26 Therapia Road Care Home provides care and accommodation to five people with a learning disability and there were five people at the service when we visited.

This unannounced inspection took place 7 February 2017. The last inspection of the service was done on 15 January 2016 and we rated the service as Requiring Improvement. At this inspection the service had made the required improvement and was rated Good.

There was a registered manager in post who has worked at the service for several years. 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 told us that they felt safe in the service. Staff had been trained in safeguarding people from abuse. Staff demonstrated that they understood the signs of abuse and how to safeguard the people they supported in line with the provider’s procedures. Staff said they felt confident that the registered manager would take appropriate action to adequately protect people.

There were sufficient numbers of staff on duty to meet people’s needs. Staffing levels were determined by looking at people’s needs and activities including appointments. Risks to people were assessed and managed appropriately to ensure that people’s health and well-being were promoted. Action plans to manage risks were in place and staff followed them.

People received their medicines safely and medicines were managed in line with procedures. Medicines were administered to people appropriately, clear records were maintained and medicines were stored safely.

Staff told us they were supported to do their jobs effectively. Staff were trained, supervised and had the skills and knowledge to meet the needs of people. The service worked effectively with other health and social care professionals and they supported people to attend their health appointments and to maintain good health.

People’s choices and decisions were respected. People made decisions about their day-to-day care and support. The service understood their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to food and drink throughout the day and staff supported them to prepare food..

Staff understood people’s needs and treated them with respect, kindness and dignity. Staff communicated with people in the way they understood. People’s individual care needs had been assessed and their support planned and delivered in accordance to their wishes. People’s needs and progress were reviewed regularly with the person and a professional to ensure it continues to meet their needs.

People were encouraged to follow their interests and develop daily living skills. There were a range of activities which took place within and outside the home. People were encouraged to be as independent as possible.

The service held regular meetings with people and staff to gather their views about the service provided and to consult with them about various matters. People knew how to make a complaint if they were unhappy with the service. There were systems in place to monitor and assess the quality of service provided. There were no outstanding actions from audit reports we looked at.

This inspection took place on 17 December 2015 and was unannounced. Therapia Road provides accommodation and support to a maximum of five people with a learning disability. At the time of our inspection, five people were using the service.

At the previous inspection carried out on 27 June 2014, the service has met standards of quality and safety.

The service had a registered manager. The registered manager was also responsible for managing other services for the provider. The service had a team leader who managed the day-to-day running of the 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.

People were provided with support that kept them safe from harm and abuse. Staff supported people to identify any risks to their safety and helped them to manage these risks. Staff followed safe medicine management procedures. Sufficient numbers of staff were provided to ensure that people’s needs were met. However, there were delays in providing staff cover at short notice because the system used was not efficient. This had an impact on the support people received with their daily activities and personal care.

People were happy with the support they received. Staff were provided with training and support they required to deliver effective care for people. Regular staff supervisions and appraisal meetings were carried out to ensure their professional developmental needs were met. Staff were aware of the Mental Capacity Act 2005 principles and ensured that people were supported to make decisions for themselves. Staff were knowledgeable about people’s health needs and asked for support from health professionals where appropriate.

We found that people were provided with limited support to make choices about the food they wanted to eat. Therefore we could not be reassured that the informed choices were available to people as required.

We made a recommendation for the service to seek advice and guidance from a reputable source, in relation to the requirements to support people with food choices as appropriate.

People liked their home and had good relationships with the staff. People’s preferred communication methods were used to ensure that their wishes were heard and acted on. Staff involved people in making decisions about their care and support. People felt their privacy and dignity were respected.

People were encouraged to learn new skills in order to maintain their independence. Staff supported people to attend regular meetings in order to review their support needs and set goals. People were provided with support to talk about their concerns if they wished to. People’s relatives provided feedback about the service and felt that issues raised were addressed.

We found that people did not regularly attend activities in the community and had limited activities in the home. There was a risk that people were not provided with informed choices about the activities they could undertake.

We recommended for the service to seek advice and guidance from a reputable source, in relation to the requirements to support people with activity choices as appropriate.

The team leader had good communication with staff and advised them where required. Staff were involved in developing the services and felt listened by their manager. The management team reviewed and monitored the quality of care provided and made changes to improve it. Staff followed the service’s incident and accident procedures, which meant that all actions were taken as appropriate to ensure good care for people.

We gathered evidence against the outcomes we inspected to help answer our five key questions; 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 describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

The building provided a safe and suitable environment for people who used the service. We noted that outstanding maintenance and decorating work still had not been completed since our last inspection. The service had an audible alarm and CCTV camera on their front door which indicated when the door had been opened and by whom. This allowed staff to monitor when people were coming and going from the service to ensure their safety. One person who used the service had high support needs and in order to maintain their safety and the safety of other people at the home, staff ensured they provided one-to-one support to this individual when they were with other people who used the service.

People were protected from the risk of abuse and neglect. Staff were trained in safeguarding. We saw evidence that they had followed safeguarding procedures when incidents took place and knew who to contact in the event of a safeguarding issue.

We were unable to look at staff personal files as these were kept at the provider's head office. However, we did speak with four members of staff who confirmed they had completed recruitment checks such as interviews, supplying references and receiving disclosure and barring service (DBS) checks.

Is the service effective?

People had individual support plans which outlined their needs and gave a detailed description of how staff supported them. We spoke with one support worker who knew how to prevent a risk from occurring with the person they were supporting on the day of our inspection.

There were systems in place to ensure staff received relevant training in order to support people who used the service.

Is the service caring?

A relative we spoke with told us, "The staff are lovely." We observed people being cared for and spoken to in a kind and understanding manner. One person who used the service indicated that the staff were kind to them. People's privacy and dignity were respected. We observed staff speaking to people with respect and kindness.

Responses from people and relatives on satisfaction surveys indicated the care being provided was good. One relative had written in April 2014 that their relative was happy and enjoyed living at the service. We spoke with a community project worker who knew both staff and people who used the service. They told us they thought the service was, "Amazing."

Is the service responsive?

Two relatives we spoke with knew how to raise a concern or make a complaint. The service had a complaints folder which contained a picture formatted complaints form for people who used the service to complete if necessary with help from their keyworker. We noted that no complaints had been received since our last inspection in May 2013.

Is the service well-led?

There were systems in place that ensured the team leader and staff learned from events such as incidents, accidents, complaints and investigations. There was evidence that learning from incidents took place and appropriate changes were implemented. Incidents had been properly documented and acted upon.

The service had quality assurance audits and systems in place. The team leader told us and we saw evidence of monthly staff meetings which covered areas that affected both people who used the service and staff. The staff received monthly supervision which focussed on their development to encourage good practice. The registered manager for the service showed us the staff's wellbeing plan for 2014 which had been devised by the provider following meetings with staff. This meant that the service's staff had an opportunity to raise issues that concerned them and to be listened to.

People using the service told us they liked staying at there, and their relatives told us they thought the service provided was “excellent”.

People had individual support plans which outlined where they needed support and gave a detailed description of how staff were to support them.

There were appropriate arrangements in relation to the management of medicines. Medicines were safely stored and administered.

The building provided a safe and suitable environment for people using the service. However, there was some outstanding maintenance work.

Staff felt supported and there systems in place to ensure staff received appropriate training. Staff received monthly supervision sessions and annual appraisals.

There were effective systems in place for checking the quality of service provision. People using the service, their relatives and staff were able to comment on the service provided and any concerns raised were acted upon.