This inspection took place on 7 August 2018 and was unannounced.

The Old Post Office Residential Home 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 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 home accommodates up to seven people in an adapted building some people live in single occupancy flats others have bedrooms and share living space. At the time of the inspection there were five people living in the care home.

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 in post, however they were not at work at the time of the inspection, the provider had made arrangements for another manager to provide cover for the home.

People were protected from abuse as staff understood how to recognise the signs and report concerns. Risks were assessed and there was guidance for staff to support people to stay safe. There were systems in place to minimise the risk of cross infection. People were supported by safely recruited staff and there were enough staff to meet people’s needs. People had their medicines as prescribed and these were managed safely. The provider had systems in place to learn when things went wrong.

People had their needs assessed and plans were in place to meet them. Staff were trained to provide support to people and offered consistent care. People were supported to have meals of their choice and had their health needs met. The environment people lived in was adapted to meet their 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 supported by kind and caring staff and they had good relationships with staff. People could make choices about their care and their communication needs were understood by staff. People were supported to make decisions and maintain their independence. People were treated with dignity and respect.

People had assessments carried out of their diverse needs and plans put in place to meet them. People needs and preferences were understood by staff, and their care plans were reviewed regularly. People had support to go out into the community and follow their interests. People understood how to make a complaint and there was a system in place to investigate these. There was a system in place to consider people’s wishes for end of life care.

The quality of the service people received was checked and the information was used to drive improvements to the service. There were regular opportunities for people, relatives and staff to give their feedback ion the service and the provider had systems in place to use the information from these to make improvements. The provider had systems in place to monitor the delivery of people’s care.

This inspection was unannounced and took place on 5 May 2017.

The Old Post Office provides accommodation and personal care for up to seven people who have a learning disability. On the day of our inspection the home was fully occupied.

The home had a registered manager who was present for the inspection. 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 recording and storage of medicines were unsafe. However, people did receive their medicines when needed. People were protected from the risk of potential abuse because staff were aware of their responsibility of safeguarding them. Systems and practices protected people from the risk of harm. People were cared for and supported by sufficient numbers of staff who were recruited safely.

The provider had systems in place to monitor the effectiveness and the quality of the service provided to people. However, theses system did not identify the shortfalls with regards to the management of medicines. People were encouraged to have a say in the running of the home. Staff felt supported by the registered manager to carry out their role.

People were cared for by trained staff who were supported in their role by the registered manager. People's human rights were protected because staff included the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards in their work practice. People were supported by staff to eat and drink sufficient amounts to promote their health. People were assisted to access relevant healthcare services when needed.

People were cared for by staff who were kind and sympathetic to their needs. People's involvement in making decisions about their care ensured they received a service that reflected their preference. People's right to privacy and dignity was respected by staff.

People's involvement in their care assessment and reviews ensured they received a service the way they liked. People were able to live a lifestyle of their choice and were supported to pursue their interests. People felt assured that their concerns would be listened to and acted on.

This inspection took place on the 11 February 2015 and was unannounced.

At our previous inspection in May 2014 we found that the provider needed to make improvements in supporting people with their communication to enable them to be involved in decisions about their care, treatment and support. People had been at risk of inappropriate or unsafe care as their care plans did not reflect the level of support they required to achieve their goals and keep them safe. At this inspection we found that improvements had been made in both these areas.

The Old Post Office provides accommodation and personal care to up to seven people with learning disabilities. At the time of the inspection seven people were using the service.

The manager had been in post since November 2014 and was in the process of registering with us. 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 who used the service were unable to tell us in detail what they thought about the care, treatment and support they received due to their learning disabilities and communication needs.

Relatives were not always involved in the decision making process about the care, treatment and support their relative received. We could not see that everyone had been involved in the planning of their own care.

People were kept safe as the provider and staff followed the correct procedures when they suspected abuse had taken place. Staff had received training in safeguarding and knew what constituted abuse.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. The Deprivation of Liberty Safeguards are for people who cannot make a decision about the way they are being treated or cared for and where other people are having to make this decision for them. We were informed that DoLS referrals had been made for several people using the service and were being considered by the local authority. The provider worked within the guidelines of the MCA to ensure that people were involved and consented to their care, treatment and support.

There was enough staff to keep people safe and to support people to maintain their independence and access the community.

Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to store medicines.

People were supported to have a healthy diet dependent on their assessed individual needs. People had a choice of foods and were involved in preparing their own meals where able to.

People had access to a range of health professionals and staff supported people to attend appointments when necessary.

People told us they liked living at the service. We observed that staff were kind and caring with people and respected people’s dignity and privacy.

Staff were supported to fulfil their role effectively through regular support and supervision and training applicable to their role.

The provider conducted regular quality monitoring inspections of the service and implemented action plans to ensure continuous improvement.

This was an unannounced scheduled inspection. During the inspection we spoke with people that lived at The Old Post Office, support staff and the manager. The person named in the report as the registered manager is no longer working at the service.

We considered our inspection findings to answer the questions we always ask;

• Is the service safe?

Safeguarding procedures were in place and staff were aware of their responsibilities to make sure that people they supported were kept safe.

The manager had a system in place to monitor and analyse any accidents and incidents that occurred. This ensured that lessons were learned from these events to reduce the likelihood of them reoccurring.

Some staff were not trained in the implications for people of the Mental Capacity Act 2005 and the deprivation of liberties provisions. Plans of care did not provide detail about how people should be supported to make decisions. We have asked the provider to tell us what they are going to do to rectify this aspect of people’s care.

• Is the service effective?

Plans of care were in place but were not specific enough to the person themselves and did not cover some aspects of people’s care. They did not show that people had agreed to their plans of care or to the actions identified to reduce risks to them. Plans of care did not always identify people’s hopes and aspirations for the future. We have asked the provider to tell us how they are going to address this shortfall and make sure that people are fully involved in the development of their plans of care.

People were supported to have their health care needs met. This included having medical checks ups and receiving specialist health care.

• Is the service caring?

People were supported by staff that were kind and caring. We observed that people were spoken with in a respectful manner and that people were offered choices about their lifestyle. People told us they were happy living at the Old Post Office. One relative told us: “My relative sees this as their home”.

People that lived at the home, relatives and professionals that visited completed an annual satisfaction survey. We saw that when some areas for improvement were identified by the people that lived there they were acted upon.

• Is the service responsive?

People had the opportunity to take part in a range of activities of their choice both in and out of the home. People's wishes about what they ate and how they dressed were acted upon.

People that lived at the home had the opportunity to express their views at regular house meetings. Action was taken when suggestions were made to improve the service.

• Is the service well led?

The new manager had recently been appointed to The Old Post Office and had only been in post a month when this inspection took place. They had already made some progress to address shortfalls that had been identified.

The service has a quality assurance system in place. Records showed that areas for improvement had been identified and an action plan was in place. Progress towards the achievement of the plan was regularly monitored by the regional manager.

Staff were clear over their roles and responsibilities. There was always someone in charge of the home at all times. This meant that there were clear lines of responsibilities.

This was a scheduled inspection. The home did not know we were visiting. During this inspection we spoke with people that lived at the home, care staff and the registered manager.

People that lived at the home told us they were satisfied with the care. One person told us: "It's alright here". Another person said: "I'm happy here".

People were involved in planning their care. They made decisions and choices about how they wanted their care provided. Systems were in place to make sure that people understood information and to gain their consent for their care and treatment.

People were supported to have their health and personal care needs met. They attended the GP and had the support of specialist health care professionals. People took part in activities of their choice.

People were supported to take their own medication. Effective procedures were in place to make sure this was done safely and that people had their medication as prescribed by their GP.

People told us they got on well with the staff. Care staff were supported and supervised to provide appropriate care to people. Some staff had not had all the necessary training but plans were in place to make sure that this training was provided in the near future.

Effective systems were in place to assess and monitor that people received safe and appropriate care that met their needs and wishes. People's views were sought and acted upon.

We carried out this inspection as part of our planned programme of inspections. The visit was unannounced and neither the staff nor the provider knew that we would be visiting.

The inspection included the observation of care experienced by people living at the

home, talking to people who were living in the home, talking with the relief and deputy managers and staff on duty, looking in detail at all aspects of care for four people with complex needs, viewing people's rooms with their consent and discussing their care with staff. This process is known as pathway tracking.

The home provided care and support for seven people who had a learning disability. All seven people who lived at The Old Post Office at the time of our visit were male. People were able to tell us that they liked living at The Old Post Office. We spoke with all people who lived at the home. One person said, "Yes I like it here it's nice". Other people also expressed a satisfaction with the accommodation, the staff, the food and daily life at the home. People told us there was always something to do and most people told us they went out somewhere each day.

We saw that all people who used the service had a support plan which gave details of the care and support needs they required. We saw that some of the plans had not been reviewed for a while. Staff told us that it was work in progress to get all plans up to date.

People who used the service told us they felt able to speak with staff if they had any concerns or worries. Staff told us the actions they would take if they became aware of any issues that may be concerning to the people who used the service.

Staff told us they felt the current staffing levels and the training opportunities were sufficient to meet the needs of people who used the service.

We saw the way the service checked and monitored the quality of the service and saw many weekly and monthly checks being completed. We saw some delays in taking swift action for some issues that had been identified. This may have an adverse impact on the welfare of some people who used the service.