This comprehensive inspection was announced at short notice and took place on 30 October 2017. When we last inspected the service in July 2016 we found that the service was meeting all of the regulations we checked. We rated the service requires improvement overall.

Support for Living - 37 Barlby Road provides care and support for up to four people living with complex learning disabilities and physical disabilities. People have their own rooms and share bathroom facilities. People shared bathroom facilities and hoisting equipment was available when needed. At the time of this inspection four adults were receiving care and support from the service.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Staff had received training on (DoLS) and the (MCA) and in theory understood what to do if people could not make decisions about their care needs in line with the MCA.

Staff developed caring relationships with people using the service. However, staff were not always adopting a creative and meaningful approach to maximising people’s quality of life in terms of the range of activities people were able to access.

People's cultural preferences were documented in their care and support plans. However, we saw little evidence that these preferences were being promoted and provided for in relation to meal choices.

Safeguarding training was completed by all staff and refreshed when needed. Staff were trained to protect people from abuse and harm and knew how to refer to the local authority and others if they had any concerns.

Risk assessments were centred on the needs of the individual and were up to date and being reviewed in line with the provider’s policies and procedures. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow and to make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There were enough appropriately skilled and experienced staff deployed to the service. Staff had completed the necessary training to equip them with the skills and knowledge to carry out their duties.

There were suitable arrangements in place for the safe storage and disposal of medicines and all medicines were administered by staff who had received the appropriate training to be assessed as competent to carry out these duties.

Staff supported people to attend healthcare appointments as required and liaised with people’s family members, GPs and other healthcare professionals to ensure people’s needs were met appropriately. Advocates and family members (where appropriate) were involved in reviews of people’s care and support.

The provider had implemented and was operating effective systems to audit different aspects of the service; these included the administration of medicines, care records and reviews, fire safety procedures and health

We carried out an unannounced comprehensive inspection of this service on 13 November 2015. 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 person-centred care, safe care and treatment, medicines, staffing, notifications and governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 ’Support for Living Limited - 37 Barlby Road’ on our website at www.cqc.org.uk’

Following the inspection in November 2015, we asked the registered provider to undertake weekly audits of all service users’ needs, care plans and risk assessments and send us a monthly report stating the action taken or to be taken as a result of these audits. We received these reports promptly along with an action plan setting out what the provider would do to meet legal requirements in relation to the above breaches.

We carried out a follow up comprehensive inspection on the 29 July 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements.

Support for Living - 37 Barlby Road provides care and support for up to four people living with complex learning disabilities and physical disabilities. At the time of this inspection three adults were receiving care and support from the service.

The recently appointed manager had submitted an application to become the registered manager of the service and this was being processed at the time of our visit. 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 our inspection, the manager was employed on a full time basis and was supported by an acting deputy manager. There were enough appropriately skilled and experienced staff deployed to the service and staff had completed the necessary training to equip them with the skills and knowledge to carry out their duties effectively.

There were suitable arrangements in place for the safe storage and disposal of medicines and all medicines were administered by staff who had received the appropriate training to be assessed as competent to carry out these duties.

People were protected from risks to their health and wellbeing because written risk assessments were up to date and were being reviewed in line with the provider’s policies and procedures.

There were systems in place to protect people from abuse and keep people free from harm. The provider had policies and procedures in place for safeguarding adults which were available and accessible to members of staff. Staff were able to demonstrate a good understanding of these policies and procedures and how they related to their roles and responsibilities.

Staff supported people to attend healthcare appointments as required and liaised with people’s family members, GPs and other healthcare professionals to ensure people’s needs were met appropriately. Advocates and family members (where appropriate) were involved in reviews of people’s care and support.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. These safeguards are there to make sure that people receiving support are looked after in a

We carried out an announced inspection on 13 November 2015. The provider was given 24 hours’ notice because the location is a small home providing care to adults who may have been out during the day. We needed to be sure that someone would be in. Our previous inspection took place in January 2014 where we found the provider was meeting the regulations inspected.

Support for Living - 37 Barlby Road provides care and support for up to four people living with complex learning disabilities and physical disabilities. At the time of this inspection three adults were living in the home.

The service did not have 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.

A service manager was responsible for the day to day running of this service and another nearby service run by the same provider.

People were not always protected from risks to their health and wellbeing because people’s written risk assessments were not always up to date and had not always been reviewed in line with the provider’s policies and procedures.

There were enough staff at the service but we could not be assured that all staff had received the appropriate training to equip them with the skills, knowledge and experience to carry out their duties effectively and with confidence.

We could not be assured that people were always protected from the risk of potential abuse because the provider did not have a robust system for recording these matters.

The service was not organised in a way that always promoted safe care through effective quality monitoring. The provider had not implemented or was not operating an effective system to audit different aspects of the service including care plans, medicines and safeguarding matters as per above.

During our visit we were unable to review people’s proof of identity, right to work status and references as this information was not held at the service. We requested and received information from the provider relating to staff recruitment demonstrating that criminal record checks and other relevant checks are undertaken before staff commence working with people living in the home.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others.

Some but not all staff had received training in mental health legislation which had covered aspects of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Senior staff understood when a DoLS application should be made and how to submit one. Following our inspection we contacted social workers to enquire as to whether DoLS applications had been received by the provider and processed by the relevant agencies. At the time of writing this report we are still waiting for this confirmation.

Staff developed caring relationships with people using the service but people were not always being supported to maintain their hobbies and interests and people’s cultural preferences were not always being respected.

The provider conducted an annual survey for people using the service and their family members. However, we saw no evidence in the records or in the information we reviewed documenting that staff or advocates had supported people to provide feedback (where appropriate).

Our findings during our inspection of 13 November 2015 showed that the provider had failed to “…meet every regulation for each regulated activity they provide…”, as required under the HSCA 2008 (Regulated Activities) Regulations 2014 (Part 3).

We found that the provider was in breach of five regulations. You can see the action we have told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

We carried out observations using the Short Observational Framework for Inspection (SOFI) and observed positive interactions between staff and people using the service. We also spoke with one family member of a person using the service. They said they were satisfied with the care and treatment their relative had received.

Staff understood the importance of ascertaining capacity and getting a person's permission before delivering care. People’s families were involved in developing their care plan and person centred documentation. People’s views were ascertained over time and their care plan was adjusted accordingly.

All people's risk assessments and care plans were up to date. Person Centred documentation was regularly updated and in place for all residents.

Staff had been trained on how to recognise abuse and the service had procedures in place to prevent abuse from happening.

People were cared by staff who had been through a recruitment process and subjected to the appropriate pre-employment checks.

There was a complaints policy in place and people were given information and assistance in making a complaint.

We undertook a responsive inspection at this location because of concerns raised with the Care Quality Commission about numbers of staff on duty at the home and the changes being made to provision of services for people following the recent change in provider.

We were unable to speak with people using the service at 37 Barlby Road because they were not able to communicate verbally with us. However, we saw that each person had constant care, support and interactions with staff. We saw that staff communicated with people in a positive way. People had up to date care plans and risk assessments which included what they liked and disliked. We saw no evidence that people who did not have family involvement had access to an advocate in recent months. An advocate is a person who speaks on behalf of another person.

On the day of our visit we saw that there were sufficient staff to meet the day to day needs of people using the service. We saw that some people were going out to activities and appointments.

We saw that action plans were in place for the improvement of the home’s facilities, such as the kitchen and one of the bathrooms. Plans also included review of staffing levels and activities for people using the service. The provider was meeting monthly with the local authority’s representatives to monitor the contract.