About the service:

St Albans is a care home for up to 6 people who have a learning disability or autism spectrum diagnosis. At the time of the inspection 6 people were living at the service.

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.

People’s experience of using this service:

• People told us and indicated they were comfortable living at the service and with staff. Relatives told us they were happy with the service. One person told us, “I like it here.” People were protected against avoidable harm, abuse, neglect and discrimination. People received their medicines as prescribed.

• Staff had the skills and knowledge to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s nutritional needs were met and they received enough to eat and drink to ensure they had a healthy diet. People accessed health care when needed.

• People received care from staff who were kind and caring and knew them well. Staff were patient and empathetic and had built good relationships with people. People's privacy, dignity and independence were respected by staff.

• People's support needs were assessed and planned to ensure they received the assistance they needed. People's support was individualised. People were supported to take part in activities they enjoyed. Their preferences, likes and dislikes were known to staff. The provider had a complaint process which people were aware of to share any concerns.

• The provider had systems in place to investigate and monitor accidents and incidents. The registered manager understood their legal requirements within the law to notify us of all incidents of concern, deaths and safeguarding alerts. The registered manager was open and honest and had a development plan in place to drive improvements.

Rating at last inspection:

At the last inspection the service was rated Good. (Last inspection report published 11 August 2016.)

Why we inspected: This was a planned comprehensive inspection scheduled to take place in line with the Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Good’ services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this home on 30 June and 05 July 2016. This was an unannounced Inspection. The home was registered to provide residential care and accommodation for up to six people. At the time of our inspection six people were living at the home.

A registered manager was in post and was present throughout 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 2008 and associated regulations about how the service is run.

One person using this service told us they felt safe. The other people we met found verbal communication difficult. We observed people looking relaxed and showing happiness with their facial expressions and body language. Relatives we spoke with had confidence that their relative was safe. Staff understood their roles and responsibilities to protect people from the risk of potential harm. Staff were aware of the provider’s processes for reporting any concerns.

There were enough staff to support people safely and recruitment checks were in place to help ensure staff that were employed were safe to work with people.

Staff had been trained to support people effectively. This included learning about the specific needs and conditions people lived with. Staff told us that they received regular supervision and felt supported. Senior staff were always available for them to seek advice and guidance.

People had access to a variety of food and drink which they enjoyed. People were supported when necessary to access a range of health care professionals.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. We observed staff working consistently in line with people's care plans when restrictions or safeguards had been agreed for people. Staff were observed seeking people’s consent before providing any care and support.

People were relaxed in the company of staff and we observed many positive, compassionate interactions between people and the staff who were supporting them. Relatives and health professionals we spoke with praised the positive regard and commitment that the staff team showed to people living at St Albans. People had been encouraged to remain as independent as possible. We observed staff ensuring people’s privacy and dignity was maintained.

Staff recognised the individuality of each person, and had planned and delivered support that reflected their individual needs and preferences.

People and their relatives knew how to raise complaints. Where complaints had been raised the registered manager had taken prompt and appropriate action.

The registered manager was aware of her responsibilities and had the skills and experiences required to enable her to effectively lead this service.

This inspection took place on 27 April 2015 and was unannounced. At our last inspection in May 2014 the provider was not meeting the regulation which required them to operate effective quality monitoring processes to keep people safe from the risk of medication errors.

St. Alban’s is a residential home which provides care to people who have learning disabilities. The service is registered to provide personal care for up to six people and at the time of our inspection six people were using the service. There was a registered manager at this location however they no longer worked at the service and were in the process of deregistering. A new manager had started working at the service in December 2014 and was in the process of applying for registration with the Commission. 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.

We observed staff continually ask people how they wanted their care to be delivered and supported them in line with their requests. People were affectionate towards staff and confident to approach them for support with activities they said they liked. Staff were knowledgeable about the individual support people required in order to maintain their privacy and dignity and relatives told us that this had improved recently.

Relatives were encouraged to visit and people in the home were supported to stay with relatives. People expressed their views about the service at regular meetings and were involved in discussing the care they received. Relatives told us they were often invited by the provider to comment on the service at regular meetings or on the telephone.

The provider identified if people were at risk of harm and had taken action to reduce the risk. However records which monitored people’s nutritional intake were not always up to date and some records contained conflicting information about foods which people could eat safely. We saw that, when necessary, the provider had involved other healthcare professionals in people’s care.

All the relatives and staff we spoke with told us that they felt there were enough staff to meet people’s care needs. Staff were able to demonstrate they had the skills and knowledge to communicate effectively with the people who used the service and expressed a good knowledge of people’s individual preferences. Staff were supported with their personal development and to deliver what was required of their roles.

People were kept safe and staff knew how to recognise when people might be at risk of harm and were aware of the provider’s processes for reporting any concerns. Records showed that the provider had worked with other agencies when necessary in order to keep people safe.

Medication was managed appropriately because staff were aware of the provider’s medication policy and people received medication in line with their care plans.

Care plans indicated where people had capacity to make their own decisions and choices. When people were thought to lack mental capacity we saw the provider held meetings to ensure decisions were made in the best interests of the people who used the service. The provider had ensured that staff were clear about the requirements of the law and that people were supported with the least restrictions of their liberties.

The provider had a system to assess the quality of the service and identify how it could be improved. The provider had developed an action plan to implement improvements at the service, however audits had not always identified that people’s care records did not contain up to date nutritional information or any discrepancies between balance of medication held and records of administration.

Relatives and staff told us that the quality of the service had improved since the new manager had joined the service and records showed that the provider had taken action in response to issues raised at regular meetings. People told us that they knew how to make a compliant and were confident that they would be responded to. Some relatives told us however that although the provider regularly sought their views they were reluctant to comment on the service because of the impact on staff.

We have made a recommendation that the provider seeks guidance and reviews how they support relatives to feel comfortable to express their views and make complaints about the service.

The inspection was undertaken by one inspector. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We spoke to one person who used the service and the relatives of three people who used the service. We spoke to the manager and four members of staff. We looked at records and observed how people were supported with their care needs.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt their relatives were safe. We saw that the provider responded appropriately to safeguarding concerns. This meant that the provider responded to concerns in order to keep people safe.

Care records showed that risks to people had been identified and appropriate plans put in place to protect people from harm. Staff we spoke with were aware of the care that people needed to keep them safe. This ensured that the provider was able to identify that people were receiving the care they needed to keep them safe from the risk of harm.

The provider had taken action to ensure that people were cared for in an environment that was safe, clean and hygienic. The provider conducted regular maintenance checks and audits. People, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Recruitment practice was safe and thorough. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to ensure that people’s health and welfare needs were safely met.

The service did not always respond to concerns identified in audits in order to ensure that people received care which kept them safe. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people’s safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit an application.

Is the service effective?

Where necessary risk assessments had been undertaken and were used to help staff provide appropriate, safe and consistent support to people living in the home. Care plans contained information and guidance about people’s specific conditions to enable care staff to meet the individual needs of the people who used the service.

The service upheld people’s human rights. We saw that people living at the home regularly visited people that were important to them.

People who used the service were asked to comment on the service provided, this included questions about the support they received. Information was provided to people in ways which met their individual communication needs.

Is the service caring?

Through observation and from speaking with staff it was clear that they genuinely cared for the people they supported. We saw staff speak to the people with warmth, dignity and respect. When a person asked for something or support with their care needs we saw that staff responded quickly and effectively.

Staff gave people choices about what they wanted to do and what they wanted to eat. People were supported to engage in the local community and visit their relatives.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

We spoke with the people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example one person told us, “They are fine”. Another person said, “There has been a lot of changes, but they seem OK. I will wait and see”.

We saw that care plans contained essential information about people’s regular health assessments from other professionals. This ensured staff had access to information about people’s needs and could provide the most appropriate care.

Is the service responsive?

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. The manager was aware of the provider’s policy and knew how to respond to concerns. We saw evidence that the provider had taken action when concerns were raised.

People were supported to comment on the care they received at regular meetings and were given information in a format which met their communication needs. People told us that the provider made them feel comfortable to raise concerns. The relative of a person who used the service told us, ““They [The manager] are always telling me that they are available to discuss things”.

The service worked well with other agencies and services to make sure people received care in a coherent way. People were supported to attend doctors, dentists and other health appointments when needed. The provider supported people to seek the opinions of other health providers in order to gain further information about specific conditions.

The service was responsive to reports by other agencies about the quality of the care they provided.

Is the service well-led?

The provider regularly sought the views of the people who used the service. We saw evidence that they had introduced changes to how people were supported in response to comments received.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. We saw that there were meetings with staff to discuss quality issues and this helped to ensure that people received a good quality service at all times.

There was evidence that the provider had ensured that learning from incidents or accidents took place and appropriate changes were introduced or implemented to keep the people safe from harm.

The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better were addressed. These included reviewing people’s care records, the safety and suitability of the environment and equipment. However the provider did not always respond effectively to recurring concerns. As a result the quality of the service was at risk of not improving.

We saw that there were systems for medicine management in operation. These included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures. However we found that these systems did not always identify errors with the recording of medicines.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the service is well led.

We found that people’s needs were assessed and their care was planned and delivered in line with their individual care plans. Their health care needs were monitored and risks presented by the person's condition were assessed and managed. People were supported to be able to eat and drink sufficient amounts to meet their needs and were protected from the risks of inadequate nutrition and dehydration. Meals were planned to provide a balanced, healthy diet but there was a range of food and drink available for people to choose from.

We found there were sufficient numbers of staff on duty to meet people's needs, including at night and there was some flexibility in staffing arrangements to meet people's leisure needs. The majority of staff held nationally recognised qualifications in social care. Staff treated people with respect, dignity and kindness.

People were not always cared for in a clean, hygienic environment. The kitchen was not effectively cleaned and kitchen fittings were worn and chipped making them difficult to clean. Procedures for cleaning the home were not followed consistently by staff and gaps in the cleaning records were not acted on by managers. We have asked the provider to improve this.

The provider had a statement of purpose for the service that set out what it offered. A recently updated copy was given to the Care Quality Commission. We observed that the service being delivered to people was consistent with what the statement of purpose offered.

We visited the service on 14 June 2012. Most people were not able to give us their views on the service because of their complex needs and conditions. Two people told us that they liked living at the home and that the care workers help them to go out, pursue their interests and to go on holidays. They said they liked their bedrooms. One person told us that they had attended a 'customer participation' meeting held by the provider organisation for people who used a number of its services locally.

We used a variety of methods to gauge other people's experience of the service including reviewing records and talking to workers. Care workers and managers treated people with warmth and respect and people appeared relaxed and at ease with their care workers.