This inspection took place on 4 and 5 June 2018. It was an unannounced visit to the service.

We previously inspected the service on the 24 and 25 May 2017. The service was rated Requires Improvement at the time. We found two breaches of the Regulations of the Health and Social Care Act 2008 and one breach of the Care Quality Commission Regulations 2009. We found people were not always protected from fire as staff did not know how to support people in the event of a fire. Staff were not always supported in line with provider’s expectations. We found the registered manager had not always informed us of events it was legally required to do so. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Effective and Well-Led to at least good. At this inspection we found improvements had been made.

The Fremantle Trust - Buckingham 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.

The Fremantle Trust - Buckingham Road can accommodate seven people in one bungalow. Five people with learning disabilities were living there when we visited. Each person had their own personalised bedroom and had access to a communal lounge, kitchen, dining room and bathroom facilities. People had access to a large private garden and outdoor space.

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.

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.

We received positive feedback from people, their relatives and staff on how the service was led. Comments included “Staff are excellent,” “I would say Buckingham Road definitely replicates a family home” and I do feel very comfortable that he is there, well cared for and well looked after.”

Staff were aware of the need to report any incidents and accidents. Systems were in place to monitor and identify any trends or learning to prevent a future similar event.

People were supported by staff that had developed a good working relationship with them. Staff were aware of people’s likes and dislikes. It was clear from the interactions we observed people were relaxed in the company of staff and welcomed their support.

People were supported to engage in meaningful activities and keep in contact with family and friends. People attended external social groups both during the day and in the evening. On day one of inspection one person was excited as they were going to a social club that evening.

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. Staff

Improvements had been made to the environment. Equipment used by people was serviced on a regular basis.

We received positive feedback about how the service was managed. One relative told us “(Name of registered manager) is driving improvements”. The whole staff team worked together to provide a homely environment and support people to live a fulfilling life.

This inspection took place on 24 and 26 May 2017. It was an unannounced visit to the service.

We previously inspected the service on 29 April and 1 May 2016. The service was not meeting one the requirements of the regulations at that time. This was in relation to cleanliness and maintenance of the premises. This was because there was mould growth in the laundry room and more significant areas in the shower room. We asked the provider to take action to make improvements. They sent us an action plan which outlined the measures they would take. We found improvements had been made.

The Fremantle Trust – Buckingham Road provides care for up to seven people with learning disabilities. Six people were living there at the time of our visit.

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. There had been changes to management since the previous inspection. The current registered manager had been in post since July 2016.

We received positive feedback about the service. A relative told us they were very happy with their family member’s care adding they were “Very well looked after.” They said their family member “Goes out most days and is always quite happy with the place.” Another relative commented “The care is very good, she’s looked after very well and has a good key worker.”

People were protected against the risk of abuse. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. People’s medicines were handled safely and given to them in accordance with their prescriptions. People were supported with their healthcare and nutritional needs. Staff knew the people they supported well and treated them with kindness and compassion.

People were not always protected against the risk of fire. We found staff had not taken part in fire drills at the frequency the provider expected. There were no records of who had attended drills. This meant there was a risk of some staff not knowing the safest way to respond in the event of a fire. A recent inspection by the fire safety officer highlighted some areas where improvements were needed. One of these was to increase staffing levels at night time. We have made a recommendation for staffing levels to be reviewed in light of this.

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.

Care plans had been written to record the support people needed. Risk assessments were in place to reduce the likelihood of people experiencing injury or harm. People accessed the community and took part in a range of activities.

Recruitment procedures had been followed in all but one case in the sample of staff files we looked at. We have made a recommendation about protecting people from the potential risk of harm where one member of staff requires a criminal records check to be undertaken.

Systems to support and develop staff had not always been used effectively at the service. We found staff had not received supervision and appraisal in line with the provider’s expectations. Training for some staff had not been kept up to date to make sure their skills were refreshed.

People’s care was monitored by the provider through visits and audits. However, we found some areas of practice had not been maintained to the standards we noted at the previous inspection.

The registered manager had informed us about some of the events which the Care Quality Commission needs to be notified of. However, there were two serious injuries that we had not be

We previously visited the service on 8 and 14 April 2014 and had concerns about some areas of practice. These were in relation to care and welfare of people, requirements relating to workers, supporting staff, assessing and monitoring the quality of service provision and records.

We set compliance actions for the provider to improve practice. The provider sent us an action plan which outlined the changes they would make to become compliant. They said they would have completed improvements by the end of July 2014.

We returned to the service on 29 August 2014 to check whether the improvements had been made. 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 caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found the provider needed to take action to ensure Buckingham Road provided a safe service.

There was some improvement to record keeping at the service and the office was now kept in better working order. This meant information was easy to locate when needed. There was improvement to care plans but further work was needed to make sure they fully reflected people’s needs, so that staff could support people safely and appropriately. We found required documents were not always in place in recruitment files, to reflect that appropriate checks had been carried out. This meant some of the records were still inaccurate.

People who lived at the home were no longer prevented from accessing the kitchen. The provider had de-activated an upper door handle which had prevented people from going into the kitchen without staff supervision. The manager was aware of who to contact within the local authority if any applications were required to deprive people of their liberty. This helped to ensure people who used the service would only be deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

We saw appropriate checks were undertaken before staff began work. This included uptake of references and enhanced Disclosure and Barring Service checks for criminal convictions and inclusion on lists of people unsuitable to work with vulnerable adults. This showed the service used thorough recruitment practices to protect people from the risk of harm.

Is the service effective?

We found the provider needed to take action to ensure Buckingham Road provided an effective service.

We saw improvements had been made to ensure staff received appropriate professional development. Staff were now receiving supervision to discuss their developmental needs and staff meetings were taking place regularly.

Some training had taken place since our last visit. However, we found there were over 40 courses collectively that staff needed to be booked on to bring them up to date with the provider’s training requirements. This meant staff may not have had the necessary skills and knowledge to meet people’s needs safely and appropriately.

Is the service caring?

We found the provider needed to take action to ensure Buckingham Road provided a caring service.

The care plans we read had not been updated with all the information staff needed to support people safely. For example, one file lacked guidance on managing the person’s behaviour and use of “as required” medication to calm them. This meant there could be inconsistencies in how people’s care was delivered.

Is the service responsive?

We found the provider needed to take action to ensure Buckingham Road provided a responsive service.

At our previous inspection, we set a compliance action for the provider to produce care plans in accessible formats for people. We found insufficient progress had been made with this work. This meant the provider had not made reasonable adjustments to reflect people’s needs.

Is the service well-led?

We found Buckingham Road provided a well-led service.

We saw the provider was now using its systems to regularly assess and monitor the quality of service that people received. There was evidence of regular unannounced monitoring visits, for example, to check the quality of people’s care. The provider may find it useful to note the home was working to an action plan to improve the service which had different timescales than the version submitted to CQC. This meant there were still actions which had not been fully completed, such as staff training. The provider had not informed us of any change to their submitted action plan. We therefore expected all improvements to be completed by the timescale they gave us of the end of July 2014. This showed there was still an element of monitoring which needed to be looked at by the provider.

We saw that care plans did not contain detailed information referring to how people communicated their wishes and choices, such as indicating yes, no, happy, sad, or in pain. We were informed that some people were unable to understand their care plans due to mental capacity issues, but they did not have a mental capacity assessment on file.

Care plans contained information such things as who is important to me, important information you need to know about me. We saw records of peoples individual health needs such as opticians, dentist, epilepsy management, medication reviews and health checks were regularly carried out.

Appropriate arrangements were in place for obtaining, storing, administering, disposing of medicine and regular auditing. The records showed that staff signed for the administering of medication. Two staff signed for the administering of controlled medication in the controlled drugs book.

We were told that the service had not received any complaints within the last year. We saw that some concerns were raised in the people`s house meetings, which were appropriately addressed by the manager at the time to the persons satisfaction.

A person we spoke to told us that if they were unhappy about anything they would tell the manager.

Staff we spoke to told us that they received regular supervision, one person said "The senior staff are approachable and very supportive. We saw that staff received regular training and updates.

People that we spoke with said they can make decisions about their care such as choosing the menus and when to get up and go to bed. One person told us that he was supported to look after a cat. People said there were regular residents' meetings and that they could discuss anything at these. People told us that an independent advocate visits the service regularly and meets with everyone to discuss how they are and if they have any concerns.

People showed us they had been enabled to personalise their rooms with items such as posters, ornaments and photographs. We saw that people were free to spend time in their rooms or to use the communal areas. We observed the manager passing on details of a telephone call to one person straight away, to keep him up to date with developments.

People said they were happy with the care they received. Comments included 'I love it here' and 'I'm very pampered'. People told us they have key workers who make sure they have what they need and that routine healthcare appointments take place. One person told us staff would contact the doctor if he felt unwell.

People said they felt safe at the service. They told us they could raise any concerns in residents' meetings or with the independent advocate. No one said they had needed to make a complaint about their care.

This inspection took place on 29 April and 01 May 2015. It was an unannounced visit on the first day and announced on the second.

We previously inspected the service on 29 August 2014. Following that visit, we asked the provider to take action to how they managed the care and welfare of people, supporting workers and records. The provider wrote to us to say what action they would take to improve the service. We checked progress in meeting these actions as part of our visit.

The Fremantle Trust - Buckingham Road provides care for up to 7 people with learning disabilities. Six people were living at the service at the time of our visit. 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.

We received positive feedback about the service. Comments from relatives included one person who said their family member was “Very happy there, and gets on well with staff and other residents,” and “It seems to be calm and well run.” One family member said “Generally (name of person) is very well looked after and it is obvious that the people at Buckingham care about him too as a person. They appear to have his best interests in mind in terms of his well-being.” Another relative’s comments included “The standard of care at Buckingham Road is excellent.”

The service had sufficient staff to meet people’s needs. This included supporting people to access the community to promote their independence. Staff had been recruited effectively, to make sure they had the right skills and attributes to support vulnerable people. Staff undertook an induction when they first joined the service. This was supported by training in core areas of practice to make sure they followed safe practices. The provider had an on-going training programme for staff to update and refresh skills and knowledge periodically.

People’s well-being was promoted through procedures and training on safeguarding. Any concerns of this nature were appropriately referred to the relevant agencies. We found people received their medicines safely. Staff had been appropriately trained to handle medicines and accurate records were kept of when medicines had been given.

The quality of people’s care was assessed during regular visits and audits undertaken by the provider. The service was managed effectively and safely. Improvements had been made to the areas where we previously identified shortfalls. People spoke highly of the registered manager and we saw several compliments had been recorded about standards of care. The one complaint that had been received was handled appropriately.

Care plans documented people’s needs and preferences for how they wished to be supported. Staff were knowledgeable about people’s needs and supported them with kindness and dignity. Risk assessments had been written to support people’s independence whilst reducing the likelihood of injury or harm.

The building complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to mould in the laundry room and more extensively in the shower room. You can see what action we told the provider to take at the back of the full version of this report.