This inspection took place over five days with an unannounced site visit on 22 January 2018 and announced site visit on 26 January 2018. Where we receive information of risk or concern about a service, or information that indicates a service has improved, we may carry out a comprehensive inspection sooner than originally scheduled. The comprehensive inspection for this service was carried out sooner as we received information of concern and risk which we needed to explore.

When we conducted a previous inspection in September 2015, we rated the service ‘Good’. During this inspection breaches of legal requirements were found and the service was rated ‘Requires Improvement’.

15 Archers Green provides care, support and accommodation for up to three adults with autism/learning disabilities and complex needs. People living at the home are supported by staff on a 24 hour basis. At the time of our inspection there were three people living in the home; each person had their own bedroom and shared communal areas. Two of the bedrooms had en-suite facilities with an additional bathroom and downstairs cloakroom. People had access to a well maintained garden at the rear of the home.

15 Archers Green 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.

There was a registered manager in post. The registered manager was also the registered provider.

Staff recruitment processes were not always safe. Files that we checked did not demonstrate robust recruitment checks in line with the provider’s policy.

Systems and processes were in place to monitor the quality and safety of the service, however these were not always effective. We saw evidence of quality assurance audits being completed, however they lacked a review and analysis from the management team and had not identified the issues found during this inspection.

Accident and incidents were recorded where required and reviewed by senior staff and managers. However one report did not contain detailed information to provide a rationale as to why physical intervention had been used. This was discussed with the behaviour manager during inspection.

Consent for care was not always gained in line with the principals of the Mental Capacity Act 2005 (MCA). We could not see any evidence of best interest involvement within the support plans viewed.

We saw evidence of detailed risk assessment at Archers Green that provided guidance for staff in managing identified risks. Risk assessments were reviewed regularly.

Each person living at Archers Green had a Personal Emergency Evacuation Plan (PEEP) in place. We saw the PEEPs did not provide guidance for staff to safely evacuate people during an emergency. This was discussed with the deputy manager during inspection.

We saw evidence that medications were stored and administered safely. Staff had received appropriate training to safely administer medication and had their competencies assessed regularly.

Staff had received training in relation to safeguarding adults from abuse and neglect. Staff we spoke with showed a good understanding of how to safeguard adults from abuse and how to report any concerns.

Staff had received training in relation to behaviours that challenge and physical intervention. Staff told us they felt confident dealing with situations when people may present with behaviours that challenge or if they became physically aggressive.

We saw that staff had received training in most areas relevant to their role, how

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

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff told us they had safe staffing levels such as one to one staff to help them to safely meet the individual needs and choices of each person living at U&I Care.

Staff had received updated training in safeguarding and felt confident in being able to maintain people's safety. Staff told us they would not hesitate to report any concerns that effected the people they supported and were knowledgeable about their safeguarding procedures.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Staff had submitted an application to the local authority and had followed relevant good practice in identifying any deprivation of liberty including keeping the front door locked for peoples safety. Staff had a good knowledge base regarding these safeguards. These policies were necessary to ensure the protection of vulnerable people who lacked the ability to consent on various issues.

Is the service effective?

One relative told us they were very happy with the care that had been provided to their family member's and they felt their needs were being met and that staff listened to her opinion and advice regarding how to provide individualised support. We observed the support being provided and it was clear the staff were knowledgeable of people's needs, in particular how they communicated with each person and in their rapport and understanding of how each person communicated their needs.

Staff described the support they provided on a day to day basis including supporting each person in what they wanted to do with each aspect of their support. They told us they tried to go out every day and had developed daily plans with each person so they knew what they had planned and could refer to their plan to help remind them of their day.

Is the service caring?

We observed staff speaking respectfully through out our visit, they were friendly and helpful to the people they were supporting. We observed that people being supported were relaxed and happy in the company of their support staff. Two people told us they liked living at U&I care and they liked the staff. We spoke with one relative. They made various positive comments such as:

"I am very happy with the care, we have all worked very hard and worked together to get things right, the staff have really listened, and what's nice is that they ask me what do I think and ask for advice as to how to approach some things"

Is the service responsive?

Each person living at the service had a detailed support plan in place to help show how their needs including health needs would be met. These records were very detailed and regularly reviewed and audited to ensure they were always meeting people's needs. One relative told us they had been fully involved in the development of their family members care and support. The staff had developed various records such as 'mood charts' which helped them to identify individualised support and helped them to gauge people's reactions to new events and activities, especially for those people unable to vocalise their opinions on an activity they had joined in with.

Is the service well-led?

Staff told us they were well supported by the provider. They felt it was a good place to work and they were encouraged to speak openly and could discuss anything with senior managers and in team meetings.

Relatives told us they were always kept informed and updated regarding their relatives support and needs.

A range of policies were in place and accessible by all staff whereby the staff had to regularly sign to say they had read any updates to their policies and procedure's. The organisation and provider oversight of quality checks at the service showed safe systems in place to show good, safe management of this service.

We spoke to four people who used the service for respite care. Their comments were very positive. One said ““Feels like a home to me. They are brilliant.”

Staff were observed to treat the people using the service with respect and patience and used a variety of communication techniques to support those who were non- verbal.

We saw that the home was clean and tidy and that people who used the service enjoyed keeping their rooms clean. One said ““I tidy up my room and vacuum my carpet.”

At the time of our visit the service was providing care and support to two people who visited the service in the day and for planned overnight stays.

We found that people were supported within a spacious comfortable, clean environment which they were able to access fully.

We spoke with and spent time with one person who uses the service. They indicated that they were happy with the service they received.

We spoke to the relative of a person who uses the service. They told us that they were confident that the service was meeting their relative's needs and that they enjoyed their visits; describing the service as "excellent." They told us that if they had a concern they felt they could approach the staff team at any time.

We spoke to two members of staff who demonstrated a good awareness of the needs and wishes of the people they supported.

We carried out an announced inspection of U&I Care (Archers Green) on 25 September 2015 and contacted a relative of people living in the home on 30 September 2015. It is with the relative’s permission we have included their comments in this report.

At our last inspection in September 2014 the service was meeting the regulations inspected.

The home provided care, support and accommodation for up to three people. At the time of the inspection there were three people living in the home. Two bedrooms had en-suite facilities, and a further bathroom and downstairs cloakroom. There was an open plan kitchen, dining room and lounge area, and a further large lounge on the first floor for the use of people living in the home. People had access to a pleasant garden at the rear of the home and there was car parking at the front of the home for visitors.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received suitable induction and training to meet the needs of people living at the home, and their work was overseen by a senior member of the staff team, the operations manager and the registered manager.

We saw that the experiences of people who lived at the home were positive. The staff had good relationships with people living at Archers Green. We saw they were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. We observed the care and support given to those living in the home throughout our visit and found all the activities were led by those living there and staff supported them with their wishes. A relative told us they had no concerns about the way their family members were treated. Comments included: “Staffing is great”; “They listen to us and work with us”; “Their ethos is spot on”; “They support my daughters to lead a normal life in the community”; “I can call in at any time, and I am always made welcome”.

People’s needs were assessed and care plans were developed to identify what care and support they required. A relative told us they had regular meetings prior to the opening of the home to ensure individual needs had been identified and appropriate support plans had been put in place. We were told staff were “brilliant”; and “we work so closely with staff”. and “I do trust them”.

Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed. People living in the home were unable to engage with us on this matter but we observed them to be relaxed and comfortable around staff. A relative told us that they would know if there was a problem and their daughters would tell them if they felt upset by any member of staff. She said “I do trust them” meaning she trusted the staff.

Staff had an understanding of the systems in place to protect people who could not make decisions and knew how to follow the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People’s health care needs were met and their medicines were administered appropriately. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The people living in the home were involved in planning and cooking their own meals with staff support. Staff supported them to choose healthy options and experience new menus.

The home was clean and well maintained.

There were systems and processes in place to seek the views of people who used the service and their representatives. Regular meetings were held with families and other health care professionals. These meetings and information from these meetings had developed the new service and informed care plans. This demonstrated that it was a learning organisation.