This inspection took place on 27 July 2018 August and was unannounced. We also inspected on 23 August and this date was announced. The service had previously been inspected in January 2016 and met all their legal requirements.

St Anne’s Smithies Moor Lane 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. The care home accommodates six people in one adapted bungalow. People at the home have complex physical and learning disabilities and require care provided by trained nurses.

There was a registered manager in place who had been registered since 2016. 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 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 and were embedded within this service which worked to ensure people could live as ordinary a life as any citizen.

Staffing levels were based on the needs of people at the home and were reviewed daily. Staff had been trained and were confident to recognise safeguarding issues which meant people were protected from harm.

Risks were well managed to ensure people’s freedoms were not overly restricted and risk assessments were based on positive outcomes for people.

The provider continued to perform safe recruitment practices which were evidenced when we reviewed the records of the one person who had been recruited since our last inspection.

We found decision specific capacity assessments had been carried out for people who lacked mental capacity to consent to aspects of their care delivery. These were compliant with the Mental Capacity Act 2005 (MCA). Staff understood the principles of the MCA and how to ensure people’s human rights were respected when making decisions on their behalf.

Staff received ongoing support from the management team through a programme of regular supervision and appraisal and they had been trained to ensure they had the knowledge and skills to care for people.

People’s nutritional needs had been assessed and detailed plans were in place to support those people with enteral feeding systems. We observed staff supporting people appropriately to maintain their nutritional and hydration needs.

People had been referred to other health professionals when the need arose and we saw this had positively affected people’s wellbeing. How to contact professionals was clearly referenced in care plans to ensure all staff had access to this information.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well.

Consideration and thought has gone into the decoration and layout to create a homely environment and relatives commented the homeliness of the service was a decisive factor which helped them choose the home for their relative.

There was clear evidence of person-centred care and records contained information detailing people’s life histories, preferences and choices

The registered manager was visible in the service and communication was open, honest and transparent. Staff had clear direction and were sure about their roles and responsibilities. Systems and processes for ensuring the quality of the service were securely and effectively in place.

There was evidence the organisation reflected on and learnt lessons following incidents ensuring learning was shared to improve safety for people usin

The inspection of Smithies Moor Lane took place on 27 January 2016 and was unannounced.

St Anne’s, Smithies Moor Lane provides accommodation with nursing to six people living with physical and learning disabilities. There were four people living at the home at the time of our inspection.

The service did not have a registered manager 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 2008 and associated Regulations about how the service is run. An acting manager was in post to provider management at the service until a registered manager could be appointed.

The service had previously been inspected on 20, 21 and 22 July 2015 and was found to be in breach of regulations in relation to person centred care, the need for consent, safe care and treatment, governance and staffing. We received an action plan from the registered provider, who told us all actions would be completed by January 2016, and we confirmed at this inspection that all actions had been completed.

At our previous inspection we found risk assessments lacked details. At this inspection we found significant improvements had been made and all risk assessments were detailed, and covered all possible risks to the people living at the home and were effective in reducing risks to the people who lived there.

We had found at our previous inspection, at certain times, there were not enough staff to support the people who lived there. At this inspection we found significant improvements had been made and there were sufficient numbers of staff to ensure the service was safe. In addition, the service had employed a driver for 20 hours a week to support people living there to attend day care but also to take part in activities in the local community.

The home continued to perform safe recruitment practices which were evidenced when we reviewed the records of the one person who had been recruited since our last inspection.

We found medicines continued to be stored and administered safely and in addition medicine competency checks had been undertaken by the acting manager to ensure staff were competent in their administration practices and followed national guidelines.

At our last inspection we found a lack of recorded decision specific capacity assessments in the care files we looked at. At this inspection, significant improvements had been made and detailed capacity assessments and best interest meetings had taken place in relation to specific decisions around the administering of medicines, restrictions in place such as lap belts and splints, bed rails, 24 hour observation, and day care.

There had been a lack of supervision and appraisal for existing staff at our last inspection. We found significant improvements and staff were supervised, appraised, mentored and trained to ensure they had the skills to provide a high quality service.

We saw evidence that the people who lived there were supported well to maintain their health and social care needs and referrals had been made appropriately to services such as physiotherapy, occupational therapy, dental services and speech and language therapy services. The home also had a good range of preventative equipment such as pressure mattresses, cushions, profiling beds and moving and handling equipment which was well maintained and serviced regularly. They had also provided one tilting bed to relieve and promote tissue viability for one person living there and were in the process of purchasing a second one. This ensured the people living there were supported using the most up to date equipment available to maximise their comfort and health.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respec

The inspection took place on 20, 21 and 22 July 2015 and was unannounced. The service had last been inspected on 13 January 2014 and was not in breach of the Health and Social Care Act regulations at that time. The Care Quality Commission is notified when there has been an unexpected death at a service. We had been notified of the death of a person who used the service and as a result we undertook this inspection to ensure the people who lived at Smithies Moor Lane were safe and received a service that met their health and social care needs.

St Anne’s Smithies Moor Lane provides accommodation with nursing to six people living with physical and learning disabilities. There were four people living at the home at the time of our inspection.

The service did not have a registered manager 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 2008 and associated Regulations about how the service is run.

We found some risk assessments were completed in detail, but others lacked the detail to reduce the risks to the people who lived there. Staff knew the people they supported well and were able to describe how they reduced the risks in practice, but they did not appreciate the importance of recording risk assessment and risk reduction plans. The lack of detail in the risk assessment, and the lack of risk assessment to manage all the risks for the people who lived there demonstrated a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As part of our inspection we looked at staffing levels. At times we found there were not enough staff to support the people who lived there and the lack of staff who could drive meant that people could not be supported to go out of the home. This demonstrated a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home undertook safe recruitment practices and was actively seeking to employ more staff.

We found medicines were stored and administered safely and we observed medicines being administered safely and professionally at the home.

We found a lack of recorded decision specific capacity assessments in the care files we looked at and although best interest decision were often mentioned there was no evidence to support how these decision had been determined. This demonstrated a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although new staff were supported in their role and undertook the Care Certificate to ensure they had the skills to perform in their role, there had been a lack of competency assessments, supervision and appraisal for existing staff over the past 12 months. This had been noted by the area manager and plans put in place to rectify this by the time of our inspection. However this demonstrated a breach of regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We saw evidence that the people who lived there were supported well to maintain their health and social care needs and referrals had been made appropriately to services such as physiotherapy, occupational therapy, dental services and speech and language therapy services. The home also had a good range of preventative equipment such as pressure mattresses, cushions, profiling beds and moving and handling equipment which was well maintained and serviced regularly.

People were also supported to maintaining their cultural requirements. People were also supported to remain as independent as possible in activities of daily living.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well and were keen for people to feel they were at home at Smithies Moor Lane. We observed staff to be kind and compassionate throughout our inspection. Staff also ensured people were supported whilst they were in hospital and acted as communicators during this period.

We found the systems of recording complicated and difficult to navigate. Information was recorded in several different places and did not lead the reader to find information quickly. This meant that information was not contemporaneous and not all information about the person was in their daily log. We did see some good evidence in the care files on how to support people and some detailed support plans but we also saw when these had been updated, instead of rewriting the support plans, additions had been added to the bottom. We found the records incomplete and not contemporaneous and this demonstrated a breach of 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We observed staff supporting people to make choices throughout the day and supporting people with choices from their agreed preferences.

The registered manager had left the home a month before our inspection. Prior to this they had been managing two of the registered provider’s homes in the area. We found there had been a lack of leadership and management in the home and staff had not been supported to develop in their roles as supervision and appraisals had not happened. We also found that policy and changes to guidance as instructed by senior management had not been put in place. There had also been a lack of oversight by the registered provider and although audits had been done monthly, actions identified had not been undertaken and no checking was done from month to month to check these actions had been completed.

The examples of the lack of governance, leadership and management at the home demonstrated a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what actions we have asked the provider to make at the end of this report.

People who used the service could not communicate clearly so we observed staff providing support and we spoke with staff about the people who used the service. This gave us assurances that staff knew the needs of people and knew how to deliver the care and support effectively.

Care staff supported people in a sensitive way using differing methods of communication to ensure that people who used the service understood what was going to happen.

Staff we spoke with said people were treated with respect and their privacy and dignity was upheld. This assured us that their rights were upheld. We saw in the care plans that people had dignity guidance in place.

There were systems and processes, policies and procedures in place to support the delivery of care. Report writing in the care records was good and reflected the changes in care and treatment that people received. We also found that staff and students were supported and monitored in their working practice.

We observed two people who used the service. They appeared comfortable in their surroundings. They appeared to be relaxed with the staff in their interactions. We noted that people who used the service had access to a wide range of activities which were personalised to their individual needs and documented clearly in the care plans.

We were shown information that indicated various sectors of the service were audited on a regular basis to make sure people’s needs were met and they remained safe.

People who used the service told us they liked living at the home and the staff we spoke with told us they enjoyed working there. We looked at people’s care plans and saw that their care was planned in a way that ensured their safety and well being. The staff told us that they would use different communication tools when working with people, we saw that communication guides were tailored to the individual.

We saw that risk assessments and action plans were reviewed regularly and updated to reflect any changes. We saw that staff talked to people before any care was carried out to ensure their rights were upheld. We saw in the care plans that people had dignity guidelines in place. The staff we spoke with told us that they felt people ‘were treated with dignity and respect’ and people are ‘treated well and the care given is good’ We saw that interaction between people using the service and staff was warm and respectful.

The staff we spoke with told us that they felt people were kept safe from harm. We saw that staff had received training in safeguarding and there was a corporate policy in place to support staff. We saw that staff received supervision every four to six weeks and their training needs identified through an annual appraisal.

The quality of the service was monitored at local level through monthly audits and annual feedback questionnaires and the people who used the service were encouraged to give their feedback in a variety of ways.