This inspection took place on 19 and 20 January 2017 and was unannounced. At the last inspection on 19 and 20 March 2015, we found the service was not meeting all the required Regulations. There were monitoring systems in place to monitor the quality of the service however these were not always effective in identifying issues or used to make improvements to the service.

246 Haymill Close is a residential care home, which provides accommodation and personal care for up to eight people. The service specialises in the care and support of adults who have moderate to profound learning and physical disabilities. At the time of our visit there were eight people using the service.

The service 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.

Family members told us that the majority of staff at the service were caring and they were happy with the care offered to their relatives.

The service protected people from harm and abuse. Staff had safeguarding of vulnerable adults training and they knew how to report any safeguarding concerns they might have. Safeguarding information was displayed throughout the service.

The service assessed the risk to people's health, safety and welfare. Staff had detailed guidance on how to minimise risk to people’s wellbeing.

The service had recruitment procedures to ensure only suitable staff were appointed to work with people who used the service.

There were sufficient staff numbers on each shift to meet people’s needs.

Medicines were stored safely, and people received their medicines as prescribed.

Relatives told us they had confidence in staff and they felt the service had a good understanding of their family member's support needs.

Each new staff member undertook an in-depth induction that consisted of the training the provider considered mandatory. Staff also received yearly refresher training to ensure continuous review of the skills and knowledge needed to support people they cared for.

Staff received regular supervision and appraisal of their work to ensure the best possible support was provided for people they cared for.

CQC is required by law to monitor the implementation of the Mental Capacity Act (MCA) 2005 and the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and least restrictive way, when it is in their best interests and there is no other way to look after them. The service met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people did not have the capacity to consent to specific decisions, staff involved relatives and other professionals to ensure that decisions were made in the best interests of the person and their rights were respected.

The service had monitored people’s nutritional needs to make sure these were being met. Family members told us they were happy with how the service supported people to have sufficient food and drink.

People were supported to maintain good health and to have access to healthcare services. The staff made appropriate referrals in a timely manner to ensure that people’s changing health needs were addressed.

The service supported people in pursuing their individual choices and supported them in achieving personal goals.

Staff demonstrated a good knowledge of people's personal needs and preferences, which they knew from people’s care plans and day-to-day interactions with them.

Staff delivered care which protected people’s dignity and privacy. People could choose if a male or a female worker supported them during personal care.

People received care that reflected their nee

We spoke with one member of staff. We also looked at medicines management in the home. We did not speak with any people using the service at this inspection.

Following our inspection that was carried out on 12 September 2013, we issued a compliance action to the provider because they were not compliant with Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place in respect of the recording and administration of medicines.

The provider told us that arrangements would be reviewed and action would be taken to ensure compliance by the 6 December 2013.

During this inspection we found that the provider had addressed shortfalls identified with medicines management and medicines were being managed safely and people were receiving the medicine they required.

We met all five people who were using the service at the time of our inspection, spoke with one person, three relatives and seven members of staff. We were not able to speak with the majority of people using the service because they had complex needs which meant that they were not able to tell us their experiences

We saw that staff had a good understanding of people’s individual needs and capabilities. Relatives told us they were involved in the development and review of care plans.

The arrangements for the management of medicines were not always effective in protecting people against the risk associated with medicines.

People had equipment that promoted their comfort and independence.

There were sufficient numbers of staff on duty to meet people’s needs. All relatives we spoke with spoke of their satisfaction with the staff and the care their family member received. Comments we received included “they talk to my family member respectfully, the staff are good, they really are excellent” and “The staffing at the home is consistent and this is good for my family member, it means the staff know my family member and my family member knows them”.

Most people who use the service were not able to communicate verbally, though we did speak to one person who said they liked living at the home. We observed staff being polite to people and speaking with them in a calm and respectful way. The staff demonstrated a good understanding of how each person communicated their needs and they responded to these to the satisfaction of the person. The staff we spoke with said they felt there were enough staff to meet people’s needs and that everyone worked well as a team.

There were appropriate systems in place to minimise the risk of abuse to people, and staff received relevant training to support them when working with people.

The majority of people living at the service had profound physical and learning difficulties. They were not able to tell us directly about the care they received and experienced. During our visit we observed and found people were receiving care, treatment and support that met their individual needs and preferences.

People living at the service had choices in all aspects of their daily living. They had their privacy and dignity respected. People were provided with information that supported and enabled them to make decisions about their care and treatment. Some people communicated to us that they were being well looked after.

This inspection took place on 19 and 20 March 2015 and was unannounced. At the last inspection on 3 January 2014 we found the service was meeting the regulations we looked at.

246 Haymill Close is a care home which provides accommodation and personal care for up to seven people. The service specialises in the care and support of adults who have moderate to profound learning and physical disabilities. At the time of our visit there were seven people using the service.

The service 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.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were quality monitoring systems in place to monitor the quality of service provision however, these were not always effective in identifying issues or used to make improvements to the service.

You can see what action we told the provider to take at the back of the full version of the report.

People were cared for safely by a staff team who received appropriate training and support to meet their needs. Relatives told us people were safe at the service. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people were assessed and management plans to minimise the risk of harm or injury were in place.

There were enough staff on duty to provide support and care to people. People were provided with opportunities to participate in activities of their choice. The staff team had an in-depth knowledge of the people they were supporting, this included people’s individual communication methods, how they wanted their care and support to be provided.

Medicines were stored safely, and people received their medicines as prescribed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.

People were supported to keep healthy and well. Staff responded to people’s changing needs and worked closely with other health and social care professionals when needed.

Staff received regular supervision and appraisal. These processes gave staff an opportunity to discuss their performance and identify any further training they required.

CQC is required by law to monitor the implementation of the Mental Capacity Act (MCA) 2005 and the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and least restrictive way, when it is in their best interests and there is no other way to look after them. The service met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people did not have the capacity to consent to specific decisions the staff involved relatives and other professionals to ensure that decisions were made in the best interests of the person and their rights were respected.

People were treated with kindness, compassion and respect. The staff took time to speak with the people they were supporting.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their individual needs and preferences. People and others important to them were involved in the development and review of their care plan.

The provider regularly sought feedback from people and relatives about how the service they received could be improved. Staff had good knowledge of whistleblowing which meant they were able to raise concerns to protect people from unsafe care.

We found there was clear leadership and an open, transparent, positive and inclusive culture within the service. All the feedback from relatives and staff we received about the service was very positive.