This inspection took place on 1 February 2017. As this is a very small service, and people regularly go out into the community, we announced the inspection shortly before the visit to make sure someone would be available at the home to assist in the inspection. The home was previously inspected in August 2015 when we checked the service was meeting the Regulation it had been in breach of in December 2014. At that inspection we found action had been taken to address the breach.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Pauls’ on our website at www.cqc.org.uk’

St Pauls is a two storey detached house situated in a residential area, close to local shops and facilities. It accommodates up to 2 people over the age of 18 years old with a learning disability or autistic spectrum disorder.

The service had a registered manager in post 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 and associated Regulations about how the service is run.

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made.

We saw staff encouraged people to be as independent as possible while taking into consideration their wishes, and any risks associated with their care. We observed that people using the service received appropriate support from staff who knew them well.

People received their medications in a safe and timely way from staff who had been trained to carry out this role.

The services recruitment system helped the employer make safer recruitment decisions when employing new staff. New staff had received a structured induction and essential training at the beginning of their employment. An on-going training and support programme ensured staff maintained and developed their knowledge and skills.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received a well-balanced diet that they were involved in choosing, shopping for and helping to prepare.

People’s care files provided detailed information about the areas they needed support in and reflected their needs and preferences, so staff could provide individualised care. Support plans and risk assessments had been regularly evaluated to ensure they were meeting each person’s needs, while supporting them to reach their aims and objectives in a safe way.

People had access to day centres and social activities which were tailored to their individual needs and interests. People told us they enjoyed the activities they took part in.

The provider had a complaints policy to guide people on how to raise concerns and there was a structured system in place for recording the detail and outcome of any concerns raised.

There was a system in place to enable people to share their opinion of the service provided. We also saw an audit system had been used to check if company policies had been followed and the premises were safe and well maintained.

We carried out an unannounced comprehensive inspection of this service on 11 December 2014 in which a breach of the legal requirements was found in relation to how the provider monitored how the home was operating. This report relates to that breach. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Pauls’ on our website at www.cqc.org.uk.

We carried out this focused inspection on 6 August 2015 to ensure improvements planned by the provider had been implemented to address this breach of Regulation. We found that action had been taken to improve how the home’s systems were monitored.

St Pauls is a two storey detached house situated in a residential area. It caters for up to two people over the age of 18 years old who have a learning disability.

There was a registered manager in post at the time of this 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.

At this focused inspection we found that quality assurance systems to check how the home was operating had been consistently completed. We also saw changes had been made to how care records were checked to make sure they were updated and reviewed in a timely manner. This meant the provider was now meeting legal requirements. However, some areas needed further development and embedding into the running of the service. For example, the system for checking all necessary care records were in place was not as comprehensive as it could be. The registered manager said they were working to improve this.

We will review our rating for this service at our next comprehensive inspection to ensure the improvements made and planned continue to be implemented, and have been embedded into practice.

The inspection of St Pauls took place on 11 December 2014 and was unannounced. This meant that the provider did not know when we were inspecting the service. At the last inspection in October 2013 we found that there were no breaches of the legal requirements in the areas we looked at.

St Pauls is a two storey detached house situated in a residential area. It caters for up to two people over the age of 18 years old who have a learning disability.

There was a registered manager in post at the time of this 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.

The service was safe for people. Staff had a good awareness of safety. They followed procedures which reduced the risk of people being harmed and which protected their rights. This included following the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests when they lacked capacity. Training records we looked at confirmed that all staff had received safeguarding adults training.

Care records contained risk assessments which were specific to the care needs of the individuals who lived at St Pauls. From the two care plans we looked at we saw that people had their health needs met. Staff we spoke with and our observations throughout the day, showed that staff were knowledgeable of how to meet people’s needs and how people who used the service preferred to be supported.

Staff were seen to treat people with respect and preserve their dignity at all times. We saw staff knocking on people’s doors and waiting for an answer before they entered, or saying who they were as they entered the room.

There was a complaints procedure in place and displayed in an easy read format. No formal complaints had been received since our last inspection in October 2013.

Records showed that appropriate pre-employment checks had been carried out to ensure that only suitable staff were employed to work with vulnerable adults.

We saw that quality monitoring was taking place however this was not always robust and some gaps were apparent. Quality was also measured by involving people who used the service, their relatives, and health care professionals. Staff received supervision although not at the bi-monthly frequency expected.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw people were asked what they wanted and care files reflected people’s preferences. Where people did not have the capacity to make an informed decision a system was in place for appropriate people to be involved in making decisions in their best interest.

People’s comments, and the records we saw, indicated they received the care and support they needed. We saw people were involved in a variety of social activities in the community and carried out day to day living skills, such as cleaning their rooms and food shopping, if they were able to. One person told us how they enjoyed gardening and going for walks.

People received a well-balanced diet and were involved in choosing what they ate. Staff promoted healthy eating and checked people were eating and drinking properly.

We saw there were effective systems in place to reduce the risk and spread of infection.

Background checks had been carried out on staff before they started to work at the home to make sure they were suitable to work with vulnerable people.

There were systems in place to gain people’s views and make sure the home was operating safely and correctly.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences. We spoke to one person who used the service, watched staff providing support and looked at records. These included care plans, minutes of meetings and surveys undertaken by the company.

People were happy with the care and support they received and felt the home was a safe place to live. We saw that people were offered choice and staff respected their privacy and dignity while encouraging them to be as independent as possible. When we asked one person if they liked living at the home they told us, “It’s nice.”

One person told us how they enjoyed the social activities staff at the home had organised. We saw there was a wide range of things for people to take part in as well as opportunities for them to be involved in everyday tasks like shopping, cleaning and preparing meals.