were four people living at the home at the time of inspection.

People had communication needs. Some people could use key words to communicate their needs; other people used body language or gestures to communicate.

There was 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.

At the last inspection on 6 October 2015, we told the provider to take action on staff deployment, management of risks to people and good governance. We also told the provider to ensure that processes were in place to ensure that people’s rights were protected if they lacked mental capacity. We found improvements had been made and these actions have been completed.

There were sufficient staff to keep people safe. There were recruitment practises in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as personal care, health, and activities and they were updated frequently. The registered manager ensured that actions had been taken after incidents and accidents occurred to reduce the likely hood of them happening again.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessment and best interest meetings had been undertaken. Staff were heard to ask peoples consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place to meet people’s needs. There was an induction programme in place which included staff undertaking the Care Certificate. Staff received supervision., however it was not always regular. The registered manager told us that they would start supervisions now.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning peoples care. People’s choices and views were respected by staff. Staff and the registered manager knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in their care plans. Care plans contained sufficient detail for staff to support people effectively. People were supported t

Redehall Cottage is a residential home which provides care and accommodation for up to six adults with learning difficulties, autism, verbal communication difficulties and who may display behaviours that may challenge others. On the day of our inspection six people were living in the home.

This inspection took place on 6 October 2015 and was unannounced.

The home was run by a registered manager, who was present on the day of the 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 and associated regulations about how the service is run.

Risks to individuals were not always appropriately managed and risk assessments for people were not detailed. We found the registered manager considered additional risks to people in relation to community activities and changes had been reflected in people’s care plans.

Not all staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. The staff we spoke to knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

There were not sufficient number of permanent staff who were appropriately trained to meet the needs of the people who lived at the service. Staff did not always have the appropriate and up to date skills and guidance in relation to their role. Agency staff did not have the appropriate skills to meet the needs of people of understand the nature of their disability.

Processes were in place in relation to the correct storage and audit of people’s medicines. All of the medicines were administered and disposed of in a safe way. However records about ‘as required medicines were not in place.”

The Care Quality commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. Capacity assessments had not always taken place for people in accordance with the Mental Capacity Act 2008 code of conduct.

People were encouraged and supported to be involved in their care. The lounge and people’s rooms were homely or personalised. People said that the staff were caring. One told us that they liked the staff “Very much.” We saw caring and kind interactions with staff and people during the inspection. People were treated with respect and dignity

People had access to a range of health care professionals, such as the GP, Community Mental Health team, dentist and opticians.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We were told by the registered manager that people could go out for lunch if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People took part in community activities on a daily basis; for example trips to the shops. The premises were suitable for the needs of people.

People had individual care plans. They were detailed but not updated regularly; staff did not always have the most up to date and appropriate information to enable them to respond to people effectively. However staff we spoke with were able to tell us about the care that they provided people and it was clear that they knew about people’s individual diagnosis and health needs.

The registered manager told us how they were involved in the day to day running of the home People, relatives and staff felt the management of the home was approachable.

Complaint procedures were not up to date. Relatives told us they would know how to make a complaint.

The registered manager had not maintained accurate, complete or detailed records in respect of people and records relating to the overall management of the service.

The home did not have a satisfactory system of recording the auditing processes that were in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager had not assessed incidents and accidents, staff recruitment practices, care and support documentation, medicines and decided if any actions were required to make sure improvements to practice were being made.

There was no discussion with people around how they could be involved or empowered to be part of any improvements to be made in the service.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This was a follow-up inspection because at our last inspection on 31 July 2013 we found the registered person was not fully meeting all of the regulations set out in the health and social care act 2008. The registered person sent us an action plan dated 07 November 2013 telling us what actions they would take and when they would become fully compliant with the regulations.

At this inspection we found that the provider had taken appropriate steps to ensure that the people who used the service could be confident that their human rights would be respected and taken into account.

At this inspection we found that the provider had implemented their action plan and that the premises were generally well maintained and safe.

We found that the provider had taken appropriate actions to ensure that confidential records were stored in accordance with the Data Protection Act 1998.

We saw that the home had areas of good practice and that other outcomes assessed compliant in previous reports remain compliant. However there were some areas for improvement needed that we identified.

People spoke about activities they were involved in, including going for a walk, using the swing, swimming, shopping and trips out. People who used the service also told us they had enjoyed their meal, liked the food they were provided and two people told us they liked coffee.

We saw people who used the service were supported to be entertained in their chosen activities and many were smiling and laughing in response to staff interaction throughout the visit.

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements because they did not have suitable arrangements in place for obtaining and acting in accordance with, the consent of the person using the service in relation to the care and treatment provided for them.

Although the building was in reasonable decorative condition in most areas, hygienic and clean, the provider had not always taken steps to provide care in a home that was suitably designed and adequately maintained in all areas.

We found that records and information for people who use the service was not kept confidentiality and did not comply with date protection legislation.

All the people we spoke to appeared confident, and free to express their wishes or displeasure. For example, a while after lunch one person felt confident to express that they were unhappy with the amount of food they had for dinner, and we saw staff listen and then support them to prepare more food.

People spoke about liking the home, the food and their rooms, and about community activities they had been involved in.

People’s relatives told us that they thought there were enough staff, their relative was looked after well and that staff kept them informed.

People’s relatives also told us they felt their relative was safe there and they had not needed to raise any formal complaints, but if they needed to raise any minor concerns, they felt listened to and action would be taken to address the situation.

We saw that previous shortfalls that we had identified regarding behaviour management of an individual had been addressed.

We saw that that staff received appropriate professional development and support.

Due to people’s communication needs it was difficult to ask all of the people directly about their views of Redehall cottage. One person told us that they liked their room and that they were happy living in the home.

Another person gestured to us with the support of staff that they also liked the home.

We spent some time on the first visit talking with staff and observing people using the service.

We returned for a second visit to meet with the manager and to view some records relating to the care of people and the management of the home.