The inspection took place on 29 January 2018 and was announced. The service was rated Good at the last inspection in April 2015. The Emmie Dixon Home accommodates twelve people who have a physical and/or learning disability who need personal care. The home is located in a residential area of Crewe, close to shops, pubs and other local amenities, local transport and road networks.

At this inspection we found the service remained good, however had achieved a rating of requires improvement in the safe domain. We found medication procedures at the home were mainly safe, however we identified a recording problem regarding medication.

The home has 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.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We spoke with the people who lived in the home and relatives who all gave positive feedback about the home and the staff who worked in it. The service had a relaxed and homely feel and people could move freely around the service as they chose. People were supported to have maximum choice and control over their lives and participate in activities they enjoyed.

Care plans and risk assessments were person centred and detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. Care plans showed that people's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary. We saw the service had responded promptly when people had experienced health problems.

The registered manager used different methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. The staff team were consistent and long standing. The providers were also heavily involved in the running of the service.

Staff were recruited safely and there was evidence that staff received a proper induction and suitable training to do their job role effectively. All staff had been supervised in their role. Staffing levels were consistent and were adapted to meet people’s needs.

Further information is in the detailed findings below.

The inspection was unannounced and took place on 8 April 2015.

The last inspection took place on the 14 January 2015 when the home was found to be meeting the regulatory requirements looked at and which applied to this category of home.

The home was managed by 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 and 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 Emmie Dixon Home accommodates 12 people who have a physical and/or learning disability who need support with their personal care. The home offers short to long term care and wherever possible a home for life. The home is located in a residential area of Crewe.

We asked people using the service if they felt safe at Emmie Dixon and they said that they did. Comments included; “The staff keep us safe and are always around to support us”, “I am safe here and staff are my friends” and “I like it here, I am not afraid”.

Visitors we spoke with told us, “My relative had a lonely and unsafe existence before coming here. This is the best place in the area, she is now safe and well” and “My friend is safe and secure which takes away a lot of pressure from us all”.

The service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

We found that effective recruitment procedures were in place. Appropriate checks had been made to ensure that staff were suitable to work with vulnerable adults.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that it was up to date. Training records viewed confirmed this.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We found that the manager and staff routinely involved people in decision making and had implemented correct procedures such as arranging best interest meetings when there were doubts that the person had capacity to give informed consent.

There was a flexible menu in place which provided a good variety of food to the people using the service. Care plans we looked at all explained what each person’s care needs were. Records showed that the plans were reviewed monthly so staff would know what changes, if any, had been made. This enabled staff to provide care that was appropriate to any changing need.

Meetings for the people using the service were held monthly and we were able to access recent minutes which identified that people living in the home were very much involved in the running of the home.

Staff members we spoke with were positive about how the home was being managed. Throughout the inspection we observed them interacting well with other staff and the people who lived in the home.

When we inspected Emmie Dixon Home previously in April 2014 we found that improvements were needed to protect people from receiving inappropriate or unsafe care. Where people did not have the capacity to consent, the provider was not acting in accordance with legal requirements.

During our last inspection we also found that the records for people who lived at the home did not always hold details to show that they experienced care, treatment and support that met their needs or protected their rights.

We considered all the evidence we gathered under the outcomes we inspected. We used

the information to answer one of the five questions we always ask;

• Is the service effective?

The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) are legal requirements that need to be followed to ensure decisions made about people who do not have capacity are made in their best interests. They are designed to ensure that people who are unable to give consent for certain aspects of their care and welfare receive the right type of support to make a decision in their best interest.

We looked at the care records for two of the 12 people who lived at the home. We found that the manager and staff routinely involved people in decision making and had implemented correct procedures when there were doubts that the person had capacity to give informed consent.

We looked at two care files and we could see that significant improvements had been made in recording, care planning and the delivery of care. The manager told us that she had addressed the issues raised at the last inspection and had reviewed the care planning document and had changed the format to ensure all records were consistent, relevant and detailed all the individual care, choices, support and treatment needs.

People living in the home said they were generally happy with the staff and services provided. They said that staff treated them well. They were all very positive about living there and said that the staff are very good. They told us that they know all the staff as they had been there for a long time and that they were all very respectful and always knocked on their bedroom door and waited to be invited in.

Some comments made included for example,

"Staff know my needs and look after me well”.

“Staff are always around to provide help and support”.

“Staff are helpful and friendly”.

People said they felt well cared for by the staff that supported them. Everyone we chatted to was positive about the support provided. Most people told us they were familiar with the staff that supported them and knew their names as they had all worked there for many years. One person said that the interactions between staff and people living in the home were always good.

People told us that they feel safe and have no concerns about the care and treatment they receive from staff. They said staff are always available to talk to if people had any concerns.

People advised they were supported to live a life of their choice and be as independent as possible.

People told us they knew about the complaints procedure and what action to take if they had a concern.

When we inspected Emmie Dixon Home previously, in October 2013 we found that improvements were needed to protect people from receiving inappropriate or unsafe care. We shared our concerns with the local safeguarded authority and immediate action was taken to protect the welfare and wellbeing of the people who lived at the home. Quality Assurance officers from the local authority’s adult safeguarding unit visited the home on a number of occasions and social workers, working alongside other health and social care professionals, reviewed the care provided to each of the people who lived at the home.

Working with the local authority the provider developed an action plan which showed us that appropriate arrangements had and were being made to protect and assure the health, safety and welfare of people living at the home. The action plan showed that all required action would be in place by the end of March 2014.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care.

As part of this inspection we spoke with a number of representatives of the local authority, the registered manager, six staff, nine of the 11 people who lived at the home and five of their relatives. Some of the people living in the home were unable to talk to us about their experiences so we carried out an observational activity called a "Short Observational Framework for Inspection" or SOFI. A SOFI is a specific way of observing care to help us understand the experience of people who may have difficulty expressing their views.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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. The summary is based on our observations during the inspection, speaking with the people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We found that the people who used the service received safe and appropriate care, treatment and support. Their individual needs had been established with their involvement and the support of their relatives and health and social care professionals. Care plans had been developed which were centred on them as an individual and considered all aspects of their individual circumstances and needs.

People were safeguarded from the risk of abuse because the provider had taken steps to ensure that staff had the skills to recognise and respond promptly and effectively to any evidence or suspicion of abuse. The people who used the service told us that they felt safe and well cared for and their relatives told us that they had confidence in the manager and staff. Representatives of the local authority told us that the manager and staff had worked in partnership with them to ensure that the people who lived at the home were safeguarded from abuse and the risk of them receiving unsafe or inappropriate care and support.

The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) are legal requirements that need to be followed to ensure decisions made about people who do not have capacity are made in their best interests. They are designed to ensure that people who are unable to give consent for certain aspects of their care and welfare receive the right type of support to make a decision in their best interest.

We looked at the care records for three of the 11 people who lived at the home. We found that the manager and staff routinely involved people in decision making but had not followed correct procedures when there were doubts that the person had capacity to give informed consent. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

We found that Emmie Dixon care home provided effective, caring and compassionate care for the 11 people who lived there and we could see that the registered manager had worked closely with service commissioners to ensure people’s needs were met.

Since our last inspection social workers from the local authority had carried our reviews for all the people living at the home, working in collaboration with each person, their relatives, staff and associated health care professionals. The reviews had identified that people’s health and personal care needs were being met but some gaps in service provision for social interaction and stimulation were identified for some of the people who lived at the home.

We could see that the manager and staff worked efficiently and effectively to meet peoples social care needs but despite their best efforts some people lacked opportunity for stimulation, social inclusion and social interaction in the home or local community. The manager of the local social services team told us that the home’s registered manager was working with service commissioners to address these deficiencies. This will ensure that all the people living at the home are offered appropriate opportunities for social interaction, stimulation and social inclusion.

Is the service caring?

We found that the manager and staff provided sensitive and compassionate care, with kindness dignity and respect. All the people we spoke with made positive comments about the staff and the care provided or indicated that they were content by other methods of communication.

People were relaxed and at ease, clean and well-presented. Those who were able to discuss their care told us that they were happy and content. One person said “I am very happy, well looked after and well cared for overall I could only say the home is excellent”.

Relatives of people who lived at the home were unanimous in their praise for the quality of care provided. One of the relatives spoken with said: “This home is excellent because here people come first”.

We observed staff engaging people in conversation frequently, listening to them, acting on their requests and supporting them with their daily activities and hobbies. This provided for a positive environment where people were acknowledged and included in the day to day comings and goings of the home.

Is the service responsive?

Since our last inspection the provider had responded to concerns we raised and had taken effective action to improve the management of the home and thereby the standard of care provided. This showed us that the service is responsive.

Deficiencies in staff training and support systems had been addressed and the number of staff employed during the day had been increased. This meant people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The manager had worked closely with the people who lived at the home and their relatives and health and social care professionals and had developed person centred plans that ensured each person received caring and compassionate care that met their needs.

Is the service well led?

We found that Emmie Dixon Home was well led. Since our last inspection the provider had appointed a suitably experienced and qualified manager who had registered with the Commission as manager.

We observed the way staff interacted with and supported the people who used the service. The staff showed their knowledge of each person's individual needs and personal preferences by the way they assisted and supported them. Staff told us that they were well supported by the new manager who was known for being person centred, and supportive. Staff told us that they had benefited from supervision and training on a range of important topics and we saw documentary evidence to support this.