The inspection of Trabel took place on 11 and 13 September 2017. The inspection was unannounced on the first day and announced on the second day. We previously inspected the service on 9 August 2016 and at that time we found the provider was not meeting the regulations relating to managing medicines. On this inspection we checked and found improvements had been made.

Trabel is a care home for twelve people with learning disabilities and behaviour that may challenge others. The home is arranged over three floors and includes two independently staffed flats with one bedroom and two bedrooms. One person is supported in a self-contained bungalow in the grounds. The home is located just outside Huddersfield Town centre.

There was a registered manager in post who had been registered since October 2010. 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.

Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Safe recruitment and selection processes were in place and medicines were managed in a safe way for people.

There were enough staff to provide a good level of interaction. Staff had received an induction, supervision, appraisal and role specific training. This ensured they had the knowledge and skills to support the people who lived there.

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, although some best interest processes had not been evidenced. We recommend the registered provider consult best practice in this area to ensure mental capacity assessments and best interest processes are always recorded when decisions need to be made on behalf of people who may lack capacity.

People were supported to eat a balanced diet and meals were planned around their tastes and preferences.

Positive relationships between staff and people who lived at Trabel were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.

People were involved in arranging their support and staff facilitated this on a daily basis. People were supported to be as independent as possible throughout their daily lives.

Care records contained detailed information on how to support people and included measures to protect them from social isolation. People engaged in social activities which were person centred.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

People told us the service was well led. The registered manager and deputy manager were visible in the service and knew people’s needs.

People who used the service, their representatives and staff were asked for their views about the service and they were acted on.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard.

This inspection took place on 9 August 2016 and was unannounced. This means the provider did not know we were coming. We last inspected Trabel House in January 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

Trabel House is a care home for 12 people with learning disabilities and associated challenging behaviours. There were 12 people living in the home at the time of this inspection.

The service had a registered manager. 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 a 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 kept safe from harm. Staff were aware of the different types of abuse people might experience and of their responsibility for recognising and reporting signs of abuse. Possible risks to the health and safety of people using the service were assessed and appropriate actions were taken to minimise any risks identified.

Robust staff recruitment processes were in place to ensure applicants were properly assessed as to their suitability for working with vulnerable people. There were sufficient staff to safely meet people’s needs and staffing was well organised to ensure people received appropriate levels of support.

We found some of the systems in place to ensure people received their medication safely were not effective and could have put people at risk. We recommended the service review its medication audit to ensure it was robust enough to identify any issues in relation to the safe administration of medication.

Staff had been provided with ongoing training and support to assist them in performing their role. Although we found supervisions were not always undertaken in line with the provider’s policy, staff we spoke with told us they felt well supported and had the necessary skills needed to care for people effectively.

The service worked within the principles of the Mental Capacity Act 2005 (MCA) to uphold people’s rights. Detailed information was held about how to communicate effectively with people in order to maximise their ability to provide their consent to care and treatment wherever possible.

People using the service were supported to meet their nutritional needs and to maintain good health through access to appropriate healthcare services.

Staff demonstrated a sensitive and caring manner in their interactions with people using the service. They were knowledgeable about people’s needs and how best to support people to be as independent as possible.

People and their relatives were involved in care planning and were actively encouraged to share their views and opinions of the service. People’s privacy and dignity was maintained.

Care plans were reviewed and updated on a regular basis to reflect changes in people’s needs. Input was sought from healthcare professionals to ensure people were receiving care and treatment which was appropriate for their needs. Care records were person-centred and provided staff with information about how to care for people in line with their individual preferences. People’s wishes and aspirations were clearly identified and they were supported to achieve these.

The service had appropriate systems in place for recording and responding to complaints and records showed complaints were taken seriously and thoroughly investigated.

Information was provided to people and their relatives about who to contact should they have any concerns. Staff we spoke with felt supported by the registered manager and were able to easily access support when they required it. The provider had a range of systems in place for monitoring and reviewing the service and action was taken to address areas for improvement.

Some of the people who lived at the home have complex care needs and have difficulties with verbal communication. Howeve, we were able to talk with of the people who used the service. One person was able to tell us ’I like it here, I like the people’. Another person told us that they had been to ‘blackpool and I want to go again’.

We saw that interaction between staff and the people who used the service was respectful and often humorous. The staff we spoke with told us that that people enjoyed having a laugh. The home was welcoming and the people who used the service were very friendly and approachable.

We spoke with three members of staff and they all told us they enjoyed working at the home. They told us that the people who lived there were treated very well. One staff member told us ‘It’s like a little family here, we know people very well because they have lived here a long time’.

We looked at four care plans of people who used the service. We saw that they were comprehensive and reflected the needs of the individual. In addition to the care plans, we saw that there were risk assessment in place and these too had been reviewed and updated to reflect the changing needs of the individual.

We saw that staff received regular training which ensured they were kept up to date with their skills and knowledge. Staff told us they received regular supervision and had annual appraisals.

During our visit there were only three people who use the service at home. Some of the people who live at the home have complex care needs and have difficulties with verbal communication, however the three people we met indicated that they liked living at the home and liked the staff. These are some of the things they told us:

"I like baking"

"I can choose what I want to do"

"I'm happy"