The inspection took place on 3 November 2016 and was unannounced. We last inspected this service in March 2016 where we identified a breach of regulation because the manager working at the service was not registered. The registered provider was no longer in breach of this regulation as the registered manager had completed their registration in July 2016.

Trescott Road is a care home without nursing for up to seven people who live with learning disabilities and autism. At the time of our visit there were six people living at the home. The property is a purpose built home with accommodation on two floors and a stair lift to facilitate access.

There was a registered manager in place who was present throughout our 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.

People and their relatives told us that they felt safe living at the home. Staff we spoke with were aware of the types of abuse people were at risk of and how to report allegations or suspicions of abuse.

People’s risks were managed safely with the support of staff who had a good understanding of people’s support needs. Fire safety procedures had been discussed and practiced with people using the service.

Although action was taken to prevent the reoccurrence of accidents and to monitor risks to people using the service, records did not always reflect this practice. People could not be confident that they would always receive their medicines and prescribed creams safely.

People were supported by sufficient numbers of staff who had been suitably recruited, to meet people’s needs and participate in activities with them.

People were supported by staff who felt supported in their roles and demonstrated a good understanding of people’s needs and preferences, although not all staff had received required training for their roles. Staff meetings and handovers provided staff with the opportunity to receive and share updates about people’s needs.

People were supported in line with the principles of the Mental Capacity Act (2005). People were encouraged to make their own choices and decisions.

People were supported to eat and drink in line with their needs and preferences. Staff helped people to access healthcare support as and when required.

People were treated with dignity and respect and empowered by staff to express their views. People and staff enjoyed positive relationships and good interactions with one another. People were involved in their care planning and decisions about the home.

People were supported to participate in a range of activities in the home and community of interest to them and to promote their wellbeing. People were supported to have their needs met and additional guidance was sought from relevant healthcare professionals as required.

The registered manager was aware of areas of development at the home and was addressing these, including for example medicines audits and record keeping. Staff felt supported in their roles and able to share their concerns with the registered manager. The registered manager had taken care to create a home environment that was comfortable and person-centred for people using the service.

This inspection took place on 22 March 2016 and was unannounced. When we last inspected this service in July 2014 we found it compliant with all the regulations we looked at.

Trescott Road is a care home without nursing for up to seven people who have learning disabilities and autism. At the time of our visit there were seven people using the service. The property is a purpose built home with accommodation on two floors. There is a stair lift to facilitate access. People who live there help to look after a pet cat in the home.

The person who was named as the registered manager had left the service over a year ago. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a new manager at the home who had been in post since August 2015.

The provider had not ensured that the registration of the former manager had been cancelled. Although a new manager was in post their application to CQC to become registered as the manager was still outstanding and the provider had failed to ensure that a complete application had been submitted. You can see what action we have asked the provider to take at the back of the report.

People who used the service and their relatives told us that the home was safe. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice.

People were protected from possible errors in their medication because the arrangements for the storage, administration and recording of medication were good and there were robust systems for checking that medication had been administered in the correct way. The manager had taken the appropriate action when errors had been identified so people did not come to harm.

People who lived in this home and their relatives, told us that they were very happy with the care provided. People had opportunities to participate in a range of activities in the home and community which they said they enjoyed. Many activities people engaged in promoted their independence. People were supported to keep in touch with their families and friends.

People and, where appropriate, their relatives, were consulted about their preferences and people were treated with dignity and respect.

Staff working in this home understood the needs of the people who lived there and how to engage with people who could not communicate verbally. We saw that staff communicated well with each other and spoke highly of the management and leadership they received.

Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills. The manager had a good support network of manager’s from the provider’s other locations when they needed advice and guidance.

The manager and staff we spoke with understood the principles of protecting the legal and civil rights of people using the service. The appropriate actions were taken to ensure decision about people’s health care needs were made in their best interests

People were supported to have their mental and physical healthcare needs met and were encouraged to maintain a healthy lifestyle. The manager sought and took advice from relevant health professionals when needed.

People were provided with a good choice of food in sufficient quantities and were supported to eat meals which met their nutritional needs and suited their preferences.

There was effective leadership from the manager and senior members of staff to ensure that staff in all roles were well motivated and enthusiastic. The manager and provider assessed and monitored the quality of care through observation and regular audits of events and practice.

The manager consulted people in the home and their relatives to find out t

We visited this service and talked with people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were seven people living in the home at the time of our visit. We saw all of the people during our visit.

We spoke with four members of staff and the acting manager. People using the service had limited verbal communication skills. We observed how people were cared for and how staff interacted with them to get a view of the care they experienced. We spoke with two relatives of people living in the home and one regular visitor to the home.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to support and care for people. We observed the interactions between the people who lived in the home and staff. People looked at ease in their surroundings. Staff spoke with them in a calm and friendly manner.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. No applications had been made. The acting manager understood how this legislation applied to people and protected their rights.

The service had robust safeguarding procedures in place. Staff were alert to the signs of abuse or potential abuse. They understood their obligation to report any concerns.

The provider monitored the quality of service provision.

We found that equipment was serviced at regular intervals to ensure it was safe to use.

Is the service effective?

People's care and health needs were assessed and planned for with the involvement of their relatives and professionals acting on their behalf if they were not able to express their opinions. Specialist mobility and equipment needs had been identified in care plans where required. This meant that people's care was planned and delivered in line with their individual needs.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

People living in the home were encouraged to maintain and develop their independence.

We saw the menus reflected the foods liked by the people who lived in the home and that choices were available.

Staff training was sufficient to meet all the needs of people using the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff told us how they communicated with people to ensure they could enable people to make choices and decisions on a daily basis.

People appeared settled and happy. The relatives we spoke with told us the home offered a good service. One relative told us, “He is very calm and contented. They (the staff) pay attention to him. They (the staff) let me know if he is unwell.” Another relative said, “The care staff give is excellent. They (the staff) always seem to try really hard with the people living there.”

We saw that people were supported to take part in a range of activities of their choice. This ensured people led fulfilling lives. People were supported to maintain relationships that were important to them. People's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

People regularly completed a range of activities in and outside the service. The home had access to transport which helped keep people who were unable to use public transport involved with their local community.

Records showed that staff responded quickly to changes in people's health. We saw people had access to a variety of health care providers to ensure their needs could be met.

Is the service well led?

There was an acting manager in post since at the time of the inspection. The acting manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

Staff were supported to meet the needs of people through the provision of regular training, supervision and staff meetings that enabled good practice to be developed.

There was a system in place to monitor the quality of the service provided. This included audits of all aspects of the care and support given to people and the views of relatives and other people who visited the home. The acting manager was able to give us examples of actions taken and changes that had been made as a result of listening to the relatives of the people who lived in the home.

People's needs were assessed to establish the care that they needed and care was planned and delivered in line with their individual care plan. People appeared comfortable with staff and we noted that staff understood people's non-verbal communication methods. Staff interacted constantly with people and supported them to make decisions of everyday living. One relative told us, "I'm pleased [person] is there, they are very happy, always smiling. The staff are very nice, very friendly, they take [them] out. I'm certainly pleased with it."

The design and layout of the premises were suitable for people who used it. The home was warm and clean and the communal rooms were large and spacious with sufficient room for people's wheel chairs to move around. We found that there were good systems in place for staff to carry out regular health and safety checks around the premises including the fire safety equipment and installations. The provider had contracts in place to regularly test, inspect and service installations such as the central heating systems, the fire detection system and lifting equipment.

Most people who used the service at the time of our inspection required specialist equipment. We found that people had the equipment they needed and it was kept clean and regularly inspected and serviced.

We found the service being delivered to people was consistent with what the provider's statement of purpose offered.

When we visited the service on 25 May 2012 we met the six people who were living in the home at that time. Most people were not able to give us their views on the service because of their complex needs and conditions. One person told us that they liked the home and their bedroom, that they often went out with care workers to the local shopping centre and they liked to do this. They said that they did not want to move.

We used a variety of methods to gauge other people's experience of the service including reviewing records and talking to workers, students and volunteers. We spent five hours in the communal areas of the home observing how workers cared for and supported people. We saw that care workers and managers, volunteers and students in the service treated people with respect and dignity. They spoke to them with warmth, friendliness and good humour. Workers were able to communicate with people because they knew them well and people looked at ease with their care workers. People were supported to actively participate in their daily living arrangements.