About the service:

The Anchorage is a residential care home providing accommodation and personal care to people with learning disabilities. At the time of the inspection there were six people living in the home. The building design fitted into the residential area and was similar to other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways, [promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

• People were protected from abuse, neglect and discrimination. Staff knew how to recognise abuse and protect people from the risk of harm.

• The management of environmental risks had improved since the last inspection and risks were managed and mitigated.

• Monthly monitoring was carried out on the water system. However there had not been an annual test of the water carried out to ensure it was free from legionella bacteria.

• We made a recommendation about following the latest guidance in regard to legionella testing.

• Risks associated with people’s care were identified and assessed and staff understood how to manage these.

• Procedures were in place to help protect against employing staff who were unsuitable to work in the service

• Medicines systems were organised and people were receiving their medicines when they should.

• The cleanliness of the environment had improved since the last inspection, and staff understood how to prevent and control the spread of infection.

• Systems were in place to ensure that lessons were learned when things went wrong.

• People’s needs were holistically assessed and staff understand how to support people to meet their needs.

• People were supported by staff who had ongoing training to help them meet people’s needs.

• People were supported to eat and drink and staff were aware of people’s special dietary needs.

• The building was adapted to meet people’s needs and there were plans in place to make further changes in response to people’s changing 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 involved in their care and supported by staff who were kind and caring.

• Staff understood how to promote people’s privacy and dignity and support them to be independent.

• People were supported to pursue hobbies and interests and to be involved in the local community.

• There was a positive person-centred culture promoted by the registered manager.

• There were systems in place to ensure that managers could monitor the ongoing quality of care and support.

• The managers engaged with people using the service, their relatives and staff to gather feedback on how the service could be improved.

• There were plans in place for continual improvement to the service.

Rating at last inspection: At the last inspection the service was rated requires improvement (Report published 20 March 2018). At this inspection we found improvements and rated the service good in all key questions.

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

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

This inspection was carried out on the 29 January 2018. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

This service 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.

The Anchorage is a care home providing accommodation, personal care and support for up to six adults who have a learning disability, sensory impairment or mental health conditions. There were five people living at the home at the time of our inspection.

The Anchorage has been registered with the Care Quality Commission (CQC) since October 2010. Since this time, a new provider Endurance Care Limited, had taken over the management of The Anchorage. This change occurred on 26 October 2017. The new provider had retained the previous staff team and registered manager. This was the first comprehensive inspection since the provider registered with CQC, as such; they had not yet received a CQC rating. New services are assessed to check they are likely to be safe, effective, caring, responsive and well-led.

We were told on the day of our visit the registered manager was no longer employed. However following our visit the provider notified us the registered manager would be resuming their responsibilities at the service. 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 area operations manager met with us and provided us with the information we needed.

We found that the systems in place to reduce risks associated with the environment were not always suitable for purpose or properly maintained and this exposed people to the risk of harm. We found that one radiator covering was not fixed to the wall as intended and there were exposed pipes in the shower room, which could result in a person being injured. The bathroom and toilet facilities were not clean or properly maintained. People told us and staff confirmed they were unpleasant to use.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced.

The service was not always well led; although the registered manager had completed regular monitoring checks these were not considered to be robust. The area operations manager took immediate action to improve people's safety and quality of care delivery. We have received assurances since the inspection and continue to be in regular contact with the provider to ensure standards improve imminently.

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.

Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had.

Care records contained guidance and information to staff on how to support people safely and mitigate risks. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. People received their medicines safely and as prescribed.

People were supported by sufficient numbers of staff to meet their needs. Robust recruitment procedures were followed to ensure only suitable staff were employed.

People’s needs had been assessed before they moved into the home to ensure staff could p