This inspection was carried out on 23 January 2018 and was unannounced. At their last inspection on 7 October 2016, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

St Agnells House 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.

St Agnells House provides accommodation for up to eight people with learning and physical disabilities. The home is not registered to provide nursing care. At the time of the inspection there were eight people living there.

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.

The service has a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

People told us they felt safe at the home and they liked the way staff supported them to live the life they wanted. Relatives told us they were happy how people were looked after and they felt the service was safe and met peoples` needs.

People were involved in developing their care and support plans and relatives where appropriate were invited to participate in developing and reviewing people`s care and support plans.

Relatives and staff told us there were enough staff to meet peoples` needs and support them with the activities they chose to do.

People lived an active life and had been provided with opportunities to pursue their hobbies and interests including going away on holidays.

People were supported by staff who were trained and received regular supervision. People were encouraged to eat a healthy, balanced diet and there was access to healthcare professionals when needed. Staff understood the importance of giving people choice and listening to their views and opinions. However staff needed more training to fully understand the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards.

The design and layout of the building met the needs of people who lived at the service, however the environment needed some redecoration and windows and high ceiling beams needed cleaning.

Staff felt supported by the registered manager and they told us that recent changes in the management structure impacted positively on staff`s morale bringing and motivated them to work as a team.

People’s personal care records were kept securely to ensure unauthorised people did not have access to them. Staff spoke to people in a kind, patient and friendly way and people were treated in a dignified manner. Staff consistently ensured people’s social needs were met, and people felt staff listened to them and valued their views.

There was a complaints process available and people were asked for their views at meetings. In addition relatives told us they were regularly asked to give feedback about the service and they felt positive about how the home was managed.

The registered manager was passionate about providing the best possible support for people and they actively supported people and staff to achieve this. There were quality assurance systems in place which were used effectively to identify any areas in need of improvement. Actions were taken to improve the quality of the care people received when it was necessary.

This inspection was carried out on 6 September 2016 and was unannounced. At the last inspection on 8 December 2015, the service was found to not be meeting some of the standards we inspected. This was in relation to ensuring people’s personal care records were kept securely and that quality improvement systems had not ensured the service identified concerns and continually improved. The provider sent us an action plan stating how they would make the necessary improvements. At this inspection we found that they had made significant improvements, however further improvements were required to meet the regulations.

St Agnells provides accommodation and personal care for up to eight people with learning and physical disabilities. At this inspection six people were living at the service.

The home did not have a registered manager. 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. The previous manager had recently resigned from the home, and as an interim measure, the deputy manager and locality manager were providing day to day management of the home.

At this inspection we found sufficient numbers of staff were deployed to provide support to people living in St Agnells. The manager had reviewed and investigated incidents and accidents to help keep people safe from the risk of harm or abuse. Risk assessments had been developed to positively respond to risks that were identified. People’s medicines were managed safely and people received their medicines as the prescriber intended.

Staff felt supported by the deputy manager to enable them to carry out their role sufficiently. Staff had received training relevant to their role, and were able to obtain further qualifications where required. People were supported to eat a healthy diet by staff who knew their individual needs well. When people required support from health professionals such as the GP or Nurse, we saw people were swiftly referred and supported.

People’s personal care records were kept securely to ensure unauthorised people did not have access to them. Staff spoke to people in a kind, patient and friendly way and people were treated in a dignified manner. Staff consistently ensured people’s social needs were met, and people felt staff listened to them and valued their views.

The home did not have a registered manager in post. People received quality care, however this continued to require improvement to ensure it was effective as a range of audits required to monitor the quality of the service had been reviewed as required, however actions resulting from these were not always implemented. People, their relatives and staff were supported by the deputy manager who they felt listened to their views and encouraged feedback.

This inspection took place on 08 December 2015 and was unannounced.

St Agnell’s provides accommodation for up to eight people with learning or physical disabilities. At the time of our inspection eight people were living at the home.

The home did not have a registered manager. 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. The current manager had only been in post at the home for five weeks. Four of these weeks had been as a deputy, and the final week as the manager. Many of the issues and concerns we identified were not attributable to the current manager as they pre dated their appointment. The manager told us they would apply for their registration shortly, however had not done so at the time of our inspection.

We carried out an unannounced comprehensive inspection of this service on 04 December 2014. A breach of legal requirements was found in respect of three regulations. Following the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 09, 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations correlate to Regulations 10, 11, and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this comprehensive inspection to check that they had followed their plan and found that although improvements had been made the legal requirements had not yet been met. At this inspection on 08 December 2015 we found a breach of legal requirements in regulations 16, 17 and 18. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Agnell’s on our website at www.cqc.org.uk.

At this inspection we found sufficient numbers of staff were not always deployed to provide support to people living in St Agnell’s. The manager had not always thoroughly reviewed and investigated incidents and accidents to keep people safe from the risk of harm or abuse. Risk assessments had not always been developed to positively respond to risks that were identified. People’s medicines were not always stored correctly. People were supported by staff who had undergone a robust recruitment process to ensure they were of sufficiently good character to be employed at the service.

Staff felt supported by the manager to enable them to carry out their role sufficiently, however people’s relatives felt the provider did not positively support the management team. Staff had received training relevant to their role, and were able to obtain further qualifications where required. People were supported to eat a healthy diet by staff who knew their individual needs well. When people required support from health professionals such as the GP or Nurse, we saw people were swiftly referred and supported.

People’s personal care records were not always kept securely to ensure unauthorised people did not have access to them. Staff spoke to people in a kind, patient and friendly way and people were treated in a dignified manner. Staff consistently ensured people’s social needs were met, and people felt staff listened to them and valued their views.

People received quality care, however this was not monitored and was not robustly reviewed by the provider. The home had suffered from a lack of consistent management and governance, and audits required to monitor the quality of the service had not been reviewed as required. People, relatives and staff were supported by a newly appointed manager who they felt listened to their views and encouraged feedback.

This unannounced inspection took place on 04 December 2014. At our last inspection on 01 August 2013 we found the service was meeting the requirements.

St Agnells House provides accommodation and personal care for up to 8 people with learning and physical disabilities.

There was not 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 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection there we identified that not all applications had been made to the local authority in relation to people who lived at the service.

The manager and staff were familiar with their role in relation to MCA and DoLS.

There were numbers of staff available to safely support people’s needs however the use of agency staff meant care was not always consistent.

Incidents that required reporting to the Care Quality Commission had been made.

Peoples medicines were stored, managed and administered safely and staff had received appropriate training.

Staff were not clear on how to identify and report any concerns relating to a person’s safety and welfare.

Staff were recruited through a robust procedure and were provided with regular professional development to ensure their knowledge was up to date.

Staff knew people well and provided support in a timely manner. There was sufficient food and drink available and people were assisted to eat and drink in a calm and sensitive way.

People had access to a range of health care professionals, such as chiropodist, mental health teams and a doctor.

People saw a doctor regularly and people were referred when there were concerns with their health.

There was not an effective system of regular auditing, review and action to ensure people received a quality service that kept them safe.

People’s feedback including staff had been sought and acted upon.

The people we spoke with told us that they liked living in the home but would like to go out more and to have more to do during the day. One person said that there was a club they used to go to and would like to start to go again. Other people told us that the staff were nice and that they cared for them well.

We found that the people were not stimulated, and that while the home took action when safeguarding were identified. The systems in place had not picked up issues which were under investigation at the time of the inspection; these issues had been brought to the attention of management outside of routine processes.

We saw that people were assisted to eat in a manner that promoted their health and welfare, and that they were given a choice on what to have for lunch. Care plans were well written and reflected the needs of the people.

A small number of people were able to verbally communicate with us. We talked to people about their experiences and made observations during our visit.

People who were able to communicate verbally told us that they were happy living at the home and that they liked the staff and felt safe. One person said, "I like living here, the staff are friendly and it’s always the same staff which is nice”.

We observed that people were treated with respect and that staff supported them during the day.

Staff told us St Agnells was a nice place to work and that they thought they had enough staff to meet the needs of people. We observed the home to be visibly clean on the day; all the people appeared to have had their personal care needs met.

We were told that people could chose their meals and that something different was offered if they did not want what was being offered from the menu. There were menus available but these did not have pictures of the meals on them to assist people with their choice.

We observed staff supporting people who needed help with eating. Although only two people needed help, assistance provided appeared rushed and the amount of food placed on each spoonful was excessive. One person appeared to be unable to cope with the speed and amount of food given to them that they coughed and choked a little during and after their meal.

During our site visit, we met some of the people using the service. They were relaxed and cheerful. Some people communicated with us with sounds and gestures and with expressions of comfort and satisfaction.

A person who was able to communicate verbally said, “Staff are very nice.”

Another person commented, “Care is ok.”

When asked about choices, a person said, “We have nice meals. I choose what I like to eat. I go out to Harvester for meals on special days. One of the staff comes with me.” The same person said excitedly that their room “is going to be redecorated” and that they “had to choose the wallpaper and colour scheme.” Another person said, “I have my cat. I am allowed to feed the cat in that room” and pointed to the recreation room with a smile.