This inspection took place on 20 April 2017 and was unannounced. Spring Bank farm is run and manged by Cabrini Care Limited. The service provides care and support for up to seven people with autism. On the day of our inspection four people were using the service.

The service did not have a registered manager in place at the time of the inspection. Although the present manager was in the process of applying to become 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.

When we last inspected the service on 5 and 6 October 2016 we found people who used the service were not always provided with safe care and treatment, the provider did not always follow safe practices when employing staff and had not undertaken quality audits which would assist them maintain safe standards of care for people who lived at the service The provider sent us an action plan telling us they would make these improvements by November 2016. We found at this inspection that this had been completed and the provider had made improvements in line with the action plan.

The risks to people’s safety were reduced as the staff had good knowledge of the different types of abuse people may be exposed to. They had received training to assist them to recognise safeguarding concerns and they were aware of the process for reporting concerns. Risk assessments had been completed in areas that had been highlighted as potential risks to people’s safety. The service had enough suitable trained staff to provide care and their recruitment processes were safe.

People’s medicines were managed safely and staff received ongoing appropriate training for their roles. People were supported to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were encouraged to follow a healthy balanced diet and any specialist diets were catered for. Staff were supported to manage the different health needs of the people who lived at the service.

People were supported by staff who had an excellent knowledge of their needs and treated them with dignity and respect. Relatives were encouraged to contribute to their family member’s support plans which were person centred and fully reflected their needs. Where required people had access to advocacy services.

People were supported to undertaken a range of social activities of their choice tailored to meet their individual needs.

The management team responded to complaints positively and relatives felt they could report any concerns to them and they would be taken seriously.

The management team undertook quality monitoring processes to monitor and improve the quality of the service provided.

This inspection took place on 5 and 6 October 2016 and was unannounced. Spring Bank Farm is run and managed by Cabrini Care Limited. The service provides care and support for up to seven people with autism. On the day of our inspection five people were using the service.

The service did not have 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 pervious registered manager had left their post in January 2016 and the provider had recently appointed a new manager to the service who had not yet applied to become the registered manager.

Safeguarding incidents were managed appropriately. Risks to people’s safety were assessed but on occasion when people’s needs changed the risk assessment did not reflect the change in a timely way.

Staff levels did not always meet the needs of people and agency staff were used to support people. There was a high turnover of staff and new staff were not always supported in their role. The recruitment processes in place lacked complete records of pre-employment checks for new staff employed. Medicines were not always managed in a safe way as errors and near misses were not recorded or monitored.

Staff received training for their roles but there was a lack of update training for staff and there was a lack of regular supervision and appraisals for staff.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People’s health needs were not always managed in a timely way. However people were protected from the risks of inadequate nutrition and specialist diets were provided for those people who required them.

People who used the service, and their representatives, were encouraged to contribute to the planning of their care and people were treated in a caring and respectful manner

People who used the service, or their representatives, were not encouraged to be involved in decisions about the service and people did not always feel their concerns or complaints were taken seriously. There was a lack of quality monitoring audits systems in essential areas such as medicines, care plans and the environment.

We carried out this unannounced inspection on 1 December 2015. Spring Bank Farm is run and managed by Cabrini Care Limited. The service provides care and support for up to seven people with Autism. On the day of our inspection six people were using the service.

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 and associated Regulations about how the service is run.

People who used the service were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed. Action was taken following any incidents to try and reduce the risks of incidents happening again. People received their medicines as prescribed and the management of medicines was safe.

Staffing levels were sufficient to support people’s needs and people received care and support when required. Staff were provided with the knowledge and skills to care for people effectively and felt supported by the management team

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed. People who used the service, or their representatives, were encouraged to contribute to the planning of their care.

People were treated in a caring and respectful way and staff delivered support in a relaxed and considerate manner. Positive caring relationships had developed between staff and the people who lived at the home and number of different communication techniques were used to assist people to make their needs known. People who used the service, or their representatives, were encouraged to be involved in decisions and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

On the day of our inspection five people were living at the home. We were not able to speak with any of the people due to their communication needs, so instead we spent time observing staff assisting them to go about their daily lives. All interactions observed between staff and people living at the home were appropriate, professional and friendly. Staff took care to preserve the dignity and respect of the people. Staff supported several people to go out into the community during our visit.

The accommodation was appropriately designed and suitable to meet the needs of the people living there and risks within the home had been assessed. The home was clean and was personalised to the people who lived there.

We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which enabled them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment, induction and training systems were robust.

People who used the service were living with autism and unable to tell us about the care they received. The service had several communal rooms that people could use. We were unable to carry out a formal observation to enable us to assess people’s wellbeing because they had free access throughout the building and did not remain in one location for very long. However, we spent time observing the care they received and the level of staff interaction.

We observed the number of staff working with people was sufficient to enable them to be safe and well supported. We saw that staff were attentive to people’s needs. Staff interacted with people in a friendly, respectful and professional manner.

The records showed that staff supported people to follow their favourite pastimes, to be part of the local community and to go on holiday if they wanted to. We saw that people’s bedrooms were comfortable and that they had their own belongings around them.

We also saw that there were Mental Capacity Act (2005) (MCA) assessments in place regarding people's capacity to make day-to-day decisions.

There were appropriate measures taken to ensure that the people who lived in the home were protected against the spread of health care associated infections.

People who used the service and their families were supported to make complaints. Staff on duty told us that they tried to ensure that complaints were dealt with informally and in line with the provider’s complaints procedure.

People living at Spring Bank Farm had limited verbal communication and were not able to tell us about their experience of the service. We therefore observed care, inspected care plans and the premises to evaluate the quality of support provided to people living at Spring Bank Farm.

We inspected the service on 06 and 07 November 2014. Spring Bank Farm provides accommodation and personal care for up to 7 people, male only. On the day of our inspection 5 people were using the service.

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 and associated Regulations about how the service is run.

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 to report on what we find.  The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The manager had applied the principles of the MCA and DoLS.

There were enough staff with the knowledge and skills to provide safe and appropriate care and support. There were systems in place to protect people from the risk of abuse.

People were able to receive their medicines as prescribed.

People were treated as individuals. Staff knew them well and understood their individual preferences and respected their choices. We observed how staff treated people with dignity and respect.

People had access to sufficient quantities of food and drink. Staff monitored their nutrition and hydration requirements regularly.

Referrals were made to health care professionals for additional support or guidance if people’s health changed.

There were audits of the quality of the service taking place to continually improve the way care was provided to people who used the service.