We inspected the service on 26 June 2017. The inspection was unannounced. Tigh Fruin provides accommodation and personal care for up to six people living with learning disabilities and an autistic spectrum disorder. At the time of our inspection there were five people living at the service.

The service had a registered manager in place at the time of our inspection. They had been appointed since our last inspection and had been at the service since March 2017. 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.

At the last inspection on 30 January 2017 we asked the provider to take action to make improvements to how people were protected against the risk of abuse, how staff were deployed, how the registered provider monitored and assessed the service to identify and act on any improvements needed and how the Care Quality Commission was informed of incidents the provider was required to report.

We told the provider they must send us a written plan setting out how they would make the improvements and by when. Following our inspection the provider immediately sent us an action plan and subsequent action plans of the action they would take to make the required improvements.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found in January 2017. We found that the provider had taken action and all the breaches had been met. In addition there is an ongoing police safeguarding investigation, the provider continues to work with the police and the local authority safeguarding team. We will continue to monitor this work.

Staff had received further safeguarding training and new systems had been introduced to help protect people from the risk abuse. Risks to people’s needs had been assessed and planned for but relatives and professionals had some concerns about information sharing relating to incidents in how these were communicated.

Improvements had been made to the deployment of staff and safe staff recruitment practice was in place and followed. Some minor improvements were identified with the management of medicines and immediate action was taken to address this. People received their prescribed medicines when required and safely. The storage, ordering and disposal of medicines were found to follow best practice guidance.

Improvements had been made to staff induction, ongoing training and support provided to staff. The implementation of the Mental Capacity Act 2005 was found to have ongoing issues. However, the registered manager took immediate action to address this.

Improvements had been made to how people’s anxiety and behaviours were assessed and planned for. However, further work should be undertaken to ensure new recording systems and processes are effective to understand better people’s unique and complex behavioural needs.

Improvements had been made with menu planning and the involvement of people in choosing their meals. People’s dietary and nutritional needs had been assessed and planned for and staff provided support with people’s healthcare needs appropriately.

Staff had a caring approach and understood people’s needs, preferences and what was important to them. Staff were more effective in how they responded to people’s communication preferences and needs. People were involved as fully as possible in choice making and independence was promoted. Independent advocacy information was available should this support have been required. Staff supported people with dignity and respect.

Improvements had been made to the activities and opportunities available to people, these were meaningful and represented people’s interests and hobbie

We carried out an unannounced inspection of the service on 30 January 2017.

Tigh Fruin provides accommodation and personal care for up to six people living with learning disabilities and an autistic spectrum disorder. At the time of our inspection there were five people living at the service.

Prior to our inspection visit we were informed that the registered manager was no longer 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. At the time of the inspection the registered manager had very recently left the service. The regional manager with the support of the assistant director for the organisation were managing the service. A new manager had been appointed and was due to commence employment in March 2017. We will monitor this.

Appropriate action was not taken in response to safeguarding issues. Staff had correctly reported safeguarding incidents to the registered manager, who failed to report these to the local authority safeguarding team or CQC. No analysis of incidents were completed to consider patterns, themes or lessons learnt.

Sufficient numbers of staff were on duty to meet people’s needs during our inspection, however, systems were not robust to ensure that sufficient staff were on duty at all times. Consideration to the mix of staff with respect to skill, training and experience had not always been considered. Staff were recruited through safe recruitment processes.

There were systems in place to monitor and improve the quality of the service provided, however, they were not effective. People and their relatives were not involved or had limited opportunities to be involved in the development of the service. The provider was not meeting their regulatory requirements.

Risks associated to people’s needs and the environment had been assessed and planned for. The provider had a policy and procedure for the use of physical restraint. Not all staff had received training in the restraint method used. Behavioural strategies to support staff to meet people’s needs were more reactive than proactive.

People received their medicines safely.

Staff received an induction but training was not always provided in a timely manner. The staff training plan showed gaps in training and refresher training. Staff received opportunities to review their work.

The Mental Capacity Act 2005 was not fully adhered to. Menu planning was not routinely being used to ensure people received an informed choice including healthy meal options. People were supported to maintain their health.

Staff were kind and respectful and knew people’s needs. People and their relatives were not always fully involved in decisions about their care. Advocacy information was available to people.

People did not always receive personalised care that was responsive to their needs. Individual activities and opportunities were limited. Staff’s knowledge and understanding of people’s preferred communication methods was limited. A complaints process was in place.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.