Redstone House provides accommodation, care and support for a maximum of eight adults with learning disabilities. There were seven people living at Redstone House at the time of our inspection.

The inspection took place on 14 November 2016 and was unannounced.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection.

We carried out this fully comprehensive inspection to check that the provider had acted on the concerns we identified at our last inspections in May and September 2015. These were around safe care, nutrition, consent, treating people with dignity and respect, providing person-centred care and quality assurance processes. We found a significant improvement during this inspection.

People were kept safe because staff understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Risks to people’s safety had been assessed and measures had been put in place to mitigate these risks. There were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

There were enough staff on duty to keep people safe and meet their needs. The provider’s recruitment procedures helped ensure that only suitable staff were employed.

People received their care from staff who knew their needs. Staff were supported through supervision and appraisal. Staff had access to relevant, on-going training and staff said they felt the registered manager had made positive changes to the home.

The registered manager understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when they needed support to make decisions and applications for DoLS authorisations had been submitted where restrictions were imposed to keep people safe.

People’s nutritional needs were assessed and any dietary needs were managed effectively. Staff enabled people to make choices about what they ate and supported them to maintain a balanced diet. People were supported to maintain good health and to obtain treatment when they needed it. People’s medicines were managed safely.

Staff, on the whole were caring treated people with respect. People had opportunities to take part in social events and activities both inside and outside of the home as well as maintaining relationships with people close to them. We have made a recommendation that the provider continues to improve to help ensure people receive person-centred individualised care in a way that demonstrates they are central to the service.

The registered manager provided good leadership for the home and led by example in their approach to supporting people. The registered manager encouraged the input of people, their relatives, staff and other stakeholders in developing and improving the service. There were systems in place for quality monitoring, which helped ensure that all areas of the service were working well.

We have made five recommendations to the registered provider to help ensure people receive individualised, person-centred care in a way that demonstrates staff put them at the centre of the service.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with three of the people who use the service, the registered manager, two care staff and three relatives of people who used the service. We also reviewed records relating to the management of the home which included, four care plans, daily care records, supervision and maintenance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People’s relatives told us they felt their relative was safe at Redstone House.

Another person’s relative told us they visit often and unannounced and have never seen anything to give them concern about how their relative was treated or their relative's safety.

Peoples relatives also told us they thought the building and their relative’s bedrooms were suitable. However, we found that people who use the service, staff and visitors were not always protected against the risks associated with unsafe or unsuitable premises because the provider had left windows unrestricted contrary to their own assessment of need, left sharps and chemical hazards accessible to people and by not maintaining the building to a suitable design and layout or a safe standard.

We saw people had a risk profile to identify potential risks. we also saw that where a risk had been identified people had specific individual risk assessments. This recorded showed how to reduce the specific identified risk for the individual concerned.

We saw that the service minimised the risk and the likelihood of abuse by making sure all the policies and procedures to promote safeguarding were in place.

We spoke to staff, who were aware of safeguarding procedures, and saw records that confirmed they had all received recent training in this area so they knew how to protect people.

Is the service effective?

People greeted us and showed us the activities they were involved in. One person had returned from activities in the community, They said they had enjoyed themselves and they also said the food was nice and they liked living at Redstone House.

A relative told us they 'couldn’t wish for a better set up'.

People’s health and care needs were assessed with them, and people who used the service told us that they were involved in their care plans.

People’s relatives told us they had no complaints and felt they were listened to when they raised any concerns or minor issues.

Another person’s relative told us they visit often and unannounced and have never seen anything to give them concern about how their relative was treated or their and safety.

Is the service caring?

People’s relatives told us the staff were caring.

We noted that staff spent time with people and gave them the time they needed to ensure they didn't feel rushed while receiving support.

We saw that people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s care plan.

Is the service responsive?

The manager gave us an example of changes to the way the service was run. The changes were made following feedback from surveys people had completed.

We noted plans that had just started to be implemented that involve changing the quality assurance system. This meant continual updating of the quality information and on-going feedback as opposed to the previous annual quality review cycle.

Is the service well-led?

People told us they thought the home was well led.

We saw that the home was subject to external audits, including for example, finances and the homes policies and procedures.

We noted that the complaints system was monitored for appropriate action needed, and to identify any overall trends where practice changes may be required to improve quality for everybody.

The Trust did its own audits and checks for example fire safety audits. The maintenance manager visited for an annual health and safety audit.

People's relatives we spoke with told us that they thought there were enough staff, they had no concerns about the home, and that they felt their relative was safe living there.

One person’s relative we spoke with said they thought the home was well run.

We observed people being offered choices and we observed a person using the service being involved in meal preparation.

We saw that care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People were not always cared for by staff that were properly supported to deliver care and treatment safely and to an appropriate standard, because the home had not provided regular formal recorded supervision for all its staff. This meant the home could not support all staff with, or effectively address, their performance, conduct, training and development needs.

People’s relatives told us that they thought the building and people’s bedrooms were adequately maintained and always found the home clean and tidy.

People’s relatives said that staff communicated well with them and they felt listened to when they raised any concerns. They said that they didn’t have any complaints but felt they could make one if they did.

People’s relatives also told us that they thought there were enough staff, that it was good that a lot of the staff had worked at the home for a while and knew the people there well, and felt there relative was safe. One relative said they visit often and sometimes without warning and had never seen anything to give them concern.

We saw that the needs of the people who use the service were met; staff listened to people; were aware and responsive to their care and communication needs. For example gestures and sounds were listened to, to try and ascertain the needs the person was trying to express. People were treated with respect and dignity throughout the time of the visit. Choices were offered, and people’s preferences were respected.

Redstone House is a residential care home for up to eight people with a learning disability such as autism or who may have a sensory impairment.

There was a registered manager in post however they had been seconded to a different area of the Trust. The area manager was acting as the manager and had begun the application process to become registered with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The area manager was acting as the manager and had begun the application process to become registered with CQC. The registered manager was not present during our inspection and we were assisted by the shift leader and deputy manager.

We carried out unannounced inspections on 19 May and 10 September 2015.

Although we found staff treated people in a kind and caring manner, we observed little interaction between staff and people during the day. We found staff did not always support people in an individualised way or plan activities that meant something to them.

Staff had not ensured they had considered all risks for people to demonstrate people were safe living at Redstone House.

Staff had not followed legal requirements in respect of restrictions or decisions made on behalf of people. Staff had not always understood the Mental Capacity Act (2005). Where people were restricted staff had complied with the Deprivation of Liberty Safeguards (DoLS).

People were not involved in choosing the food they ate and records in relation to people’s dietary requirements were not always accurate. We observed some elements of incorrect medicines management processes by staff and information relating to people’s PRN (as required) medicines had not been reviewed recently.

Staff were aware of their responsibilities to safeguard people from abuse or able to tell us what they would do in such an event, although we noted some staff were overdue in updating their safeguarding training.

People’s care would not be interrupted in the event of an emergency and if people needed to be evacuated from the home as staff had guidance to follow.

Staff were provided with training specific to the needs of people. Although we found some staff were overdue in some training this had been identified by the deputy manager and action was being taken.

Quality assurance checks were carried out by staff, however these checks did not pick up on areas that required improvement. For example, the cleanliness of the home or the lack of robust records.

Staff responded to people’s changing needs as they ensured people had access to external healthcare professionals when they required it. There was evidence of health and social care professionals being involved in the home.

It was evident staff had a good understanding of the individual needs and characteristics of people and knew how to communicate with them. We heard staff speak in a kindly manner to people.

There were enough staff deployed in the home. People who required one to one care received this at all times. There were enough staff to enable people who wished to go out to do so.

Appropriate recruitment checks were carried out to help ensure only suitable staff worked in the home.

A complaints procedure was available for any concerns and relatives and people were encouraged to feedback their views and ideas into the running of the home.

Staff had the opportunity to meet regularly with each other as a team as well as on an individual basis with their line manager. Staff felt supported by the deputy manager, although morale was low because they had not been kept up to date with regard to the registered manager and when they would return to the home.

During the inspection we found 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.