We carried out an unannounced inspection of Six Acres Residential and Supported Accommodation Limited on 27 June 2018.

Six Acres is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Six Acres a small privately owned care home providing accommodation and support for up to six adults with learning disabilities. The home is a bungalow with six separate bedrooms, shared bathroom and toilet facilities and two communal lounge/dining areas. At the time of our inspection there were two people living at the home.

At our last inspection on 21 December 2016, we rated the service as 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 ongoing 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.

During the last inspection, although the home was rated as good overall, it was rated as requires improvement in the key question effective, as we identified one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to good governance, specifically that neither nutritional screening nor pressure ulcer risk assessment tools were in place. At this inspection we found the provider had addressed the previous regulatory breach and was now meeting all regulatory requirements.

The service had a registered manager. 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.

People told us they felt safe living at Six Acres. The home had appropriate safeguarding policies and procedures in place. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Staffing levels were based on the needs of people living at the home and their schedules. Rotas demonstrated enough staff had been deployed to meet people’s needs and accommodate outings or activities.

We saw the home was clean and had appropriate infection control processes in place. The staff carried out all cleaning tasks, following a daily and weekly cleaning rota. All cleaning equipment was stored safely and securely.

Care files contained detailed risk assessments, which were reviewed regularly to reflect changing needs. This helped ensure staff had the information they needed to support people to stay safe and well.

Medicines were stored safely. The home had effective systems in place to ensure medicines were ordered, stored, received and administered appropriately.

Staff received appropriate training, supervision and appraisal to support them in their role. Training completion was monitored via a matrix, to ensure staff remained up to date.

People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible, with the home’s policies and systems supporting this practice.

People were encouraged to make decisions and choices about their care and how they wanted to be supported. People had control over how they spent their time and what activities they completed. People's consent to care and treatment was sought prior to care being delivered.

Both the registered manager and staff we spoke with demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be

We carried out an unannounced inspection of Six Acres Residential and Supported Accommodation Limited on 21 December 2016.

Six Acres is a small privately owned care home providing accommodation and support for up to six adults with learning disabilities. The home is a bungalow with six separate bedrooms, shared bathroom and toilet facilities and two communal lounge/dining areas. At the time of our inspection there were three people living at the home.

The home was last inspected on 07 September 2015, when we rated the service as ‘requires improvement’ overall. We identified four breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines, premises and equipment, consent and good governance.

At this inspection we found the service had made improvements in regards to the management of medicines, premises and equipment and consent however identified one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to good governance, specifically that neither nutritional screening nor pressure ulcer risk assessment tools were in place. You can see what actions we told the provider to take at the back of this report.

At the time of the inspection the home had a registered manager. ‘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 saw that the home was clean and had appropriate infection control processes in place. The staff carried out all cleaning tasks, following a daily and weekly cleaning rota. All cleaning equipment was stored safely and securely.

People we spoke with told us they felt safe. The home had appropriate safeguarding policies and procedures in place. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Both staff and people living at the home told us enough staff were employed to meet people’s needs. We saw that staffing levels were determined by both the needs and plans of the people using the service, with resources being used flexibly to accommodate outings or activities.

Robust recruitment procedures were in place to ensure staff working at the home met the required standards for working with vulnerable people. This involved everyone having a Disclosure and Baring Service (DBS) check, two references and full work history documented.

Staff reported that they received a good level of training to carry out their role and were encouraged and supported to attend more if required. We saw that all staff completed an induction training programme when they first started and that on-going training was provided to ensure skills and knowledge were up to date.

Staff also told us that they felt supported through completion of supervision meetings and appraisals. Team meetings were also held, which staff were encouraged to attend and contribute towards.

We saw that the home had systems in place for the safe storage, administration and recording of medicines. Medication was kept in a locked cupboard within the office. All necessary documentation was in place and was completed consistently. Staff responsible for administering medicines were trained and had their competency assessed.

We looked at three care plans and two service user files, which contained detailed information about the people who lived at the home and how they wished for staff to support them. The care plans also contained individual risk assessments, which helped to ensure their safety was maintained. We did not see evidence that either a nutritional screening tool such as the malnutrition universal screening

This unannounced inspection took place on 07 September 2015.

This was the first inspection of Six Acres Residential and Supported Accommodation, although we had previously inspected the service on 25 September 2014 when it was registered as a different legal entity and known as ‘Six Acres’.

Six Acres is a small privately owned care home providing accommodation and support for up to six adults with learning disabilities. At the time of our visit there were three people living at the home. The home is a bungalow with shared bathroom and toilet facilities. It is located in the village of Bickershaw, near Wigan.

We found four breaches of the regulations, which were in relation to medicines, premises and equipment, consent and good governance. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our visit 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.

We found medicines were not always managed safely. We found one person was prescribed a medicine that was not on the medicine administration records (MAR). We found stock of this medicine, which were out of date. Staff were unaware of when this medicine was required. Although we were told the medicine had never been required, this demonstrated poor management of medicines. We also observed poor practice in relation to the administration and safe storage of medicines. This was a breach of the regulations.

People we spoke with told us they felt safe. Staff had received training in safeguarding and were aware of procedures to follow should they have any concerns. We had previously raised concerns about the management of people’s finances within the home. We found some actions had been taken, although we found the charging policy for a shared mini-bus lacked clarity or evidence that people had been offered any alternatives. The local authority were in the process of reviewing this aspect of support provision at the time of writing this report.

We had some concerns in relation to the prevention and control of infection. The laundry was located in a shed, which was also used as a workshop. We saw an item drying in this area, which was not clean. The service had a dog and we observed this entering the kitchen, which posed a risk in relation to food hygiene. The home was also not following its policy in relation to the disposal of offensive waste. This was a breach of the regulations.

Staff had been recruited safely and the required checks carried out for all new staff. Not all information required was in place for family members of the registered manager who were working for the service however. We have made a recommendation in relation to having evidence to support all staff employed are of good character.

We saw that a lounge and two bedrooms were being used permanently as ‘staff accommodation’, and a further bedroom was being used as an office. Whilst there was adequate room for the three people living at Six Acres, if more people moved in the space would be limited. We saw a fire door was wedged open for part of the day and the closing mechanism had been disconnected from another door. This would increase risks in relation to fire safety.

Staff had a working knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA and DoLS). The service had made DoLS applications as required. The registered manager told us one person had a power of attorney for care and welfare, and finances in place. However we found this not to be the case. This meant the service was not fully aware of who had legal authority to provide consent to certain decisions on behalf of this person and meant they would not be able to act in line with the MCA. This was a breach of the regulations.

We saw a range of health professionals had been involved in people’s care. One relative told us the service had been pro-active in arranging assessments for their family member. We saw advice from professionals was documented in the care plan and staff we spoke with were aware of the guidelines in place.

People told us they liked the food on offer and we found people were supported to choose their meals on a daily basis.

We spoke with staff who had been recently recruited. They told us they had undertaken a range of training and had been enrolled to undertake the care certificate. The care certificate provides learning outcomes against a set of identified standards that all health and social care workers should adhere to. Staff said they had shadowed other staff and had felt confident to undertake their role at the end of their induction. Staff were positive about the training and support they received.

We saw positive and friendly interaction between staff and people living at Six Acres. People and their relatives we spoke with told us they had developed good relationships with staff members and between the people living at the home. Family members we spoke with told us they were kept informed and involved in their family members’ care. Two staff members we spoke with told us they found the home had a ‘family atmosphere’.

We received positive feedback from an advocate who worked with a person living at the service. They told us they found the home recognised people as individuals and worked flexibly and creatively to meet their needs. We saw care plans contained limited details of preferences, although staff were aware of people’s likes and dislikes.

There were no scheduled activities and there was a lack of clear recording of choice offered around activities. However, people and relatives said a range of activities were offered that met people’s preferences. During our inspection people were supported to go out to the shops and we heard staff and people discussing various options for activities that might interest them. We saw activities had been discussed at residents’ meetings.

The service had recently introduced new systems to monitor the quality and safety of service provision. However, we found some issues in relation to this area. A gas safety check had been scheduled on the business development plan, however we found this was two weeks overdue and was only carried out on the day of our inspection. There were also no audits of care plans or medicines, which were areas where we found some short-falls. Checks were not carried out of all equipment used by the home, meaning the safety of this equipment could not be ensured. This was a breach of the regulations.

The staff, family and people living at Six Acres we spoke with were all positive about the leadership of the service. Everyone we spoke with told us they felt able to approach the registered manager with any concerns they might have and felt that they would be listened to. We saw evidence that families had been involved in care planning and one relative we spoke with told is the service had acted on their suggestions.