United Response - 66 & 66a Lemsford Road provides accommodation and personal care for up to 11 people with physical and learning disabilities or autistic spectrum disorder. At the time of our inspection nine people were living at the service.

At the last inspection the service was rated good. At this inspection we found the service remained good.

People were unable to communicate with us due to their complex medical conditions. However relatives told us they felt their family members were safe living at the service. Individual risks to people were appropriately assessed, identified and managed.

We observed that there were enough competent staff to provide people with support when they needed it. Staff had been recruited through a robust recruitment process and had received appropriate training, support and development to carry out their roles effectively.

People received appropriate support to maintain healthy nutrition and hydration. Where required specialist diets were provided and professional input was sought.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control over their lives. Staff supported people in the least restrictive way possible and the policies and systems in place at the service supported this practice.

People's relatives told us and we observed that people were treated with kindness by staff who respected their privacy and maintained their dignity.

People and their relatives were given the opportunity to feedback on the service and their views were listened - and acted upon.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access and participate in meaningful activities and to pursue hobbies and individual interests.

People were supported to share their views by commenting or to complain if they were unhappy with any aspect of the service and were confident they would be listened to. We saw feedback forms had been completed, for example a person was unhappy about a delay in food being served in a restaurant, and staff assisted them to complete a feedback form.

There was an open, transparent and inclusive atmosphere within the service. People and staff had regular meetings to take part in discussions around shaping the future of the service, along with a suggestion box to share ideas.

There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below

United Response - 66 & 66a Lemsford Road provides accommodation and personal care for up to eleven people with physical and learning disabilities or autistic spectrum disorder. The building is in two parts with eight people living in one part and three people in the smaller building. The ground floor of the main building had been specially adapted for people who use wheelchairs, to ensure there is adequate space to accommodate their needs.

The inspection was carried out on 19 November and was unannounced. At the time of our inspection the service was providing support to eleven people.

The service provided personalised support to people and they told us they were happy living at Lemsford Road. Staff were aware of people’s needs and abilities and support was tailored around individual’s abilities to support and maximise their potential. Staff spoke about people they supported at the service in a kind caring and sensitive way. The registered manager and staff demonstrated an open and transparent approach to all aspects of the service.

We saw that there was adequate staff on duty at all times to meet people’s needs. People were supported with hobbies both within the home and to access activities in their local community. We saw that there were appropriate recruitment processes in place, which ensured that people who were employed were appropriate to work with vulnerable people. The staff group were diverse and this was representative of the people who lived at Lemsford Road.

We saw that people’s privacy and dignity was respected. Staff treated people in a way that was respectful and caring. We saw that staff went at a pace that people were comfortable with and did not hurry them.

We saw records which demonstrated that safeguarding incidents were appropriately reported and investigated and these had also been reported to CQC by the provider. The manager showed us the quality monitoring audits that were in place. This was an area that was undergoing some further development to strengthen the processes that were already in place.

The manager told us about the complaints process and showed us how people were supported to make a complaint or to raise a concern. We saw that the complaints process was available in an easy read format supported with pictorials to enable people to understand the process.

Staff had received training relevant to their roles and had regular supervisions with their line manager. Staff demonstrated they were clear about their roles and responsibilities and received support from the manager and staff also supported each other.

People were supported to do their shopping and to cook meals for themselves with support from staff. People and staff spoke positively and told us they had choices of what food and drinks they had. People were supported to maintain good health and staff accompanied them to attend appointments at the GP, opticians and other health related appointments.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The manager and staff were fully aware of their role in relation to MCA and DoLS and what they were required to do if people were at risk of being deprived of their liberty. No one at the service was being deprived of their liberty however staff did accompany people to events in the community to make sure they were kept safe.

We observed that staff supported people in a way that promoted their independence, and enabled them to do as much as they could for themselves.

People had personalised activity programmes, these were detailed on a chalk board in people’s bedrooms. People were supported to attend events in their local community including an ethnic specific facility, for people from a Caribbean background.

People had individualised care and support plans and these were regularly reviewed. We saw that there were risk assessments in place which were reviewed whenever there was a change to people’s abilities. People’s support plans ensured staff had all the guidance and information they needed to provide individualised care and support.

There were systems in place to monitor the quality of the service. The provider had obtained feedback from all stakeholders. This was used to enable the manager and staff to identify where improvement were required and to support continual improvements.

When we carried out an inspection of United Response - 66 & 66a Lemsford Road on 10 April 2013, we found that the provider was not meeting the standards for the care and welfare of people who used the service, safeguarding people from abuse, management of medicines, supporting workers and assessing and monitoring the quality of service. We asked the provider to address the concerns we had identified and to provide an action plan to show the progress they had made. We returned to the home on 22 October 2013 to carry out a follow up inspection at the service to see that the provider had taken the required action to address the identified concerns.

We found that the provider was now meeting the standards we had inspected.

We were unable to speak with people who used the service because they were unable to communicate verbally and some people were experiencing challenging behaviour on the day of our inspection and others had left the home to attend day centres.

One of the people living at Lemsford Road was able to verbally communicate with us. We talked to people and staff about their experiences as well as making observations during our visit.

People told us they were happy living at the service and that they liked staff and felt safe. One person told us, "All the staff are nice, there’s no-one I don’t like” and that, “I go out a lot, to the park or the pub and to a local day centre, I also go to a local book club”.

Staff also told us Lemford Rd was a nice place to work and that they felt supported by management. We were also told that people’s privacy and dignity was respected and that staff always close the doors when they’re helping with personal care. We observed the home to be visibly clean on the day; all the people appeared to have had their personal care needs met.

During our visit we identified a number of concerns. We found that safeguarding referrals were not all being completed or reported to the Care Quality Commission. Staff had not attended an appraisal in line with agreed timescales and a significant proportion of training records were out of date. We also found that people’s care plans and risk assessments were not reflective of recent changes and that one person was delayed in receiving their medication because medication had not been obtained from the pharmacy on a timely basis. Quality monitoring systems, for example, audits and incident reporting were not adequate.

A small number of people were able to communicate whether they were happy living at Lemsford Rd. We talked to people and their relatives about their experiences as well as making observations during our visit.

People told they were happy living at the service and that they liked the staff and felt safe. One person told us, "I’ve lived here a long time and I love living here” and that, “I like all the staff, they’re always nice to me”, “I like going to town and to the library”. One of the people’s relatives told us, “the home does as much as they can, the carers have been really lovely, and I’ve never seen anything other than kindness and patience”.

Staff also told us Lemsford Rd was a nice place to work and that they felt supported by management. We were also told that people’s privacy and dignity was respected and that staff always closed the doors when they helped with personal care. We observed the home to be visibly clean on the day of our visit; and all the people appeared to have had their personal care needs met.

Overall we found that standards were met although we found that care plans had not been updated regularly and that the quality monitoring arrangements failed to identify this.