The inspection was carried out by one inspector on the 11 and 17 December 2018.

Underhay House provides accommodation and personal care for 12 people. There were nine people living in the home at the time of the inspection. People who live at the home have a learning disability. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

People in care homes receive accommodation and nursing or personal care as a 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. 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 our last inspection in 2017 we rated the service as requires improvement. This was because some improvements were required to the environment to ensure it was safe and meeting the needs of people. Some areas of the home were not clean and carpets and furniture were stained. There was not always sufficient staff with the right skills who received regular supervision or support. Staff were not following the guidelines set down by professionals, which meant a person might be of risk of choking. Training focused on mandatory training rather than the health and social care needs of people, which meant there was a risk of people not receiving effective and consistent care that was based on current best practice. Checks were not being consistently completed on the quality provided to people.

The provider sent us an action plan after the last inspection. What they told us they would do had been completed to address the breaches in regulation.

People now received a safe service. Staff ensured that people got on well. Risks had been assessed and safe systems of work were in place to ensure people’s safety whilst not curtailing their independence. Staff had been through a thorough recruitment process to ensure they were suitable to work at Underhay House. Safe systems were in place to ensure that people received their medicines as prescribed.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people and there was very much joint working with them and family. Improvements were needed to ensure the recording of care was consistent. An action plan was in place including further training for staff on report writing.

People were supported by suitable numbers of staff, with the right skills and knowledge. Staff had received training and were supported in their roles. They regularly received supervision and team meetings were organised monthly. This area had improved since the last inspection.

People were valued and supported to be as independent as possible. People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

People were provided with nutritious food and drink, which met their dietary preference

This inspection was carried out on the 28 and 30 November 2017. Underhay House provides accommodation and personal care for 12 people. There were ten people living in the home at the time of the inspection. People who live at the home have a learning disability. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

There have been three changes in management in the last twelve months. A new manager had been appointed and had started the day before the inspection. They had worked in a number of Freeways services as an assistant manager and then as a trainee manager since August 2016. They had submitted an application to us to register. 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.

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.

The changes of management have had an impact on the way the service was operating. This was because one of the managers had not completed what was expected of them in respect of completing staff supervisions, monitoring staff training and completing care reviews. This had been addressed by the provider who have been able to show us evidence that they had been addressing these concerns with this manager. The manager appointed in May 2017 had devised an action plan that was being monitored by the senior management team of Freeways. The newly appointed manager was committed to implementing the action plan to address these shortfalls to ensure on-going compliance.

Some improvements were required to the environment to ensure it was safe and meeting the needs of people. Some areas of the home were not clean and carpets and furniture were stained.

People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was generally positive in respect of the staff’s approach to people and the delivery of care.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes. However, not all staff were following the guidelines set down by professionals, which meant a person might be of risk of choking.

There was not always sufficient numbers of staff supporting the people living at the service. Regular meetings were taken place however, other systems to support staff such as one to one meetings were not happening at regular intervals and, there were no annual appraisals of staff’s performance. Training had lapsed throughout the year for staff due to the management changes. Training focused on mandatory training rather than the health and social care needs of people, which meant there was a risk of people not receiving effective and consistent care that was based on current best practice.

People had a care plan that described how they wanted to be supported in an individualised way. These had not been kept under regular review. The provider was aware of these inconsistencies and showed us evidence of how they were addressing the concerns about compliance. There was an action plan in place to address this and work had commenced on this area since June 2017 but this was still work in progress.

People were treated in a dignified, caring manner,

This inspection took place on 13 July 2015 and was unannounced. The previous inspection of Underhay House was on 2 October 2013. There were no breaches of the legal requirements at that time.

There was a registered manager 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.

Underhay House is run by Freeways, a charity that supports people with a learning disability. The home provides personal care and accommodation to up to 12 people.

People told us they received support in different areas of their lives. They said the support helped them to feel safe and enabled them to do activities in the community they enjoyed.

For the most part, risks to people were being reduced and arrangements made so that people received a safe service. However, there were risks associated with people’s behaviour which meant they did not always experience a good level of safety.

People’s rights were protected because action was taken by staff in accordance with the Mental Capacity Act 2005. Their independence was being promoted and staff provided support which was focused on people’s individual needs. Staff helped people to maintain their health and advised people about healthy eating.

Regular meetings were held where people talked with staff about their goals and new things they would like to do. People were encouraged to give their feedback the service and their concerns were followed up.

Staff felt supported in their work. They received the training they needed to do their jobs well. There were systems in place for checking the home and for identifying how the service could be improved.

At the last inspection of the home in July 2013 we found that people’s medicines were not being well managed. The correct procedures were not being followed and not enough was being done to reduce the risk of errors occurring.

During our visit on 2 October 2013 we found that improvements had been made. The medication cabinet had been moved to a more suitable location and the contents were better organised. Checks were being undertaken which helped to ensure that the correct medicines were administered at the right time. These changes meant that people were better protected from the risks associated with medicines.

We looked at four standards that were not being met when we last inspected the home in February 2013. Plans had been produced which set out the actions that would be taken in order to meet these standards. When we visited the home again we found that people who used the service were benefiting from a number of improvements that had been made.

People told us that they liked the look of the bathrooms which had been redecorated and had new floor coverings fitted. We found that the staffing arrangements had improved. Additional members of staff were being deployed so that people had more support in the evenings and at the weekends.

Arrangements were being made so that people received the healthcare services that they needed. There was better information about people’s individual needs and the support that they required. One person told us that they had a care plan which helped them to “see how well I’m doing”.

We also looked at the arrangements being made for supporting people with their medicines. We found that people were at risk because of shortcomings in how their medicines were being managed in the home. Relevant guidance was not being followed and there was a risk of errors being made when medicines were administered to people.

We met seven people who lived at Underhay House. We were not able to speak to all of the people who used the service due to their complex needs. We relied on our observations of people with the staff who supported them to help inform our judgments during our visit.

We saw that people were effectively supported to live an active fulfilling life in the home and the community.

Care plans and risk assessments records partly set out how to assist people and how to minimise risks to their health, safety and wellbeing. Care plans and risk assessments were not all being consistently regularly reviewed and updated. This meant they may not accurately reflect changes in people’s needs. One person's risk assessment records were insufficiently detailed. This could put people who used the service at risk in Underhay House if staff were not able to assist people who had complex needs safely.

The environment was homely in design but there were parts of the home that were inadequately clean. There were also parts of the home where action was required to make the areas totally safe and fit for purpose.

The numbers of staff on duty were not always sufficient to meet people’s needs.

There was a system in place to check and monitor the quality of the service that people received at the home.

People spoken with told us that they were encouraged to have an active role in the day to day running of the home. We were told that they could choose what to do each day and we saw that staff respected their decisions. People liked living at the home and felt safe.

We saw people in different areas of the home, some people were in their rooms whilst others were in a large communal area using the computer and taking to staff. We were told that some people were going to Leigh Court where they took part in different activities.

We spoke with and observed staff supporting people during our visit. We saw that they had developed good relationships with people and knew how people should be supported with their care.

We looked at various records kept at the home including some peoples' care plans, how people were being kept safe and how staff were being trained to meet peoples' needs.