About the service: Surrey Place is a residential care home that was providing accommodation and personal care to two adults with learning disabilities.

The 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/or autism using the service can live as ordinary life as any citizen.

People’s experience of using this service: Improvements had been made since the last inspection in 25 June 2018. People told us the changes had improved the service.

Changes to the environment had a positive impact on people. Improvements had been made to ensure medicines were managed, stored and administered safely by staff trained for this role.

New risk assessments were in place. Staff knew how to keep people safe and were trained in safeguarding.

Audits and monitoring systems were effective at managing the service and making improvements.

Robust recruitment and selection procedures ensured suitable staff were employed.

Staff received appropriate training and support to meet people’s individual needs.

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 supported this practice.

People were supported to have enough to eat and drink.

Appropriate healthcare professionals were involved in people’s care and support as and when this was needed.

People spoke positively about the registered manager and the wider management team. There was an effective quality assurance system in place to ensure the quality of the service and to drive improvement.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings, phone calls and resident meetings.

People had strong links to the local community through regular access to local services.

People were supported to be independent and their rights were respected. Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection: The rating at the last inspection was Requires Improvement (report published 8 August 2018).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor information we receive about the service. If any concerning information is received, we may re inspect sooner.

This inspection took place on 19 and 25 June 2018 and was unannounced. This was the first inspection of this service under the current provider.

Surrey Place is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Surrey Place is registered to provide support for up to three people with a learning disability and/or autism and is based in a two-storey property. Nursing care is not provided. At the time of the inspection there were two people using the service.

The care service was not acting within 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 were not receiving support in line with legislation, standards and evidence based guidance. Some areas of the premises had not been adapted to meet people’s needs and ensure they could be safely independent and live as ordinary a life as any citizen.

The service had a registered manager in place. 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 lack of management oversight had resulted in several areas of concern being unidentified until we raised them. Audits were not effective and the registered manager had not been proactive in ensuring records were up to date and accurate. There was a reliance on external professionals to make decisions around the support people needed and insufficient action taken to follow up concerns or minimise risk.

Medicines were not always managed safely for people. Improvements were also needed in the correct storage and recording of medicines.

Risks associated with people’s support needs were not always fully considered or correctly documented in support plans. Procedures to be followed in an emergency had not been adequately risk assessed and would not ensure people were safe in the event of a fire.

Staff had received safeguarding training and were aware of reporting procedures should they have any concerns.

The premises had not been appropriately adapted to meet people’s needs. There was no bath for people who wished to use one and the shower did not have any support rails. Some external areas were in a poor state of repair making them hazardous.

Environmental checks were carried out on the premises to ensure it was safe. This included gas and electrical testing. The testing of portable electrical appliances was not being done in line with the provider’s policy and a check of window restrictors was not documented. Where an issue was identified, such as hot water temperatures being a scalding risk, no action was taken to reduce the risk.

Capacity assessments were not being conducted in line with the Mental Capacity Act 2005. Some people had been identified as lacking capacity by external professionals but this was not reflected in support plans. One person was going out independently when there was a doubt as to whether they were safe to do so however no action had been taken prior to an external review giving advice on this.

We found there were no staff on duty to support people with their assessed needs overnight. However, following feedback on the first day of our inspection the registered manager changed the rota to include a regular sleep-in member of staff. At times one person was left in the property alone during the day. The risks around this had not been adequately addressed.

Comprehensive, up to date training records were not kept and the records that were available indicated several gap