This announced inspection took place on 22 October 2018 by one inspector. United Response - 33 Station Road is a house in a residential part of Chesterfield. The service offers personal and social care to six people with a learning disability with associated conditions. There were six people receiving a service at the time of our inspection.

The accommodation consisted of a lounge, a kitchen and dining room, six bedrooms and a bathroom. There was a large garden at the rear of the property for the people to use. There were good public transport links to local amenities.

United Response – 33 Station Road 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.

The service had a registered manager in place at the time of 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.

At our last inspection in June 2016 we rated the service, good. At this inspection we found improvements were now needed and the service is rated as Requires Improvement.

Quality monitoring systems were not always effective. Improvements had not been identified that people did not always have a care plan that reflected their needs and risks that had been assessed. Improvements were needed to ensure medicines were recorded and stored safely and to staffing needed to be reviewed to ensure support was available for people. We have made a recommendation about how staffing is provided. Staff listened to people’s views about their care although information was not always in a format that was meaningful to people. People did not receive information about how their views influenced the service provided.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Where staff were concerned about safety they knew who to speak with. People were supported by staff who had the knowledge and skills to provide safe care and support. The registered manager monitored the staff’s learning and developmental needs to ensure staff had developed the skills they needed to support people.

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 support this practice. People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

People could develop their independence and were provided with opportunities to develop their interests and join in social activities. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required.

People were treated with kindness, compassion and respect and staff promoted people’s independence. People liked the staff who supported them and had developed good relationships with them.

People were involved in the review of their care and staff supported and encouraged people to go out and maintain relationships with their families and friends.

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There were five people using the service at the time of this inspection. During our visit we spoke briefly with the manager, two members of or care staff and two people who were using the service. However we gained little from people about their experience of living at the home. We had limited opportunities to speak with people as one person was in hospital and two people were ill on the day of our visit.

We observed that people receiving care were clean and well dressed. People told us about the holidays they had each year and told us they liked living at the home.

Where people had capacity to make decisions they were consulted and given information to help them make choices in an informed way. Where people did not have capacity we saw there were not systems in place to demonstrate decisions had been reached in people’s best interests.

Some care needs were identified and assessed. However we found that the planning and delivery of care did not always meet the person's individual needs and or ensure the welfare of the person.

Staff monitored medication stock levels regularly. Medications were not always given to people in accordance with the prescriber’s instructions. Medicines requiring refrigeration were not suitably stored.

A homely environment was provided for people to live in. Routine maintenance works were completed quickly however significant repairs such as replacing a bath were not attended to in a timely manner.

There were systems in place to handle complaints but people did not have access to up to date information on who they could complain to.

We spoke to people who lived at the home, spoke to relatives and observed the care being provided. We spoke to one person who told us that they knew their relative was happy at the home. The person was with their relative when we contacted them because they were on a home visit. They told us that their relative's bedroom in the home was about to be re-decorated and they were very happy about that.

Another relative told us that they had visited regularly and felt that the home was clean and the staff were reasonable. They said they knew most of the staff well and thought they provided good support. They had had concerns about one member of staff who had left.

One person told us they were quite content living there and looked forward to their holiday.

We saw that the standard of decoration was poor in some areas and that one person who used a wheelchair had difficulty moving about within the home. The manager told us they were about to re-decorate.

When we visited the home, because of the degree of learning disability exhibited by most of the people living there, we only spoke to one of them directly. We spoke to some of the staff who support them and observed interactions taking place during our visit. We were told ‘I’ve retired from the day centre now and please myself with what I do. I’ve been very happy here, this is where I want to stay’.

Our discussions with the team manager and staff indicated a commitment to individual working and they told us that ‘We have the best interests of the people in mind throughout our work. People are much more involved in controlling things’ and that ‘the person centred approach that we use is all about individuals and their choices; this varies all the time’.

We observed that staff were aware of people's individual needs and knew to best to communicate with and support people make choices for themselves regarding their daily routines. Staff told how they routinely contribute to the care records and documentation and how it is continually being improved to make it more meaningful for the safe completion of support activities. They told us that ‘the people living here have a sense of ownership of their care plans and each one is kept by the person in their room‘.

The motivation of everyone we spoke to about the work carried out by the agency was at a high level.

United Response 33 Station Road provides accommodation for up to 6 people with a learning disability who require personal care. There were 5 people using the service at the time of our inspection.

This inspection took place on 12 January 2016 and 26 January 2016. The first day was unannounced.

Our last inspection of June 2014 found the provider was not meeting one regulation. This was in relation to the management of medicines. At this inspection we found that the actions we required had been met. Medicines were managed safely.

There was a registered manager at the service. 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.

Consent to care and support had been sought and staff acted in accordance with people’s wishes. Legal requirements had not been followed consistently where people were potentially being restricted.

The service was following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. People’s records were up to date and indicated that the required interventions had been undertaken. The records had also been updated to reflect changes in people’s care needs.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about how to reporting procedure.

People told us they enjoyed their food and we saw meals were nutritious. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. They were involved in the planning of their care and support. People were able to take part in hobbies and interests of their choice.

Complaints were well managed. Systems to monitor the quality of the service Identified issues for improvement. These were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives and staff.