We undertook an unannounced inspection on 7 March 2018.

Saint John of God – 1 Bedes Close 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.

Saint John of God – 1 Bedes Close is a residential care home for up to four people living with learning disabilities. All of the living accommodation is on the ground floor of this detached house. All of the bedrooms have en-suite toilets and baths. At the time of our visit there were three people using the service and there were no plans to offer the fourth place to anyone else.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People were safe at the service. Staff knew how to identify abuse and understand the safeguarding procedures to follow to protect people from abuse. Risks to people’s health and well-being were assessed and managed. Appropriate risk management systems were in place which ensured staff delivered safe care.

Staff had been recruited safely, were well trained and supported in their roles. There was enough staff to make sure people were kept safe and to deliver person centred care.

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 supported this practice.

People got enough to eat and drink which met both their dietary and cultural needs. Staff support people to attend health care appointments and make sure they receive any medicines they are prescribed.

Staff were kind and compassionate and treated people with dignity and respect. People who used the service had developed positive relationships with staff.

Staff knew people’s likes and dislikes and people received personalised care. People’s care plans were person-centred and provided staff with good information about how to support people. Relatives told us they had never made a complaint but would speak with the registered manager if they were not happy about anything

The service was well-led by the registered manager who understood people’s needs and worked well with people and staff to improve the care delivery. There were effective audits and monitoring systems in place to ensure people’s safety and quality of care.

Further information is in the detailed findings below.

We set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

Is the service caring?

We saw care workers showed patience and gave encouragement when supporting people. People’s preferences, interests, like and dislikes were recorded and care and support had been provided in accordance with peoples wishes. People’s families had a chance to give their feedback in the annual questionnaire sent out.

Is the service responsive?

People completed a range of activities in and outside of the home. On the day of inspection all three people went out during the day. The provider’s quality assurance process had picked up areas for improvement. The manager said they were working with the seniors on all areas to improve quality. The provider has a complaints policy in place but no complaints had been received in 2014.

Is the service safe?

People are treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. We saw risk assessments in place to identify, reduce and remove risk where possible. We observed staff following these guidelines on the day of inspection. The service was safe clean and hygienic and staff told us they are given sufficient cleaning products and protective clothing to keep people safe.

Is the service effective?

We looked at peoples plans of care and found there needs were assessed with them and they were involved in the writing of the plans. One person made use of assistive technology to communicate in a more effective way. We saw evidence of professionals input and guidelines put into place. Staff were aware of the guidelines and could list specifics about people’s plans of care.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system in place, records seen by us showed that identified shortfalls were promptly addressed. Staff told us they were clear about their roles and responsibilities and understood why there were quality assurance processes in place.

We found people were asked for their consent and the provider acted in accordance with their wishes and where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Two relatives told us they were fully informed and consulted “weekly” about their relatives care and treatment.

People experienced care, treatment and support that met their needs. One person said they were “liked” living at 1 Bedes Close. Two relatives told us they were very happy with the care and treatment their relatives had received.

There were appropriate checks were undertaken before staff began work. One person told us they “Liked the staff”. One relative said the staff were “Excellent”.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to help make sure people were given the correct medication.

1 Bedes Close also had effective systems in place which identified assessed and managed the risks to the health, safety and welfare of people who used the service and others. Relatives told us they were comfortable in raising any concerns with the staff.

Our inspection of 1 Bedes Close on the 5 July 2012 found the registered care provider did not have an effective system to regularly assess and monitor the quality of service people received. In addition, people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider wrote to us on the 30 July 2012 and told us how they would make improvements. We carried out this visit to check that improvements had been made.

We did not speak with any people who used the service on this inspection. This was because two people were attending day centres and the one person who remained at the home had complex needs which meant they were not able to tell us their experience. However, we used a number of different methods to help us understand the experiences of people who used the service. For example we reviewed care records and records relating to the management of the service, observed care practices and observed how staff engaged with the one person who remained at the home.

The support workers we spoke with told us there were clear lines of communication and accountability within the home and they were supported through a planned programme of supervision, appraisals and training. However, they also told us they felt there was a lack of connection between senior management and the service they provided locally.

We were not able to speak with people who use the service because they were out for the day during our visit. We used a number of different methods to help us understand the experiences of people using the service, such as reviewing care records and speaking to the relatives of the two people who lived at the home.

People we spoke with told us they were involved in making decisions about their relatives care and treatment. They said staff supported their relatives to live as independently as possible and they were happy with the care and support their relatives received.

People said staff were supportive and had appropriate skills. One person told us, “There is a nucleus of staff who have been at the home a long time, they know people who live there exceptionally well and can meet their needs”.

Both of the relatives we spoke with told us that they had not been given the opportunity to provide formal feedback about the quality of the service in the past year.

On the 03 and 07 September 2015 we inspected 1 Bedes Close. This was an unannounced inspection.

The service was last inspected in July 2014 and was fully compliant with the outcome areas that were inspected against.

1 Bedes Close provides accommodation and personal care to a maximum of four people who are living with learning disabilities. All the accommodation is in single rooms and the service is located in the residential area of Thornton, close to Bradford city centre.

There was a registered manager in place. A registered manager is a person who has registered with the 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.

Staff were recruited is a safe way. We found all staff had relevant training to work in the service. Staff records showed us staff had been interviewed, references checks and appropriate background checks completed.

People had one to one staffing levels during the day. We looked at the rota and saw sufficient staff working to keep people safe.

Before people came to live at the service, a needs assessment was carried out by the registered manager. This ensured people’s support needs could be identified and met before they moved into the service.

Care records were created from the initial needs assessment for people. Care records were then developed in consultation with people and their family members. Care records were person centred and up to date.

People told us they felt safe and enjoyed living at the service. They told us they got to do activities they wanted to do and they could change their minds if the wished. People’s independence was promoted and staff actively encouraged people to participate in activities.

People had risk assessments completed and these covered a range of areas including guidance around accessing the community and personal safety. People using the service and their relatives expressed positive views about the service and the staff.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People’s rights were protected and where people were deprived of their liberty this was done lawfully.

Staff were familiar with the provider’s safeguarding policies and procedures and able to describe the actions they would take to keep people safe. Staff supported people to attend health appointments. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being.

People told us the food was good. Staff promoted balanced diets and supported people to create their own menus. People’s religious beliefs were respected when food was bought. Staff supported people to complete shopping tasks, design menu plans and prepare meals. Staff were aware of people’s specific dietary needs and preferences and offered people choices at mealtimes.

There were arrangements in place to assess and monitor the quality and effectiveness of the service. This included annual surveys, tenants meetings and medicines administration auditing.

Medicines were administered by trained staff in line with their prescription. Medicines recording was complete and signed. Medicines were stored and accounted for appropriately.