The inspection took place over two separate dates. The first date on 18 January was unannounced but we arranged with the provider to come back on a second day to inspect the second part of their service. This took place on 30 January 2018. The provider is registered for both residential care and supported living, which comes under the umbrella of two regulated activities but under one location. The last inspection to this location was 19 December 2016 and 05 January 2017. At this inspection the service was rated as requires improvement in 3 out of the 5 key questions we inspect against. We identified one regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was for regulation 17- Good governance

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the service in relation to the improvements and identified breach of regulation. This was provided when requested.

Fryers Walk provided two separate services. It was registered as 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. There were fifteen people living in three bungalows called Poppy, Daisy and Foxglove. All bungalows were staffed separately around people’s individually assessed needs. In addition to the bungalows, there were offices on site for staff to use.

Fryers walk also provided care and support to fourteen people living in supported living settings, so that they can live in their own home 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. At the time of the inspection, they were supporting eleven people with personal care. Some people lived by themselves and some lived with others who may or may not receive a regulated care service. The accommodation was owned and managed by a housing association.

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. Registering the Right Support CQC policy.

The service had a registered manager 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.

However, the registered manager was in the process of leaving to take over the responsibility of another Mencap service. The service had appointed new managers who were not yet registered with CQC. They were sufficiently experienced and working alongside the existing registered manager. They were going to oversee the residential service with one manager overseeing two residential bungalows and the other manager the third bungalow. There was also a deputy manager for the residential service but they were off sick at the time of this inspection. In addition to the residential managers, another manager was employed and had applied for registration for the supported living service and had a date with the CQC for their interview. An experienced deputy manager supported them. The managers were well supported by the regional manager who was at the service each week.

The service was mostly well led and improvements had been made since the last inspection. The service was in the process of registering new managers with CQC. T

Royal Mencap Society – Fryers Walk provides services to people living with a learning disability. The regulated activity accommodation for people who require nursing and personal care is provided for up to 16 people. These people lived in a care home which consisted of three bungalows called Foxgloves, Daisy and Poppy. Nursing care is not provided. The regulated activity personal care is also provided to people living in their own flats. These people received a supported living service. All services are provided within walking distance of each other.

The service that is provided has changed since our last inspection on 15 and 24 September 2015. At that time the regulated activity accommodation for people who require nursing and personal care was provided to up to 31 people. The regulated activity personal care was not provided to anyone.

As a result of our findings at our last inspection we asked the provider to make improvements to staff knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We received an action plan detailing how and when the required improvements would be made by and these actions have been completed.

This unannounced inspection took place on 19 December 2016 and 5 January 2017. There were 15 people receiving care in the care home and seven people receiving care in their own homes.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Although two managers were registered to manage the services, one of these had left in August 2016. The manager of the supported living service registered with the CQC in November 2016. She was also registered to manage another service in South Lincolnshire and divided her time between the two services. Two managers, who were not registered with the CQC were responsible for the care home. One of these managers had responsibility for Foxgloves, and the other for Poppy and Daisy.

Although improvements had been made to the service provided, there was a lack of day to day management oversight. People and their relatives were encouraged to provide feedback on the service. However, this feedback had not always acted on.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were trained, and well supported, by their managers. There were sufficient staff to meet people’s assessed needs. Systems were in place to ensure people’s safety was effectively managed. However, these were not always followed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People’s medicines were stored safely. However, people did not always receive their medicines as prescribed. People’s health and care were effectively met and monitored. People were provided with a balanced diet and staff were aware of people’s dietary preferences and needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process. People’s rights to make decisions about their care were respected in the care home. However, this was not always the case where people received the supported living service.

People received care and support from staff who were caring. Staff in the care home treated people with respect but this was not always the case in

Fryers Walk is a residential care service that provides accommodation and support for up to 34 people living with a learning disability or mental health problem. People using the service live in shared housing that consists of three bungalows, two blocks of flats and two cottages.

The inspection took place on 30 December 2014 and was unannounced.

The service had a registered manager in place 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.

Safeguarding procedures had been followed and action was taken to keep people safe, minimising any risks to their health and safety. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks. However we had not always been informed of significant events that had affected the welfare of people who used the service in a timely way. There were adequate numbers of staff on duty to support people and ensure everyone had opportunities to take part in activities which reflected their individual hobbies and interests.

People were supported by qualified and experienced staff. Robust recruitment and selection procedures were in place prior to staff starting work to ensure they were suitable to work with people.

People’s needs were assessed and support was planned and delivered in line with their individual care needs. Support plans contained a good level of information which explained how to meet people’s needs. People were supported to access relevant healthcare services where necessary.

The CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005and Deprivation of Liberty (DoLS) and to report on what we find. Some people who used the service did not have the ability to make decisions about aspects of their care and support. Where people lacked the capacity to make decisions about something we found that best interest meetings had been held and details documented in their care records. However staff were less sure about DOLS, and we found that some people were being deprived of their liberty without the proper safeguards in place.

People felt able and comfortable to raise concerns and the provider carried out a thorough investigation of complaints where necessary. The quality of the service that people received was regularly monitored to ensure it was of a good standard

However not all advice given by health care professionals was followed by staff and there were shortfalls in relation to how people’s medicine administration was recorded.

You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with people who lived at the home and relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that staff members were responsive to the needs of people and that they were given the support and attention they needed. We saw that people had a positive experience of being included in conversations, decision making and activities.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted and protected.

People spoken with and their relatives told us that people were provided with the care and support they needed and that the staff were kind.

Medication was administered, recorded and stored accurately and safely.

Staffing levels were adequate when all staff absence was covered. However, relatives told us that people using the service had to sometimes wait to receive the one to one support they required for them to go on individual outings.

People told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

We spoke with people who used the service and their relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations and decision making.

The updated plans of care contained the information staff members needed to ensure that the safety of people was promoted. We had received information of concern and the area manager showed us that the provider had taken the appropriate action to ensure that improvements were being made and that people were protected.

Regular checks and audits of medication records had been recently carried out and all staff members had completed updated training in medication administration.

Relatives told us that people received the care and support they needed but that there seemed fewer staff around at times, often in the afternoon and at the weekend.

There was evidence that learning from incidents/investigations took place and appropriate changes were implemented. The provider took account of complaints and comments to improve the service.

This unannounced inspection took place on 15 and 24 September 2015. Fryers Walk provides personal care and accommodation for up to 34 people who have a learning disability. There were 31 people living there at the time of our inspection. Accommodation is provided in a mix of bungalows and flats.

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.

Improvements had been made to the management of medicines. Medicines were stored appropriately and people received them at the prescribed times. Regular audits were being carried out to identify any issues which were then dealt with appropriately.

Recruitment of new staff had taken place over the last few months and so the staff team were more consistent although agency staff were still being used for night shifts. Staff enjoyed working at the home and felt that the morale within the team was improving.

Staff knew people’s needs well and worked hard to meet these. In general, people’s needs were assessed and a clear plan of care was written to provide guidance to staff about how to meet individual needs. However, improvements were needed to ensure that people’s capacity to make their own decisions was appropriately assessed. Improvements were also needed to ensure that staff received appropriate training to support people whose behaviour may present a risk to themselves or others.

You can see what action we have told the provider to take at the back of the full report.

People were supported to take part in hobbies and interests that were of importance to them. They felt well supported by the staff team and felt that the staff were kind and caring. People received support to attend healthcare appointments as required.

The senior management team had recognised that the staff morale needed to improve and have taken action to address this. Whilst they have taken some action to make necessary improvements to the service the timescales for these have been slow. Improvements to the interior and exterior maintenance and décor have not taken place in a timely way.