Strathallen is a 'care home.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Strathallen is an adapted building in the heart of Saltburn-by-the-Sea. It is an established service for up to nine people who live with a learning disability. Each person had their own bedroom on the first or second floor with access to several communal areas on the ground floor. At the time of inspection, there were seven people using the service.

This inspection took place on 13 November 2018. We made telephone calls to relatives and professionals on 21 and 23 November 2018.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider was also the registered manager and had been in post since the original registration in 1999. 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 the last inspection on 18 and 19 March 2016, we rated the service as good. At this inspection, we found the service remained good, but the responsive domain had significantly improved since the last inspection and we rated this domain as outstanding. The provider and staff had been extremely proactive in delivering responsive care since our last inspection.

Staff were committed to delivering extraordinary care to people to ensure they lived fulfilled lives and were able to remain as independent as they could be. People were supported to maintain relationships with people important to them. Privacy and dignity was maintained throughout. Staff worked alongside health and social care professionals to provide exceptional end of life care.

An effective and consistent staff team were in place who delivered remarkable levels of care to people to ensure positive outcomes for people. The service was positive, proactive and supportive of people who lived with a learning disability. The service had continued to develop since the last inspection. Effective quality assurance systems were in place and the service regularly sought feedback from all those involved in the service.

Staff supported people to live in a safe environment where the risks to them were proactively managed. This had led to people living independent and enriched lives. There were always sufficient staff on duty to ensure this. Medicines were safely managed and infection prevention and control procedures were well managed. Systems were in place to ensure lessons were learned when incidents took place and to make sure people remained safe at the service.

Staff followed recognised guidance to provide people with the support they needed. Staff received regular supervision, appraisal and training to assist them in their role. Records reflected people’s nutritional needs, visits with health professionals and details of any recommendations. People were supported to have maximum control of their lives; their views and choices were recorded and people were involved in any decision making. The environment was suitable for people using the service and the building had been well maintained.

People received exceptional person-centred care from an experienced staff team. Records were regularly reviewed and updated. People had access to regular activities, with some people attending voluntary work and a variety of social clubs. No complaints had been receive

We visited Strathallen on 18 and 19 March 2016 and this was an unannounced inspection. This meant the provider and staff did not know we were going to visit.

In December 2014 we inspected Strathallen and found improvements needed to be made to the systems for monitoring the performance of the home. The registered provider sent us an action plan detailing how and when these improvements would be made. We re-inspected the service in July 2015 and found improvements had been successfully made.

Strathallen is a nine bedded home providing care and support to adults with a learning disability. It is situated in the centre of Saltburn, close to all local amenities. The home has a communal lounge and dining room and all bedrooms are single occupancy.

The registered manager is also the registered provider. 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 the time of the inspection eight people lived at the home and we met five of the people who used the service. They told us that they were very happy with the service and found it met their needs.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle. Staff readily identified triggers that would lead people to become distressed or that their mental health was deteriorating. We found this had a very positive impact on people and led to a marked reduction the number of occasions people were admitted to hospital.

People who used the service required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff provided consistent responses and took appropriate action when people’s needs changed, which had ensured staff could continue to meet the individual’s needs.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

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.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities.

Staff had also received training around safeguarding vulnerable adults and clearly understood how to implement these procedures. We observed that staff consistently maintained people’s privacy and dignity. We found that staff treated people with respect and compassion.

Staff had also received training around the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The staff we spoke with fully understood the requirements of the MCA and were ensuring that where appropriate this legislation was used.

People and the staff we spoke with told us that there were enough staff on duty. We found there were suffici

A comprehensive inspection took place at this service on 18 December 2014. At this inspection a breach of legal requirements was found. People who used the service and others were not protected against the risks associated with unsafe care because effective systems were not in place to ensure that regular auditing was undertaken. No analysis of accidents and incidents had been carried out. Audits had been carried out randomly and audit records were confusing and disorganised. Audits of the environment had been carried out. A health and safety audit had not been carried out, this meant that fire alarm testing and water temperature checks had not been completed and could have been identified if an audit had have been carried out.

The registered provider wrote to us telling us what action they would be taking in relation to the breach. As a result we undertook a focussed inspection on 20 July 2015 to follow up on whether action had been taken in relation to the breach.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Strathallen on our website at www.cqc.org.uk’

Strathallen provides care and accommodation for up to nine adults who have a learning disability. The service is located centrally in Saltburn and is very close to local amenities.

The service does not require a registered manager. The registered provider manages and works at the service on a day to day basis. 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 focussed inspection on 20 July 2015 we found that the registered provider had followed their plan and legal requirements had been met. This was an unannounced visit which meant the staff and provider did not know we would be visiting.

We could see that improvements had been made to audits at the service. Audits had been carried out more regularly. This meant that service had been able to improve the levels of quality assurance.

Accidents and incidents which had occurred at the service had been recorded. No analysis of these had been carried out. This meant that we could not see if any patterns or trends had been identified and where appropriate action taken to minimise the risks to people who used the service. We highlighted this at our last inspection. When we looked at the records, we could see patterns between the types of accidents and incidents and the people involved.

Audits for medicines had been carried out and we could see medicine reviews for all eight people who used the service had been completed since our last inspection.

Care plan and health action plan audits had been carried out regularly. We could see that changes had been made to increase the quality of these audits. There were some gaps in these audits which we highlighted to the deputy manager.

An infection control audit showed that the home was clean and had appropriate arrangements in place to maintain the prevention of infection control and to keep people safe. Mattresses were checked to make sure they were clean and safe for use. A hand washing audit needed further improvements to ensure it was effective in monitoring the quality of hand washing procedures carried out by staff.

A health and safety audit showed that the service had kept up to date with checks of fire alarms and exits ad that regular fire drills had been carried out. The audit showed that certificates required for the health and safety of the building, such as gas boiler checks were up to date and checks of water temperatures had been checked. We could see that water temperature records showed that they were not always within the correct water temperature limits. Some temperature checks were below 43 degrees Celsius.

We inspected Strathallen on 18 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Strathallen is a nine bedded care home providing care and support to adults with a learning disability. It is situated in the centre of Saltburn and is close to all local amenities. The home has a communal lounge and dining room and all bedrooms are single occupancy.

The service does not require a registered manager. The provider manages and works at the service on a day to day basis. 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 were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and staff had received safeguarding training. Staff were aware of the action to take if abuse was suspected.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, however there were some gaps in the recording of water temperatures.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed.

We saw that staff had received supervision on a regular basis and that staff had received their annual appraisal for 2014.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs. Staff understood the requirements of the Mental Capacity Act (2005) 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.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Generally good systems were in place for the management of medicines; however some minor improvements could be made. At the time of the visit staff were not recording medicines coming into the home or when and why some medicines had been given.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed understanding, were patient and interacted well with people. When people became anxious staff provided reassurance.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. However, staff had not undertaken nutritional screening to identify specific risks to people’s nutrition.

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 people had hospital passports and that this information had been shared with local hospitals. This helped to ensure that people received care and treatment in a way that they wanted. People had health action plans, however some of these required updated to reflect current weight and healthcare appointments undertaken.

Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Support plans were developed with people who used the service and relatives to identify how they wished to be supported.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. People told us that they knew how to complain and felt confident that staff would respond and take action to support them. However the complaints procedure needed some changes to be made to ensure that people were clear of whom they were able to contact if they were unhappy.

Staff told us that the home had an open, inclusive and positive culture.

There were systems in place to monitor and improve the quality of the service provided. However improvements were needed in respect of auditing. Accidents and incidents were not monitored by the provider to ensure any trends were identified

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.

During the inspection we spoke with three people who used the service. We also spoke with the owner, a senior carer and two care staff. One person we spoke with told us, I am going to college today, I am doing gardening. Another person told us, "The staff are nice, they help me clean my room.”

People told us they were able to make their own day to day decisions and lifestyle choices. They also told us they were treated with dignity and respect. We found that people had their needs assessed and that care plans were in place. All the people we spoke with were satisfied with the service they received.

People were provided with a choice of suitable and nutritious food and drink.

There were appropriate arrangements in place for the recruitment of staff.

There was a complaints procedure in place and this was accessible to people.

We found that people’s personal care records were accurate and fit for purpose and were stored securely in the home.

We spoke with four people during the visit to Strathallen. People confirmed that they could make decisions about their daily lives, which included how they spent their days, where they went on holiday and choices in regard to meals and activities.

One person said, "I look after my own room, the food is nice and there is a choice at every mealtime" and "I have been on holiday this year to Paris and Euro Disney." They also confirmed that they had their own key for their room, that staff knocked on their room doors and waited for them to answer. People told us they could use the kitchen when they wanted to make their own cup of tea.

Another person said, “We sit down as a group and discuss the menu, I do my own washing and ironing and sometimes help with the cooking.”

We observed positive interactions between people living at the service and staff. We saw that staff always used the names of the people using the service, and observed staff and people chatting, laughing and dancing together.