Our inspection of Spring Lake took place on 3 and 4 July 2018 and was unannounced.

Spring Lake provides accommodation for up to 11 people with varying support needs including people living with learning disabilities, autism, behaviours may be challenging to staff and other complex needs. At the time of this inspection there were 9 people living at the home.

There was a registered manager in place at the home. 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 home was registered prior to Registering the Right Support (2017). However, although a larger service, we found that it was following the values that underpin this document along with 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.

Following our last comprehensive inspection of Spring Lake on 13 and 16 January 2017 we rated the home as ‘Requires Improvement.’ The care plans and risk assessments for some people living at the home did not always include information and guidance for staff about how to support people in relation to their identified needs. The home was not well maintained and the provider’s safety checks had not addressed some maintenance failures. The home had failed to ensure that they had fully followed guidance associated with the Mental Capacity Act (MCA) 2005). We also found that laundry arrangements at the home did not reduce the risk of infection to people. Although the provider had arrangements in place to assess the quality of the service provided by the home, we found that these were not robust and actions identified had not been acted upon.

We returned to the home to undertake a focused inspection of the provider’s quality assurance processes on 24 August 2017.We found that actions had been taken to address the failures that we had identified and that there was a robust system in place to ensure that quality of the care and support provided at the home was effective. We gave the home a rating of ‘Requires Improvement’ since we needed to see if improvements were maintained.

At this inspection we found that the provider had maintained the improvements that they had made since our previous visits. The quality assurance procedures for the home showed that regular monitoring and auditing of care and support had taken place. Actions resulting from these had been promptly addressed.

People’s risk assessments and care plans were person centred and included guidance for staff members on how to support people effectively and safely. We looked at the daily care records for people living at the home. Although the written records were detailed a new online system had recently been introduced and we found gaps in the records which were being maintained electronically. The registered manager told us that they would raise this with the provider in order to seek a resolution.

The home was meeting the requirements of the Mental Capacity Act 2005 (MCA). Assessments of people’s capacity to make decisions had been carried out. People had up to date Deprivation of Liberties Safeguards (DoLS) authorisations and meetings had taken place to ensure that any actions or restrictions were in people’s best interests.

The home had robust quality assurance processes in place and we saw that any actions identified as a result of these had been addressed in a timely manner. These included improvements to the home environment and the quality of care plans and risk assessments. There were processes in place to seek the views of people who lived at the home and their family members and we saw that the results of these surveys were

We carried out an unannounced comprehensive inspection of this service on 12 and 16 January 2017. During this inspection we found the provider to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems or to monitor the quality and safety of the service to ensure compliance with the regulations. We served a warning notice.

After our comprehensive inspection in January 2017, the registered provider submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook a focused inspection on 24 August 2017 to check that the registered provider had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this focussed inspection which looked at whether the service was 'well-led'. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Spring Lake on our website at www.cqc.org.uk.

Spring Lake provides accommodation for up to 11 people with varying support needs including people with learning disabilities, autism, behaviours that challenge services and other complex needs. At this inspection there were 10 people living at the service.

There was a registered manager in post who was present throughout the 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.

At this focused inspection, we found that the provider had followed their plan and legal requirements had been met.

We found the provider had put in place procedures to monitor the quality of the service. We saw evidence that regular audits on care records had been completed since our comprehensive inspection in January 2017. Audits had been carried out covering a range of areas including, medicines administration, care documentation, maintenance, health and safety and infection control. There was evidence audits were used to improve the quality of care people received.

This inspection took place on 12 and 16 January 2017 and was unannounced.

Spring Lake provides accommodation for up to 11 people with varying support needs including people living with learning disabilities, autism, behaviours that challenge services and other complex needs. At this inspection there were 10 people living at the service.

There was 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. A registered manager was in place.

During our inspection we identified a number of concerns about the care, safety and welfare of people who used the service. The quality assurance processes in place at the service were not robust enough to assess, monitor and mitigate the risks relating to the health and welfare of people using the service and to drive service improvement.

Although relatives and professionals told us staff were kind and caring, some staff expressed concerns that people’s choices and preferences were not always respected. We saw that not all people received personalised care and support that met their needs and took account of their preferences. Improvements were required to ensure care was provided in line with people's individual needs, and to make sure people’s choices and dignity were respected.

There were processes in place to seek the views of people who used the service and those acting on their behalf but it was unclear how this feedback was used effectively to improve the quality of the service. Improvements were required to ensure people's concerns and complaints were acted upon.

Risks to people's safety and wellbeing were not always managed effectively to make sure people were protected from harm. We saw that some risks to people's well-being had not been identified or adequately mitigated. This had put people's welfare at risk.

Facilities at the home were not well maintained in order to meet people's needs safely and effectively. Some areas of the premises were in a poor state of repair and required attention in order to reduce risks to people. We observed that the emergency lighting system required repairing and the hot water supply and showering facilities at the home were faulty.

People were not protected against the risk of the spread of infection. Staff did not follow correct procedure to ensure laundry was processed correctly in order to reduce the risk of cross infection.

Staff did not always gain consent from some people before providing care and treatment. In one example, we saw where people did not have mental capacity to make specific decisions about their care and treatment, The Mental Capacity Act (2005) was not fully adhered to. The provider had failed to appropriately assess this person’s mental capacity in relation to restrictions of their freedom and liberty.

There were procedures in place to ensure people's medicines were managed safely. Staff regularly reviewed and audited medicines to ensure they met people’s current needs.

Staff were aware of the provider’s safeguarding policies and procedures and their role and responsibilities in keeping people safe. The provider was working with the local authority in investigating some current safeguarding concerns.

Staff received training to provide them with the skills and knowledge to care for people effectively.

People were supported to maintain balanced diet based on their preferences. Staff had a good understanding of people's preferences and supported them to make choices in relation to their nutrition.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take. Full information about CQC's regulatory response to any concerns

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Spring Lake is a care home that is registered to accommodate up to 11 people who have learning disabilities and require support with personal care. At the time of our visit, the service was providing care for 10 people.

This was an unannounced inspection. The service was last inspected in October 2013, and was found to be meeting regulations relating to consent to care and support, care and welfare of people who use services, staffing, medicines management and assessing and monitoring the quality of service provision.

The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff understood people’s needs and we saw that care was provided with kindness and compassion. People’s relatives told us staff were kind and caring, which we observed during this visit. We saw staff treated people with respect and dignity.

All staff had undertaken the required training and where necessary refresher training had been booked to keep their skills up to date and to ensure that the care provided was safe and effective to meet people’s needs.

The registered manager and staff considered families as a valuable source of information, with a role to play in care decisions. We saw from people’s care records that families were involved in people’s care. However, in a few cases the service had failed to respond to the needs of some people.

The manager and deputy manager demonstrated an understanding of their role and responsibilities, and staff told us they felt well supported. There were systems in place to monitor the safety and quality of the service provided. The manager encouraged feedback from families and other stakeholders, which they used to make improvements to the service.

Staff understood how to safeguard people they supported. Managers and staff received training on safeguarding adults, the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA).

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs, which meant they were unable to tell us their experiences.

People looked content and well supported. Staff we spoke with were knowledgeable regarding their roles and responsibilities and the needs of people who used the service. Staff demonstrated they understood aspects of the safeguarding process relevant to them.

Staff understood that they needed people’s consent before providing care and support, which meant the provider acted in accordance with people's wishes.

The provider cooperated with others involved in the care of people who used the service, which meant people’s health, safety and welfare was protected when more providers were involved in their care and treatment. This ensured people received continuity of care.

All the people using the service had significant communication needs, which included being unable to speak or being able to say only a few words. Some people were able to answer questions by nodding their head, providing one word answers or by gestures and facial expressions. Observation was therefore the main tool used during the inspection. We saw signs of people’s well being. They smiled, laughed and were well dressed. We saw people were supported to make decisions, which included what they wanted to eat, and what they wanted to do.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff respected people’s privacy and knew about their roles and responsibilities in meeting the needs of people that they supported in a sensitive and respectful manner. We saw people using the service approach staff without hesitation and they accessed their bedrooms and communal areas freely within the home.

Each person had a plan of care that had been regularly reviewed, and included information about the individual support and care that people using the service needed. There were enough skilled and experienced staff to meet people’s needs. Medication was stored and administered safely and records were accurate and up to date.

During our visit to Spring Lake we spent most of the day with people using the service. Most people using the service had significant communication needs so were unable to communicate verbally with us. Some people nodded or shook their head, used signs, gestures, facial expressions or one or two word answers in response to questions we asked them. Due to people’s communication needs we spent the major part of our visit observing people’s interaction with staff and other people using the service.

During our visit we spoke with staff, looked at people’s care plans and other records to enable us to make a judgement about outcomes for people living in Spring Lake. People showed people showed signs of ‘well being’. They were seen to smile and laugh, approached staff without hesitation, went out into the community, and participated in a number of activities.

Prior to our visit we spoke with some other people who had contact with the home.

Staff spoke of enjoying their job supporting and caring for people at Spring Lake. They confirmed there was good teamwork and consistency of care provided to people using the service.