This focussed inspection took place on 24 April 2017. We gave the provider two working days’ notice of our visit. St Anne’s provides services for nine people who are living with a learning difficulty. There were nine people living at St Anne’s when this focussed inspection took place.

St Anne’s 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.

St Anne’s was last inspected on 23 and 26 August 2016. At that inspection, the service was rated as good overall, but we found the service required improvement to ensure it was well-led. A breach in Regulation 19 of the HSCA 2014 Regulations was identified. This regulation related to staff recruitment. This focussed inspection was to review the provider’s progress on meeting this breach, and improvements in quality monitoring.

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 Anne’s on our website at www.cqc.org.uk.

The provider had met the breach in Regulation 19 in full. All staff now had necessary evidence on file to show relevant documentation about them had been sought. Staff employment files were regularly audited.

The provider had embedded their quality monitoring processes, to ensure people received safe and quality care. Audits included reviews of relevant areas relating to people’s needs, and the management of the service. These reviews took place regularly. Improvements in service provision, where relevant, were identified and took place in a timely way.

Management supported an open and inclusive culture for both people and staff. People and staff said management supported them. Links were established with people’s families and other supports, such as healthcare agencies, to ensure people were able to live the life they chose.

This inspection took place on 23 & 26 August 2016 and was unannounced. St Anne’s Residential Care Home provides accommodation and personal care for up to nine people with a learning disability.

We carried out an unannounced comprehensive inspection of this service on 1 and 5 June 2015. Three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check they had followed their plan and to confirm that they now met legal requirements.

The home 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.

At this inspection we found that considerable improvements had been made. However, we found the provider had breached a different regulation. Not all of the appropriate recruitment checks had been completed before staff began work, including disclosure and barring service and employment history. If a member of staff had a criminal conviction, the provider had not completed the relevant risk assessments to make sure staff were suitable to work with vulnerable people.

At the inspection in June 2015 we found essential maintenance had not been completed around the home. This included gas, electrical and fire systems safety. At this inspection we found the provider had taken appropriate action and all of the relevant maintenance was up to date. There was also a robust schedule in place to make sure maintenance was kept up to date in the future.

At the inspection in June 2015 we found the provider did not have a robust quality monitoring system in place. At this inspection we found the provider had made good improvements to the quality monitoring processes in place. However, these processes needed time to be developed and improved further.

At the inspection in June 2015 we found that while care workers demonstrated they had the skills to meet people’s needs effectively, they were not well supported with training, supervision and appraisal. Most training needed refreshing and supervision and appraisals had not been completed regularly. The provider did not have a schedule in place for when this should happen. At this inspection we found the provider had supported and encouraged staff to complete a variety of training. This included safeguarding, health and safety, moving and handling, and food hygiene. Staff were also given specific training so they could effectively meet the individual needs of each person. This included supporting people with autism and/or behaviour that may challenge people and others. Staff gave us positive feedback about the training and support they received.

People experienced excellent care and support. They were supported to live safe, and meaningful lives in the way they wanted to. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were well managed and people were able to stay safe without having their freedoms restricted. Managers and staff promoted peoples independence and encouraged people to develop a skills to help them live a more independent life. If an incident or accident did occur, they were well reported and investigated. Staff understood the importance of learning from incidents, so they could reduce the risk of them happening again.

Staff were very caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person living in the home. People had developed positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. We gathered more evidence by looking at records, observing care practice and talking to staff.

We found that people liked living at St Anne’s and were involved in the running of the service. One person told us they were ‘very happy’. People were well supported by an experienced staff team. One person commented ‘If I have a problem I will talk to staff’. The systems in place helped people to develop confidence and independence.

This inspection took place on 1 & 5 June 2015 and was unannounced. St Anne’s Residential Care Home provides accommodation and personal care for up to six people with a learning disability.

The home 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.

Essential maintenance had not been completed around the home. This included gas, electrical and fire systems safety. Certificates were out of date and the provider had not identified this until the inspection. They took immediate action and appropriate safety certificates were obtained.

The provider did not have a robust quality monitoring system in place. Areas for improvement such as maintenance and training had not been identified. Where other areas had been identified, action was not always taken.

While care workers demonstrated they had the skills to meet people’s needs effectively, staff were not well supported with training, supervision and appraisal. Most training needed refreshing and supervision and appraisals had not been completed regularly. The provider did not have a schedule in place for when this should happen.

There were some minor gaps in pre-employment checks, such as full employment history, but disclosure and barring service checks were completed for all staff before they began work. There were enough staff to keep people safe and meet their needs and people’s medicines were managed safely.

Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were well managed and people were able to stay safe without having their freedoms restricted. Incidents and accidents were well managed and staff understood the importance of learning from incidents so they could make sure they did not re-occur.

The registered manager and staff had a good understanding of the Mental Capacity Act (2015) and gained consent from people in line with legislation. Deprivation of Liberty Safeguards referrals had been made to the appropriate authorities.

People were well supported to eat and drink enough. Food was homemade and nutritious and people were involved in making decisions about menus. People were supported with healthy eating and to maintain a healthy weight. Everyone was supported to maintain good health and all of the appropriate referrals were made to health care professionals when required.

Staff were caring and ensured they treated people with dignity and respect. They had a good understanding of the care and support needs of every person living in the home. People had developed positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well supported to do the things that were important to them, such as going to college or church. People’s social and spiritual needs were met.

The provider asked for feedback about the service from people, relatives and staff. Any feedback received was acted on where possible. There was a complaints procedure in place and the registered manager and staff knew what they should do if anyone made a complaint.

There was an open culture in the home, and the registered manager was described as “dedicated”. Staff felt confident to discuss any concerns they might have and said the registered manager would act on them. Staff said they were well supported and were well motivated to provide good care. The registered manager knew all of the people who lived in the home very well and ensured care was person centred.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Required maintenance had not been completed, staff did not receive appropriate training, supervision and appraisal and a robust quality monitoring system was not in place. You can see what action we told the provider to take at the back of the full version of this report.