This inspection took place on 16 October 2018 and was unannounced. The last inspection to this service was 23 and 25 August 2017. We rated the service requires improvement in three key questions: Safe, caring and well-led. We identified two breaches of Regulation 10: Privacy and dignity and Regulation 12: safe care and treatment. We found people's privacy and dignity was compromised by the inappropriate use of monitoring equipment. We also found that risks associated with the safety of the premises, including access to substances that might be hazardous had not been adequately controlled. There were also concerns about the cleanliness of the service. Risks to the safety and well-being of people using the service were not always robustly managed and mitigated and medicines were not always managed safely and consistently.

Following the last inspection, the service submitted an action plan telling us what action they were going to take to improve the service. They have kept the action plan up to date. At our latest inspection on the 16 October 2018 we found some improvements have been made but still identified a few areas of concern in relation to records and care.

The service can accommodate up to seven people who have a learning disability, physical disability, sensory disability and, or autism. Most of the bedrooms are on the ground floor and accommodation is provided across two separate dwellings which are interconnected. At the time of our most recent inspection there were four people living at the service and a fifth person was due to move in.

Taylor Road 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. It does not provide nursing care.

The care service has not 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. We have identified some concerns about people's opportunity to access the community and engage in everyday activities.

The service had a registered manager in post. 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 working hard to improve the quality and safety of the service and provided mainly good outcomes for people. They had met the previous breaches of regulation identified at the last inspection.

Further though needed to be given to the deployment of staff and the range and availability of appropriate activities for people. There were enough staff to support people with their physical care needs but there was not always sufficient opportunity for people to go out as they wanted as they needed one to one support which was not always provided due to existing funding arrangements.

There was a plan of care for each person but their daily notes did not clearly show how people’s needs were being met in line with the plan of care. Care records were not kept in sufficient detail and did not clearly establish clear objectives and how these would be measured. We could not see if people were being supported in the way they wished and in line with their goals and preferences.

Staff understood how to support people lawfully in line with legislation relating to mental capacity.

Risks to people’s safety were identified and there was a plan in place to reduce the risk. This was clearly documented but we raised concern about a lack of documentation in relation to lap b

The inspection took place on 23 and 25 August 2017 and was announced.

Taylor Road provides accommodation and care for up to seven people with a learning disability. People living in Taylor Road may also have a sensory impairment or physical disability. At the time of our inspection, there were seven people being supported.

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

Some aspects of the service had deteriorated since our last inspection, when we rated it as good in all areas. We identified breaches of Regulations 12 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The safety of the service people received was compromised in some areas. This included risks to infection control within a kitchen area because of some damage that had not been repaired. There were also potential risks of accidentally swallowing or otherwise misusing toiletries including aerosols, a cleaning product and a thickening agent. The risks associated with insecure storage of these were in particular need of review following a change in the group of people living in the home. One person's risk of losing weight was not being fully addressed with remedial action in line with professional advice. Their risk of developing pressure ulcers was not consistently addressed and mitigated.

Systems for managing medicines needed some improvement to ensure prompt action was taken if anomalies arose. This included the need to respond more quickly to shortfalls in audits and to ensure medicines were always stored safely.

These concerns represented a breach of Regulation 12 for providing safe care and treatment.

We identified that there was also a breach of Regulation 10 for maintaining people's dignity and respect. The service was using monitors which broadcast what was happening in people's private rooms into a communal area of the home. This was not in line with the explanation the registered manager gave to us about its use and compromised people's privacy and dignity. We noted that there was some thoughtlessness in the use of the equipment as an intercom to communicate with one person in their room. Due to their additional conditions, this had the potential to cause confusion and distress. It was not respectful of the person's dignity or taking time to communicate with them properly, face to face.

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

We found that the systems for assessing the quality and safety of the service were not robust in identifying the issues that we found in relation to people's privacy, care records and risk management. However, we concluded this did not amount to a breach of specific regulations for the management of the service and the registered manager took action promptly to address important areas of concern. The provider's representatives had also completed checks on the quality of the service and drawn up action plans for improving where necessary. The management team needed to ensure that they sustained the improvements.

Other aspects of the service continued to work well for people living in the home. There were enough staff who were trained and competent to meet people's needs. They knew how to recognise and respond to any concerns that people were at risk of abuse and their understood their obligations to report such concerns. Recruitment practices contributed to protecting people from the appointment of staff who were not suitable to work in care services.

Staff understood their legal obligations in relation to seeking people's consent to deliver care. Systems within the service supported their pr

An inspector for adult social care carried out this this inspection. This was to check that improvements had been made following our last inspection on 23 May 2014. The focus of that inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We found that there were shortfalls in the safety of the service which we needed to follow up.

As part of this inspection we spoke with two people of the six people who used the service. However, they had significant communication difficulties and were not able to tell us verbally what they thought about their care. We spoke with the registered manager and two other members of staff. We also carried out observations, reviewed records which included care plans for three people and their daily records. We reviewed medication administration records for all six people using the service and looked at some quality assurance monitoring records.

Below is a summary of what we found. The summary describes the information we gathered from records and what staff told us. If you wish to see the evidence supporting this summary, please read the full report.

Is it safe?

At our inspection in May 2014 we found that people's safety was compromised. This was because medicines were not being managed and stored properly and people's records were not accurate and up to date.

At this inspection we found that improvements had been made to the way medicines were stored. This included the provision of proper storage and recording for controlled drugs. These medicines require additional precautions in their management. We found minor omissions from the record of administration of medicines for two people which were addressed promptly by the manager while we were present. We concluded that people's safety was promoted because medicines were managed appropriately.

We also found that improvements had been made to records so that these were up to date. Staff knew where to find information and what they told us about people's needs matched what we found in their records. One inconsistency within a health action plan was put right while we were present so that it properly reflected changes in the person's health. We concluded that people's safety was promoted because accurate records about them were being kept.

We spoke with four of the people living in the home although all had limited verbal communication skills and were not able to tell us what they thought. Because of this, we observed what was going on and how staff were supporting people. We reviewed the information the manager sent to us and sought specialist pharmacy advice. This helped answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People responded well to the staff who worked with them.

Prescribed medicines were not consistently managed in a way that ensured people were protected from the risk of harm. This was because they were not always recorded accurately so that any misuse or errors in administration could be identified promptly. Controlled medicines, requiring additional precautions, were not stored as required by law. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe storage of controlled medicines.

The safety of the service was monitored. Regular checks were being made to ensure fire detection systems worked properly although a fire drill was slightly overdue. Systems were in place to ensure that health and safety within the environment was checked. This reduced the risk to people and helped the service to continually improve.

The home had procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We were given an example of how the manager had taken advice to see whether an application was needed regarding deprivation of liberty for someone living at the home. This meant people would be safeguarded as required. We provided information to the manager about a recent legal decision regarding DoLS so that further advice could be taken if required.

Is the service effective?

People received specialist advice regarding mental health, behaviour, dietary needs, and communication and swallowing difficulties where this was appropriate. It was clear from our observations and speaking with staff that they understood people's care and support needs. A survey completed by a visiting relative said that all the person’s needs ‘are met fully.’

However, we found that records were not always in place or kept up to date particularly in relation to people whose diet needed monitoring. This meant that staff would not know whether care delivered was effective and when to seek further advice. We asked the provider to tell us what they are going to do in relation to meet the requirements of the law in relation to record keeping.

Is the service caring?

We saw that people were supported by attentive staff. A relative commented in their survey that the person they visit ‘is well cared for in a kind and compassionate environment.' Another relative’s survey indicated they were impressed by the way the person ‘is included in all conversations/discussions.’

We observed that staff respected people's privacy and knocked on bedroom doors before entry. Our discussions showed that staff understood the individual experiences of people living with dementia and how this mental health condition affected them.

Is the service responsive?

People were able to engage in activities inside and outside their home, with staff support as needed. One person had been on holiday and showed us some of the things they bought while they were away.

Staff were able to give us examples of where people's needs had changed and how they were arranging for further advice in relation to their care. Support plans reflected how people’s concentration and ability fluctuated and that sometimes people may need higher levels of assistance.

Is the service well led?

The service had a quality assurance system so that the quality of the service could be improved where necessary. The manager had improvement plans in place to respond to any issues raised by the operations manager or from within the provider’s health and safety audits. Relatives were offered regular opportunities to comment about service quality.

Staff spoken with were clear about their roles and responsibilities.

In November 2012, we identified concerns that staff were not having regular supervision sessions with their manager, and did not feel supported to do their job. We told Taylor Road to make improvements. We returned on two subsequent occasions and found that staff were still not receiving supervision or receiving adequate support from their manager. The manager and provider were issued with a warning notice, telling them to make improvements within a short timescale set by CQC.

We returned to the service in January 2014 to see if they had made the improvements we told them to make. We found that staff now received appropriate professional development and were supported to do their job.

In November 2012, we visited Taylor Road and identified issues with the support and professional development care staff received at the service. We told Taylor Road to make improvements, and in July 2013 we returned to the service to see if they had made the necessary improvements we told them to make. We found that the service had not made the required improvements in order to comply with the regulations. We told Taylor Road to make further improvements. In November 2013 we returned to the service and found that they had still failed to fully comply with the regulations, and that staff were still not receiving appropriate appraisal and supervision.

We found that the service had in place processes for obtaining consent to care and treatment. Mental capacity assessments were in place for everyone using the service, and the provider acted in accordance with legal requirements where people did not have capacity to consent.

We found that there was care planning in place to meet people's needs and information about the person to help staff support them better. This information had been reviewed regularly. However, the provider may find it useful to note that there was no care planning for one person with regard to two aspects of their care that staff told us about.

We found that there were enough staff to meet people's needs. People were engaged in meaningful activity throughout the day by staff who understood their needs.

We found that staff had access to appropriate training in order to meet people's needs, including some specialist training to help them meet the needs of people using the service who were living with epilepsy. We found that staff did not always have access to regular supervision and annual appraisal. However, staff told us they felt well supported and could raise issues and problems with senior staff.

We found that the service had a complaints policy and procedure in place. This was provided to people using the service in an easy read pictorial format which they could better understand. The service had received no complaints at the time of visit.

People living in the home were not able to tell us verbally what they thought. Because of this we spent time observing how staff interacted with three of the people living there. We observed that people were comfortable and calm in the presence of staff. We saw that they were encouraged to do things for themselves at either lunch time or tea time and were offered choices about what to eat and drink and where they wanted to sit for their meal. There was guidance for staff about how people expressed themselves and staff gave us consistent information about this.

We found that guidance for staff about how people were to be supported safely and the risks to which they were exposed, was not always up to date and did not always reflect people's changing needs. We also found that staff were not confident that a plan for supporting someone with eating and drinking was still current and did not consistently follow this to ensure the person's safety.

We found that although most staff were well trained, some were not always completing training promptly so that they could support people safely. Systems for ensuring their development needs were addressed needed improvement. However, the incoming manager had only taken over running the home a few weeks before our visit. There were good systems for monitoring the quality of the service. The manager was clear about the actions needed to improve had established a plan for achieving these.

This inspection took place on 5 and 8 May 2015 and was unannounced.

At our last inspection dated 23 May 2014, we found that the service was non compliant with regulations in respect of safe management of medicines and care records not being consistently maintained. At this inspection we found that the service was compliant with both regulations. Safe management practices were being followed in respect of medicines and all care records were up to date.

Taylor Road provides accommodation and support for a maximum of seven people who have learning disabilities. They may also have physical disabilities. On the day of our inspection there were five people living at this home.

This service is required to have a registered manager in post. 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 was a registered manager employed at the time of our inspection.

There were safe arrangements in place in respect of the ordering, storage, administration and recording of medicines. Staff received training about safe medicines practice and their competence was checked periodically.

People had limited verbal communication skills but they were able to indicate to us that they were happy living at this home. People appeared relaxed in the presence of staff. All staff had completed training about how to recognise if abuse was occurring and what to do if they had concerns.

There were enough staff on duty to meet the needs of people living at the service. Sufficient staff were available so that people could take part in activities in and outside of the service.

Staff knew about the Mental Capacity Act and the Deprivation of Liberty Safeguards. They understood how to support each person around making choices and acting in the best interests of the person.

People were cared for by kind, attentive and compassionate staff. They were offered choices around daily living and these were respected. People’s diverse needs were met in a dignified way and staff understood the equality and diversity ethos of the home.

Audits were in place to ensure the service operated in a safe way. Quality audits were completed regularly and people’s views were sought frequently and acted on. There was a complaints procedure available and this showed that all expressions of concern were investigated and resolved quickly. People had the complaints process explained to them and they were supported by staff to raise any concerns they may have.