About the service: The service provided accommodation for up to eight persons who require nursing or personal care, all of whom were living with learning difficulties.

People’s experience of using this service:

• The provider had not always identified areas for improvement and development in the service. There were not robust governance systems in place.

• The home environment was not always kept safe and properly maintained.

• Whilst the majority of care plans and support provided met people’s needs, there were gaps in one person’s care provision. They did not always receive thorough individualised care.

• Risks associated with people’s healthcare needs had been identified and people told us they felt safe and well looked after. Staff administered medicines as prescribed.

• Staff were kind and caring and supported people to be as independent as possible. Staff asked for consent before delivering care.

• People had access to healthcare professionals when required.

• Staff were competent and knew how to care for people and received training in their roles.

• Staff supported people to have a choice of healthy balanced meals and enough to drink.

• The registered manager supported an effective staff team, who communicated well. The registered manager was approachable and available to people and staff.

• The service had been developed and designed in line with the values that underpin the CQC guidance, Registering the Right Support, and other best practice guidance.

• We found the service had deteriorated in some areas and met the characteristics of a “Requires Improvement” rating in Safe, Responsive and Well-led, which meant it was rated “Requires improvement” overall.

Rating at last inspection: Good (Published 30 August 2016)

Why we inspected: We inspected this service in line with our inspection schedule for services currently rated Good.

Follow up: We will continue to monitor this service according to our inspection schedule.

The inspection took place on 3 August 2016 and was announced. The service provided accommodation for persons who require nursing or personal care, all of whom were living with learning difficulties. There were eight people living in the home when we visited.

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. There was a registered manager in post.

People were safe living in the home and staff understood their responsibilities to protect people from harm. They had received relevant safeguarding training, and knew who to report any concerns to. Staff were confident in reporting incidents and accidents should they occur.

There were effective processes in place to minimise risk to individuals. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce risk. People received support to take their medicines safely. The environment in which people lived was safely maintained.

Staff were trained in supporting the people who lived at the home. Staff were supported with supervisions and to obtain care qualifications. Staff had knowledge of gaining consent from people and sought this before providing support to them.

People were supported to eat and drink sufficient amounts, and could make themselves drinks whenever they wished. People had regular on-going access to healthcare and staff supported them to attend appointments if needed.

People were supported by a consistent team of compassionate staff who cared about everyone’s wellbeing, and knew them well. Staff had built strong relationships with people and always respected people’s dignity and privacy. People were supported to maintain their relationships with their loved ones, who were always welcome to visit them.

There were many opportunities available to people to go out to do activities and access the community. Their health needs were responded to in a timely manner and the records contained a great deal of detail of information about people’s needs.

The manager was supportive to the staff in the home, who worked well together as a strong team. There were many systems in place to assure quality of care through the auditing and monitoring of specific areas.

On the day of this inspection there were seven people living at St Brannocks.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the home safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

At this inspection we looked at written records, which included people's care records, medication systems and quality assurance documentation. We spoke with six people who lived at the home and a relative who was visiting. We also spoke with the manager and the other member of care staff on duty.

Is the home caring?

We spoke with six people who lived at the home and a relative of one of the people. One person said to us, "I like living here; I especially like living near the sea." Another person said, "The staff are really nice. I like living here much more than my last home."

We witnessed the care and attention people received from staff. All interactions we saw were respectful, encouraging and friendly. There was a relaxed atmosphere throughout the home and a good rapport between staff and the people who lived at the home.

Is the home responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements. Care plans and risk assessments were informative, up to date and regularly reviewed.

One staff member told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service.

Is the home safe?

The accommodation was warm, clean and properly maintained.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the home effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with generally positive feedback from people reported in the provider's own annual quality assurance survey.

People were cared for by staff who were properly trained and supported to develop professionally. People were treated with respect and were encouraged to promote their independence. People were given information and support to help them understand the care and support available to them.

Is the home well led?

One relative said, "I think they [the provider] have really got it right here. It's like a big extended family. The manager is so considerate. It's such a weight off my mind knowing [my relative] is so well looked after."

The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

We spoke with three of the seven people living in St Brannocks at the time of our inspection. One person told us, “It’s ideal here. Staff are great, they help me if I need it. But I‘m alright usually.” Another person told us that the staff were “….very good.” A third person told us, “We have a good laugh here.”

People were supported in promoting their independence and community involvement. One person's goal was to visit the local shops on their own. Whilst staff observed them for road safety, they went into the shops on their own.

People’s physical and emotional needs were assessed and reviewed regularly and used to inform people’s care plans. We saw that people were involved in this process.

The people we spoke with told us they felt safe living there and felt safe with the staff. They said that if they had any concerns they would speak with staff or the manager.

Whilst a good range of training was provided, we found that no staff had received recent mandatory training in food hygiene. The majority of staff had not received up to date mandatory training in infection control. One staff member had not completed an annual appraisal in the last two years. There were no appraisal records for a second member of staff in four years.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We spoke with five of the eight people who lived at St Brannocks. We also spoke with two members of staff, looked at care plans, policies and procedures and observed how people were supported.

We saw that several people were occupied with their individual household tasks, one was vacuuming the lounge, another was cleaning their bathroom while a third was cleaning and changing their bed linen. They told us that they carried out household tasks when they had a 'home day'.

One person showed us their care plan and discussed how they enjoyed living there. Two people enthusiastically told us about their last holiday when they went skiing and of a camping trip they had recently returned from. They confirmed they knew who their key worker was and that they would talk to any member of staff or the manager if they had any concerns or worries.

Two people showed us round their home pointing out various pieces of art work they had displayed throughout the premises. We observed the home was clean and tidy, people appeared very content and we saw how well all interactions between staff and people were carried out. It was clear that people knew what was organised during the day and about their own routines.

One person said: "I love living here, there's loads of space and I can go to the cafe/pub in the village. I like to go to the beach as well." Another person told us: "The staff are really good to me, they help me a lot."

On the day of this unannounced visit we found that all the people who live in St Brannocks were attending their chosen placement for activities which is also owned by the company that own St Brannocks. This being the case we went to the activities centre and spoke to the eight people individually about their lives both in and out of the home.

We were told about the way the home is run and how each person living there is actively involved in the day to day decisions.

The people we spoke with told us about their care plans. They told us how they talk to their key worker and how their care plan is updated as and when they have any different needs.

We were told how much they valued their key worker and how the staff have supported them with ways that would help them when they needed help.

The people told us that the staff team who work at St Brannocks had been there for some time. They said all the staff were good and supportive.

We were also told about how the manager and staff would make checks around the home to ensure they were safe.