We undertook an announced inspection at 29 & 30 Dominion Road on 9 August 2018. The last inspection of the service was carried out on 3 October 2016. At that time, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Shortfalls related to people's rights being consistently upheld in line with the Mental Capacity Act

2005 and staff not consistently receiving regular training and supervision to enable them to carry out their duties.

The provider sent us an action plan in November 2016. This described what they were planning to do to comply with the regulations and improve in specific areas. At this inspection, we found that necessary improvements had been made.

Action on Hearing Loss at 29 & 30 Dominion Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dominion Road can accommodate four people in two modified semi-detached houses. At the time of our inspection four people were living there. Dominion Road had four en-suite bedrooms upstairs, with communal living areas downstairs. This included a main open plan living and dining area, as well as a kitchen and garden. Office space and staff sleep-in facilities were also on the ground floor.

The service worked 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.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Systems and processes were in place to protect people from the risk of harm. Staff were trained in safeguarding, and they told us about what they would do if they saw or suspected any harm or poor care at the service.

Staff were trained in a range of relevant subjects, although some training records required reviewing and updating. Staff received regular supervision and appraisals, and the staff we spoke with were enthusiastic about their roles and the service.

We found that safe recruitment and selection procedures were in place and sufficient staff were in post to meet people’s needs. Staff were skilled and experienced in their roles and they knew people well.

People were involved in a range of activities, and were encouraged to try new things to improve their quality of life. Staff supported people to be as independent as possible in carrying out a range of activities.

A complaints policy was in place, and people, staff and relatives all felt able to make a complaint or raise concerns. Most people said that they would do this informally through the registered manager, but relatives and staff were aware that a formal process was in place if needed.

Policies, procedures and checks were in place to manage health and safety. This included the management of incidents and accidents.

The provider had processes in place to ensure that medicines were stored safely and people received their medicines correctly.

Staff helped people to access healthcare appointments when necessary. Health and social care professionals were involved in people’s care, plans and reviews.

Care records were clear and reflected people's needs and preferences, as well as risks associated with their needs or care. These were reviewed and updated regularly to ensure they continued to meet people’s needs.

Staff spoke positively about the management of the service. The m

This inspection took place on 3 and 4 October 2016. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in February 2014 there were no breaches of the legal requirements identified.

29 & 30 Dominion Road is registered to provide accommodation and support for up to four people with sensory and associated needs. At the time of our inspection there were four people living at the service.

A registered manager was in post at the time of 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 2008 and associated Regulations about how the service is run.

We found that people’s rights were not in all cases being upheld in line with the Mental Capacity Act 2005. Where a person lacked the mental capacity to make specific decisions about their care and treatment, and no lawful representative had been appointed, their best interests were not consistently established and acted upon in accordance with the Mental Capacity Act 2005. This included the duty to consult with others such as health professionals, carers, families, and/or advocates where appropriate.

Staff members did not consistently receive regular training and supervision to enable them to carry out their duties.

People were supported to maintain good health and had access to external health care professionals when required. People’s care records demonstrated that their healthcare needs had been assessed and were kept under review.

Risks to people were assessed regularly and where required a risk management plan was in place to keep the person safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely.

People’s medicines were managed and received by people safely. People were receiving their medicines in line with their prescriptions. Staff had received training in medicines.

Staff communicated with people in a meaningful way, taking an interest in what people were doing, suggesting plans for the day and asking how people were feeling. Staff continually offered support to people with their plans.

Staff demonstrated they had a good understanding of people’s individual needs and told us they understood people’s preferences. Staff were very knowledgeable about people’s different behaviours and specific needs such as the person’s preferred morning and evening routines.

The service was responsive to a person’s needs. People’s needs were met by a small staff team who worked together to offer the best care they could. People received good care that was personal to them and staff assisted them with the things they made the choices to do.

People maintained contact with their family and were therefore not isolated from those people closest to them. Family members were encouraged to visit regularly and people were enabled to visit their families. Relatives we spoke with felt the service kept them well informed about their relative’s welfare.

Staff felt well supported by the registered manager. There were systems in place to assess, monitor and improve the quality and safety of the service.

We found two 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 this report.

We used a number of different methods to help us understand the experience of people using this service, because people had varying levels of hearing loss. Staff communicated in different ways. For example, by use of sign language, pictures, photographs and by gestures. In addition, staff interpreted for us throughout the visit.

We met with three people during our visit. Two people were happy to talk to us. One person told us that they "like it here" and were "very happy". The other person smiled broadly and said they were "very happy" and added that "they go out, to town".

People received a good quality of support, were encouraged to express their wishes and were totally involved in designing their daily support. People told us they were happy to be asked what things they liked to do. For example, leisure pursuits.

Staff were confident to raise concerns, and both people we spoke to said they felt safe and could talk to any staff if they were worried. Their body language was relaxed and trusting with staff. One person, who declined to speak to us, appeared happy and relaxed with staff who were working with them.

Staff attended training that was specific to the service, such as sensory loss. Staff were caring and considerate in their manner and worked in person centred ways. They were also knowledgeable about how each person wished to be supported.

There was a system in place that monitored quality, obtained feedback and maintained clear records.

We used a number of different methods to help us understand the experience of people using the service, because people had varying levels of hearing loss. Staff communicated in different ways. For example, by use of sign language, pictures, photographs and by gestures. In addition, staff interpreted for us throughout the visit.

We met with three people who used the service. One person told us they were “happy, happy, happy here” and another person told us “I want to stay forever”. People said they felt safe and could talk to staff if they had any complaints.

We saw that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People received a good quality of care and support. People were encouraged to express their views and were involved in their care. People who did not speak to us appeared happy and content.

From records, we saw that the service ensured all staff knew how each person wished to be supported. People said they were happy to be asked what things they liked to do when they came to the service.

We saw that staff received good training, especially regarding sensory loss. People were supported by staff who understood diversity. We saw staff were caring and considerate in their manner and worked in person centred ways.

When we visited Dominion Road we took an 'expert by experience' with us. The expert by experience in this case was someone who is deaf themselves and has experience of communicating with deaf people with complex needs. We took an interpreter with us to further assist our communication with the ‘expert by experience’ and people who use the service. The purpose of involving an expert by experience is to help us understand the views of people using the service.

People told us that they were very involved in all that goes on in the home and were able to discuss their life at the home and what they enjoyed about living there.

We saw that staff members acted promptly when people asked them for assistance.

People said that they liked having their own rooms, and being able to choose how they are decorated and what things they can have in them. People told us that they choose what they did during the day and that they made decisions about where they went in the evenings. One person said that they enjoyed being able to meet up with their friends.

One person told us that they felt safe at the home and that staff ”are nice”. Another person told us “Sometimes the staff tell me off and I don’t like it”.

People told us that the food was “lovely” and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene if required and their privacy and dignity was respected. People told us that their rooms were comfortable.