The Malting's provides care and accommodation to three people with learning disabilities and this inspection was unannounced and took place on 26 July 2017.There were three people living at the service.

At the previous inspection dated July 2016 we found breaches of Regulation 11 and 17 and at this inspection we found there had been improvements with quality assurance systems. We also found members of staff were knowledgeable about the principles of the Mental Capacity Act and consent to care had been mainly sought in line with legislation and guidance.

A registered manager was 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 staff were knowledgeable about the principles of the MCA and had attended the training. Mental capacity assessments were in place for some specific decisions which included dental treatment and personal care. However, personal care assessments did not cover staff making decisions for administration of medicines and topical creams.

Care plans and combined risk assessments were in place. However care plans were not always updated for some people as their needs changed. The care plans describing the support for one person were not consistent with other documentation about the person’s ability to move around the home independently.

Risk assessments and care plans were combined. The staff were aware of the risks to each person and how they were managed. Staff said there were risk assessments in place on how risks were to be minimised.

Medicine systems needed some improvements. There had been persistent errors, however the registered manager had taken appropriate action to ensure safe handling of medicines. Where people took their medicines other than in accordance with the prescription, for example they chewed the tablets or had them in food rather than swallowing, the pharmacist had not been contacted to ensure that this was appropriate..

Medicine Administration Records (MAR) charts were signed by staff to show the medicines had been administered. Body maps were in place for the applications of topical creams.

Daily routines included people’s preferences as well as the assistance staff had to provide. Where people were able; guidance was given to staff on supporting the person to manage some of their personal care needs for themselves.

People were not able to tell us what feeling safe meant to them. We saw people approach staff for company and when they needed assistance or support. We heard people singing with staff and depending on the situation we saw staff treat people with kindness and firmness when it was needed. The staff we spoke with were knowledgeable about the procedures for safeguarding adults from abuse. We saw copies of the No Secrets guidance pinned onto notice boards in the office and kitchen. This meant the procedure was available to staff and visitors to the home.

The staffing levels had improved within the last 12 months and there was a stable team. New staff were recruited to vacant posts. The rotas in place showed there were two staff on duty at all times of the day and night. At night the staff slept in the premises. Staff told us the staffing levels were appropriate to meet people’s needs and to undertake activities with them.

Staff were supported to meet the responsibility of their role. New staff had an induction to prepare them for their job. Staff attended training set by the provider as mandatory and other training specific to the needs of people living at the service. Staff had an opportunity to discuss issues of concerns, performance and training needs during one to one supervision with their line manager.

People were subject to continuous supervisions and DoLS ap

This service provides accommodation and support to three people with learning disabilities. This inspection was unannounced and took place on the 7 January 2016. At the time of our inspection there were three people living at the service. The home was last inspected in April 2014 and all the standards we inspected were met.

A registered manager was not post at the time of our inspection visit. An application to register as manager was received at the Care Quality Commission. 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.

Members of staff said the team worked well together. They said the team was long standing and supportive of each other but there had been a period of instability with the three changes of manager in 12 months

Members of staff had some understanding of enabling people to make decisions. However, they were not clear who would be responsible for making decisions that may be made in peoples best interests. . Next of Kin without power of attorney had given consent inappropriately for care and treatment. Mental Capacity Assessments (MCA) 2005 were not developed for specific decisions, such as audio monitors.

DoLS procedures within MCA 2005 require providers of care homes to apply to the supervisory body for authorisation to deprive people of their liberty where they lack capacity to make decisions and subject to continuous supervision. Deprivation of Liberty Safeguards (DoLS) applications were not made by staff at the home to the supervisory body for people under continuous supervision.

People were referred to specialists such as Speech and Language Therapists (SaLT). Members of staff followed the guidance given by the specialists but care plans were not developed on how the recommendations made by specialist were to be consistently followed. The Care plans in place needed updating and they lacked detail on how staff were to meet the needs of people. Records were not personal and confidential for each person. Communication books held information about people’s health and wellbeing. For example, outcome of GP visits and medicines administered.

Members of staff were knowledgeable on managing risk and the actions needed to minimise the risk to people’s health and wellbeing. However, risk assessments were not always developed. For example, risk assessments were not in place for people at risk of choking or for people with low weight.

The views of relatives were gathered but their suggestions about activities were not always acted upon or used to improve the service. Quality Assurance systems were not effective. Where gaps in the standards of care were identified, action plans were not developed on improving the service for people.

We observed good interactions between people and staff. Members of staff were knowledgeable about developing relationships with people to gain their trust and meet people’s needs in their preferred manner.

We saw people approach staff and by their facial expression, the attention from staff was welcomed. We saw people use their preferred communication method to request specific activities. Members of staff knew the types of abuse and were clear on the responsibilities placed on them to report suspected abuse.

Sufficient staffing levels were deployed to meet people’s needs but there were vacancies for bank staff to cover annual leave.

Staff attended training set by the provider as mandatory and other specific training to meet people’s changing needs. One to one meetings with the manager gave staff opportunities to discuss concerns, the people they delivered care and treatment to and their performance.

Medicine management systems met people’s needs. Individual profiles with pictures and words wer

One inspector visited the home and answered our five questions, Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, communicating with people using the service, 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?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. Each person had health support guidelines and a health action plan. People's diversity, values and human rights were respected.

Safeguarding procedures were robust and staff had a clear understanding of their responsibilities with regard to protecting the people in their care. There had been no safeguarding referrals made in 2013 or 2014.

Mental Capacity Act assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS). The home had not made any Deprivation of Liberty Safeguards referrals in 2013 or 2014. We saw that people had best interests meetings and advocates were involved in decision-making processes, as appropriate.

The home had been altered to ensure the physical environment was as safe as possible for the people who lived there.

The home made sure that there were enough staff on duty to ensure people’s comfort and safety.

Systems were in place to make sure that managers continually monitored the quality of care offered to people. Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

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Is the service effective?

The families of people were involved in their care planning and knew what actions would be taken to support them.

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. They were involved in developing their plans of care, as far as they were able, if they chose to be. Care plans were detailed, they clearly identified people’s health and well-being needs and how they should be met.

Is the service caring?

People were supported by well trained, experienced and knowledgeable staff. We saw that care staff interacted positively with people who used the service. We saw that staff were able to interpret people’s individual methods of communication. They responded sensitively and appropriately to people.

People’s preferences, interests and diverse needs had been recorded. The home ensured that they gained people’s views by using a variety of methods. People’s wishes were, often, interpreted from the behaviour they displayed if they were unable to communicate them verbally.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Each person had an individual weekly activities plan, which met their current needs.

The home took a number of actions in response to views expressed by the people who lived in the home or their advocates. It had a comprehensive complaints procedure.

Is the service well-led?

The service had a robust quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was being maintained or improved.

Staff told us that they were offered good training opportunities and were well supported by the manager.

The three people living at the home all had complex needs so were not able to tell us about their experiences.

We spoke with family members who said their relatives were “quite happy” and the staff were “excellent.”

During the visit we observed positive interactions by staff with all three people. Staff were responsive to individual needs. For example, by offering different activities to reduce anxiety.

We spoke with staff and they were able to demonstrate they knew people well. This was confirmed by family and other professionals.

Records showed staff worked with other professionals and family to make decisions about care and treatment in people’s best interests where people could not do this for themselves.

Other records demonstrated there were systems in place to check for improvements of the quality and safety of care in the service. This included audits of the administration of medicines and complaints. Staff felt well supported and had completed a range of training.

Each person had a support plan that detailed how to meet care and welfare needs. We found information was missing in some areas that could help staff to be consistent with the support they gave to people.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke to the relatives of two people who told us they were happy with the service provided.

We looked at satisfaction surveys completed by the people using the service and their supporters. Comments included “dedicated and friendly, can’t fault them in any way”, “I have no concerns” and “the staff are good and very helpful”.

We saw that people looked relaxed and comfortable in the presence of the care staff. We observed that people were clean and well presented.

We noted that various activities took place both within and outside the home. People could choose to join in or not.