We undertook an inspection at Gallaudet Home on 11 and 13 December 2018. The first day was unannounced. The last inspection of the service was carried out in October and November 2017. At that time, we identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rated the service ‘requires improvement’. Shortfalls related to training and supervision, people’s involvement in developing care plans and risk assessments, the implementation of actions identified in audits, and people’s feedback about the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve in specific areas. At this inspection we rated the service ‘good’ because we found the necessary improvements had been made, and further improvement work was ongoing.

Gallaudet Home 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.

Gallaudet provides care for up to eight people. At the time of our inspection there were eight people living there. The service is in a long, single storied building which is accessible to people in wheelchairs or with limited mobility. Communal areas included a lounge, dining area and kitchen. Bedrooms were all accessible from the main corridor, and some were en suite.

The 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.

A manager was going through the process of registering with CQC at the time of our inspection. Their registration was completed shortly after our inspection. A registered manager has 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 harm, and staff had received training in safeguarding. They knew what they must to do protect people and the provider had made safeguarding referrals to the local authority appropriately.

The provider had systems in place to ensure people were safe, including risk management, checks on the environment and safe fire management processes.

Risk assessments relating to people who used the service were clear and described potential hazards and control measures in place. These gave staff information about how to support people safely and ensure risks were managed effectively.

People were supported by adequate numbers of staff to meet their needs, although regular agency staff supported shortfalls in staffing numbers. Recruitment was ongoing, and the provider followed safe procedures to ensure prospective staff were suitable to work in the service.

People's medicines were administered as prescribed and managed safely. Medicines administration records were accurate and clear. Some staff required updates in medicines competency checks. We have made a recommendation about the storage of controlled drugs.

Staff were trained in a range of relevant subjects, although some training and records required updating. Staff usually received regular supervision and appraisals, and the staff we spoke with felt supported.

People were supported to have choice and control in their lives. Their privacy and dignity was respected and people were encouraged to be as independent as possible; the policies and systems in the service supported this practice.

Relatives told us that they were consulted and informed about people’s care. Records were clear and reflected people's needs and preferences.

Staff had a good understanding of people's needs and preferences, and we

This inspection took place on 24 & 25 October, 3 & 6 November 2017 and the first day was unannounced.

We inspected Gallaudet Home in May 2016. At that inspection we found the provider to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found risk assessments relating to the health, safety and welfare of people were not reviewed regularly. People had not been involved in risk assessments. During this inspection, we found the required improvements had been made. We found people’s rights were not being upheld in line with the Mental Capacity Act (MCA) 2005 because people were being inappropriately deprived of their liberty. During this inspection we found the required improvements had been made. Staff did not receive regular training and supervision to enable them to carry out their duties. During this inspection we found partial improvement. We found care plans were not consistently written in conjunction with people or their representatives. Care plans and risk assessments were staff led. During this inspection, we found partial improvement. We found audits had identified areas where improvements were required, but the necessary actions had not been implemented within a reasonable timescale. During this inspection, we found the required improvements had not been made. People and their representatives were not encouraged to provide feedback on their experience of the service. During this inspection, we found partial improvements had been made. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gallaudet Home on our website at www.cqc.org.uk

Gallaudet provides accommodation and care for up to eight adults with hearing impairments who may need additional support for conditions such as autism, learning or physical disability or their emotional development. At the time of the inspection, seven people were living in the home.

There is 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.

The registered manager did not always report allegations of abuse to the local authority safeguarding team. Not all staff had a clear understanding of what may constitute abuse and how to report it. The provider’s safeguarding policy was out of date and staff safeguarding e-learning was also out of date.

Staff had not been provided with the required number of fire drills and had not had the required fire training in 2017. Some staff did not understand why the fire alarm consisted of different coloured strobe lights.

Staff were not always fully supported to ensure they understood care plans, systems and processes within the home. People were not always given the information and explanations they needed, at the time they needed them.

Staff had mixed views about whether there were sufficient staff to meet people’s needs. Staff numbers impacted on the activities people were able to participate in. Staff had not received regular training to give them the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home.

Systems and processes for managing medicines were reliable and appropriate to keep people safe. Medicine audits had been introduced monthly.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty,

This inspection took place on the 24 and 25 May 2016 and was unannounced. When the service was last inspected in February 2014 there were no breaches of the legal requirements identified.

Gallaudet Home is registered to provided accommodation and care for eight deaf adults who need additional support for conditions such as autism, learning or physical disability or their emotional development. At the time of our inspection there were seven 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.

Risk assessments relating to the health, safety and welfare of people were not reviewed regularly. There was no evidence that people using the service or their families had been involved in the risk assessment process. This meant people were at risk of not having their specific needs met.

People’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. Care plans did not include mental capacity assessments. 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 established and acted upon in accordance with the Mental Capacity Act 2005. This includes the duty to consult with others such as health professionals, carers, families, and/or advocates where appropriate.

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

There were ineffective systems in place to assess, monitor and improve the quality and safety of the service.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Safe recruitment procedures ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. Staff demonstrated a good understanding of abuse and knew the correct action to take if they were concerned about a person being at risk.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines. We found one discrepancy regarding the stock balance of paracetamol.

People had their physical and mental health needs monitored. Care records showed people had access to healthcare professionals according to their specific needs.

People’s nutrition and hydration needs were met. People were provided with food that respected their choices and preferences. Specific dietary requirements were catered for, such as diabetes.

We observed that people were treated with kindness and compassion by the staff. There was a friendly atmosphere in the service. People spoke positively about the staff.

Where appropriate people were encouraged to maintain contact with their family and were therefore not isolated from those people closest to them.

People were cared for in a safe, clean and hygienic environment. The rooms throughout the service were well-maintained.

We found five 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 spoke with two staff members, the manager and an administrator and they were able to describe the care needs of people who used the service and what kind of support each person needed.

We read three people’s care plans and saw the care plans had been reviewed so there was sufficient information to assist staff to care for people safely. The manager told us people's care plans were reviewed by key worker teams on a regular basis.

A professional who visited the home for the care review of one of the people who used the service told us they had seen a recent improvement in the content of the care plans and reviews.

On the day of the inspection there were five staff members on duty. This was more than usual because an activity had been planned for one person who used the service which required additional staff. We saw all the staff were caring and kind in their manner towards the people who use the service. We saw they communicated with people in a thoughtful and considerate way. They were able to convey to us a good understanding of the needs of people who use the service and what kind of care and support each person needed.

We saw people's privacy was protected. There were flashing doorbells and entry systems to all rooms. This meant people were aware if a staff member wished to enter their room and they could choose whether to open their door.

Health and safety audits and risk assessments were completed about the use of the premises and equipment. Other checks included fire equipment checks, portable appliance tests, and electrical checks and there was a maintenance log for repairs to the home.

We looked at the staff rotas to see if there was sufficient staff on duty to care for people safely. We saw the home had not always been staffed according to the assessed hours of support people needed, but recently this had been better, but not totally resolved.

We read four people's care plans so that we could find out how people were supported with their care needs. We saw there was not sufficient information to assist staff to care for people safely.

A compliance action had been set at the last inspection about the systems the provider had in place to monitor the quality of the service.. At this inspection we checked the improvements that had been put in place.

We spoke to the manager and one member of staff. The manager told us that they had met with senior members of the organisation and had developed an action plan to meet the compliance action.

The manager told us they had started asking people who used the service about the care they received at their monthly review meetings. The manager was also starting discussions at team meetings and staff supervision meetings to review service quality and discuss ideas for improvement. We looked at staff supervision records which confirmed staff supervision was more structured.

We saw the manager analysed and monitored the levels of complaints and incidents in the home. Other audits including health and safety and medication were also completed by the home to ensure the safety of people who used the service.

During our inspection, we met with four people who used the service and three members of staff, including the deputy manager.

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

We saw on the care files that the views of relatives, social workers and health professionals were sought in the provision of care. One person told us" I am asked about how I want to spend my own money. I like it here".

We saw staff meetings were held yearly. They were detailed and provided staff members with information about people who used the service and aspects of the management of the home. We saw evidence of staff supervision on online files and a system in place to ensure staff received supervision.

We saw the staff who were on duty at the time of our visit, were caring and

kind in their manner towards the people who use the service. We saw them helping people in a thoughtful and considerate way. They were able to convey to us a good

understanding of the needs of people who use the service and what kind of care and support each person needed.

When we visited Gallaudet 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.

We spoke with people who used the service using sign language and other forms of communication such as lip reading.

People told us that they felt safe at the home and that staff" are nice”.

People told us that the food was ‘good’ and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

One person told us they liked the newly decorated house and that they also liked helping staff member’s complete maintenance of the home.