This inspection took place on 3 May 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. A second day of inspection took place on 10 May 2017, and was announced.

St Anne’s Community Services – Astbury consists of two large, modern, purpose built bungalows. The bungalows are connected via a doorway. The service is in a residential suburb of Middlesbrough, with local amenities nearby. The service can provide care and support for up to eight people with learning disabilities and/or autistic spectrum disorder. The service is a care home without nursing. At the time of our inspection eight people were living at the service.

The service was last inspected on 4 December 2015 and 6 January 2016. During that visit we identified a breach of our regulations. Mental capacity assessments did not always take place and decisions made in people’s best interests were not always documented. We took action by requiring the provider to send us action plans setting out how they would make improvements. During our latest inspection we found action had been taken and improvements had been made.

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.

Risks to people were assessed and plans put in place to reduce the chances of them occurring. The registered manager monitored accidents and incidents to see if improvements could be made to keep people safe. Plans were in place to keep people safe in emergency situations. Policies and procedures were in place to safeguard people from abuse. People’s medicines were managed safely. The registered manager monitored staffing levels to ensure they were sufficient to keep people safe. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. The premises were clean and tidy.

People’s rights under the Mental Capacity Act 2005 were protected. Mental capacity assessments were documented, and guidance on the decisions people could make themselves and those they would need support with were detailed in people’s care plans. Staff received a range of training in order to support people effectively. Newly recruited staff were required to complete the provider’s induction process before working with people without supervision. Staff were supported through regular ‘personal development review’ supervisions and appraisals. People were supported to maintain a healthy diet. People were supported to access external professionals to monitor and promote their health.

Throughout the inspection we saw that support was delivered to people in a kind and caring way. Relatives spoke positively about the support people received, and described staff as caring. Staff had a good knowledge of people and were able to communicate effectively with them. People were encouraged to be as independent as possible and were treated with dignity and respect. Policies and procedures were in place to support people to access advocacy services and end of life care.

Care and support was based on people’s assessed needs and preferences. Staff were knowledgeable about people’s support needs and were able to talk in detail about how people liked to be supported. People were supported to access a range of activities based on their personal interests. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and said they were proud of where they worked. Staff spoke positively about the registered manager and deputy manager. The registered manager carried out a number of quality assurance checks to monitor and improve standards at the service. The registered manager had informed CQC

At the last inspection in August 2013 we found that people who used the service, staff and visitors were not protected against the risks associated with unsafe or unsuitable premises.

We found that the provider had taken action to improve flooring in bedrooms and communal areas which were showing signs of wear and tear. We saw that repairs to bathroom flooring had been carried out.

Fire exits were free from obstruction and safe to use providing easy exits during an emergency.

We found that the provider had taken action to ensure safe staffing levels were provided in the home.

During the inspection we spoke with four people, the manager and three care staff. People told us what it was like to live at this home and described how they were treated by staff. People expressed satisfaction with the care and service that they received.

One person told us “I like it here, my care worker looks after me, I like them.”

We saw that staff interacted and communicated well with people. The staff were attentive and demonstrated a good knowledge and understanding of the needs of people. We saw that the atmosphere in the home was friendly and relaxed.

We saw that people had their needs assessed and that care plans were in place. We saw that there were effective processes in place to ensure safe sharing of information with other providers.

The care and support was provided by suitably qualified, skilled and experienced staff. However we found that staffing levels were not always appropriate to provide care in the home. The manager told us that more staff had been recruited to address this and were undergoing pre-employment checks.

We found that medicines were administered safely.

We found that systems were in place to deal with comments and complaints.

We found the home had systems in place to ensure maintenance and improvements were carried out. However we found that the fire exits were not maintained to provide a safe escape route.

We spoke with two people during our visit who said the following:

"I choose my own clothes and can say what time I would like to get up or go to bed. I choose what I want to eat and I attend resident meetings where we discuss things.

"I am well looked after and my family visit me. It's a nice place to live. I go out to the pub and the theatre and go on outings to different places."

"I feel safe here, I am well looked after."

Both people we spoke with said that they liked the staff.

We inspected St Anne’s Community Services - Astbury on 04 December 2015 and 06 January 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 06 January 2016.

At the last inspection in November 2014 we found the provider had breached several regulations associated with the Health and Social Care Act 2008. We found that the service did not ensure accurate records in respect of each person using the service. Also there were not effective systems for monitoring the service and this included the staff development plan not being updated. We saw improvements had been made during this inspection visit.

St Anne’s Community Services – Astbury consists of two large, modern, purpose built bungalows. The bungalows are connected via a doorway. The service is in a residential suburb of Middlesbrough, with local amenities nearby. The service can provide care and support for up to eight people with learning disabilities and/or autistic spectrum disorder. The service is a care home without nursing. At the time of our inspection eight people were living at the service.

The home had a registered manager in place. 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.

Staff understood the requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. However they were not following the process required to evidence MCA assessment and best interest decisions

We saw people’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated. We saw evidence to demonstrate that people were involved in all aspects of their care plans. A new care plan system was being introduced, we saw one completed plan which included person centred information about the person and easy to navigate risk assessments and professionals’ advice.

There were effective systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the registered manager and senior staff within the organisation. We also saw the views of the people using the service were regularly sought and used to make changes.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as moving and handling, choking, health and behaviour that challenged. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual performance development review.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Where only a few staff required training the registered manager was working towards ensuring they received this.

People told us that there were enough staff on duty to meet people’s needs. We found that safe recruitment and selection procedures were in place. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that the registered manager was starting to implement hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were closely monitored. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.