This inspection took place on 5 June and was announced. Redroof House provides care and support to people living in ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. 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. At the time of our inspection, five people were using the service.

At our last inspection in January 2017 we found three breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These related to staff knowledge of the Mental Capacity Act 2005, governance of the service and failure to notify CQC of relevant incidents. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Redroof House’ on our website at www.cqc.org.uk. The provider sent us an action plan on how they would meet these regulations. At this inspection we found the provider had made the required improvement and now complied with the regulations.

There was a Registered Manager in place. 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.

Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care before they were delivered.

The registered manager and provider carried out various checks to assess the quality of care provided to people. Actions were put in place to address areas of concerns identified. The registered manager submitted notifications to us as required. The provider worked in partnership with other organisations to improve the service.

Staff were trained to safeguard people from abuse. They knew the signs to recognise abuse and the procedure to report any concerns. Staff told us they would whistle-blow if needed to protect people. There were sufficient staff available to support people with their needs. Recruitment checks were carried out to ensure staff recruited were suitable to work with people.

Risks to people were identified and management plans developed to lessen harm to them. People received support to take their medicines as prescribed and the management of medicines was safe. Staff knew how to report incidents and accidents and records of these were maintained. Actions were put in place to reduce reoccurrence. Staff were trained and followed good infection control procedures.

People’s care needs were identified through assessment process. Individual support plans were developed on how identified needs would be met. Staff supported people to meet their needs, develop new skills, and achieve their goals. People were supported with activities that they enjoyed. People were supported to maintain relationships that mattered to them.

Staff were supported through an induction, supervision, appraisal and training to provide an effective support to people. Staff supported people to meet their nutritional needs and to access health and social care services to maintain good health. The provider ensured people’s support was well coordinated with other services and professionals.

People

Redroof House is a domiciliary care agency (DCA) that provides personal care for up to six people who have a learning disability within a supported living scheme. The supported living scheme is located in Epsom and is a short walk from shops and other local facilities. On the day of the inspection five people were being supported. The people have a range of needs and are supported with a full range of aspects of their lives, including maintaining their health and well-being, personal care and support to ensure they have enough to eat and drink.

On the day of inspection we met the registered manager. 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 inspection took place on 13 January 2017 and was announced.

We found three breaches of the regulations and have made three recommendations. You can see what action we told the provider to take at the back of the full version of this report.

We found a lack of managerial oversight of people’s overall support. We found examples where concerns with people’s support had not been identified by the registered manager. This put people at risk of not receiving the support they needed. The provider had failed to submit information in the form of relevant notifications and a PIR to CQC. This had an impact on us being able to monitor and regulate the service effectively. These were breaches of the regulations.

The requirements of the Mental Capacity Act (MCA) were not being met. The registered manager had not assessed people’s capacity and was unclear on who had the legal right to make decision on behalf of people who lacked capacity. Although consent for support was sought staff had a limited understanding of MCA and DoLS. The provider had submitted incorrect DoLS applications.

Although responsibility for DoLS applications falls to the funding authority the registered manager had not followed this up. There was no evidence the funding authority were aware of restrictions in place at Redroof House. On the day of inspection some people were being unlawfully restricted as the right processes had not been followed to allow the front door to be locked. This was a breach of regulation.

Staff felt they had the knowledge and skills to support people with learning disabilities and said they understood how to support people who may become anxious and distressed. Despite this there was no formal training or detailed guidance on how to support people when they became distressed and anxious. We recommended that these areas are reviewed in line with best interest guidance and people’s needs.

People said they were treated with dignity and respect and we saw examples of this during the inspection. Despite this there was a one off incident where a person’s privacy was not upheld. Care plans were sometimes written in an undignified manner. We have recommended the provider makes improvements in these areas.

People and relatives said that Redroof House was a safe place to live. Staff understood how to report suspected abuse so that action could be taken if necessary.

Incidents and accidents were reported and the registered manager who reviewed reports to prevent them from re-occurring and implemented actions where necessary to reduce the risk of harm to people. When risks to people had been identified they were appropriately managed. People had risk assessments that staff followed to minimise risk and keep people safety.

People were supported by sufficient numbers of staff who were recruited safely and had the right to work in the UK.

People received medicines in a safe way. Staff had a good understanding of the medicines they were supporting people to take and medicines were stored and disposed of approp

On the day of our inspection, the agency was providing care to two adults with a learning disability and one elderly person. All of the people who used the service resided in the same house.

We spoke to one person who used the service, four members of staff, the manager, two relatives and two health care professionals. Everyone that we spoke with told us that staff were kind and treated them with respect. For example, one relative told us “They are always very nice to him.” The person who used the service told us “The staff are perfect.”

We saw that people could choose how they spent their time and that they had opportunities to take part in activities they enjoyed. Whilst we were there we saw that one person was playing dominoes with a member of staff. We were told it was their favourite game. People were involved in their local community and were supported to maintain their independence.

We found that people’s healthcare needs were monitored and there was access to treatment or specialist input when they needed it. One healthcare professional we spoke with said “”If there’s a change to anything in his care, I pick up the phone and speak to the manager.”

We looked at staff files as part of our inspection and found that the provider had robust recruitment processes which ensured that only appropriate people were recruited to the role.

We saw that the provider asked people if they were happy with the service and acted promptly with any concerns.