This inspection took place on 9 and 10 October 2017 and the first day of the inspection was unannounced.

Warwick House provides accommodation and care for up to seven people. People living at the home have a learning disability. On the day of our inspection, four people were living at the home. People had their own bedrooms with en-suite facilities. Communal space consisted of a large lounge area, kitchen and dining room. People had access, to an enclosed garden.

The home was managed by the registered manager. 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 and associated Regulations about how the service is run.

People at the home were safe. Risks to people were managed well and gave people freedom, yet kept them safe. The risk assessments identified guidance for staff to follow about how to manage the risk in order to promote and maintain people's safety and also how to minimise risks to further promote and maintain people's independence, wherever possible. Records showed a fire risk assessment was in place. The home had personal emergency evacuation plans for each person living at the home. These identified how to support people to move in the event of an emergency.

Staff had received training in how to recognise and report abuse and they knew what to do should they suspect any form of abuse occurring.

The atmosphere in the home was calm and relaxed during our visit. Staff treated people with respect and it was apparent that people had positive relationships with the staff that supported them. We observed staff supported people in a kind and sensitive way, ensuring their well-being and comfort when providing their care.

Staff had good relationships with people and had an excellent understanding of the individual needs of the people they were caring for. They were aware of their preferences and interests as well as their health and support needs, which enabled them to provide personalised care.

Detailed and comprehensive care records were in place which reflected peoples identified health care and support needs. Information about people's dietary requirements, how people wanted to be supported when support was required, and how this was to be delivered, were clearly detailed in the care files we examined.

The home was working to the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. We saw staff sought people's consent wherever possible. For example, with how and where they wished to spend their time. Staff we spoke with understood the MCA and could describe the basic principles. Staff knew how to make decisions in people's best interests if they were unable to make decisions or provide consent. However, not all decisions made in people’s best interests had been recorded. The registered manager immediately dealt with this and arranged for each person to have a review of their care and all decisions made.

People were encouraged to be as independent as possible and were supported to make choices about how they wanted to live their life. We saw examples of people being empowered to take control of their own lives, such as, being supported to gain employment. Staff encouraged people to do as much for themselves as they could and people were supported and encouraged to take part in the preparation of meals and keeping their rooms and the home clean and tidy.

People could make choices about their food and drink and where to eat their meals. People told us they enjoyed the food at the home. One person said, “The food is nice.” Relatives told us, “[name] is fed well. [Name’s] a fussy eater and they are good with her. They choose something with her.” Staff encouraged healthy eating and supported people to choose and eat a healthy and varied diet to maintain

Warwick House is registered to provide accommodation and personal care for up to seven people with learning disabilities and mental health issues. The home is a large detached house situated on the edge of Paignton Town. People living at the service regularly accessed the town centre facilities including, pubs, shops and cafes.

This inspection took place on 23 July 2015. At the time of the inspection there were three people living at the service. We spoke with two people, the third person was out with staff during most of the inspection and declined to speak with us when they returned. Everyone had a high level of care needs and received one to one care from a member of staff throughout the day.

The service was last inspected on 27 November 2013 when we found people’s care records were not being appropriately maintained. At this inspection in July 2015 we found that some improvements had been made. People’s main care and support plans were large documents in which information was difficult to find. People also had a ‘Quick support plan’ that had been completed with the person and highlighted important aspects of their care so staff could find relevant information quickly.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their wishes. One person’s physical health had declined and their care plan had been amended accordingly and in line with the advice of visiting professionals.

Staff were knowledgeable about people’s daily care needs and told us about each person’s daily routine. People told us staff knew how they liked their needs to be met and always asked them what they wanted. We heard staff asking people if they were alright and if there was anything they needed.

People received effective care and support from staff with the skills and knowledge to meet their needs. There was a comprehensive staff training programme in place, a matrix indicated when updates were needed. Training included medicines administration, first aid, food hygiene, safeguarding people and infection control. Training also including topics specific to the needs of people who lived at the service, including mental health, autism and positive behaviour management. The training gave staff the skills to deal with any behaviours that may present challenges to the person or others around them.

There was an effective system in place to ensure staff were putting their learning into action and remained competent to do their job. Staff received regular supervision. The registered manager used this as an opportunity to check staff understood their role, had learned from training and were familiar with any changes to people’s needs.

People had one member of staff to support them during the waking day. On the day of our visit two people were out in the community each being supported by a member of staff. The registered manager told us that the designated staff member would be changed throughout the day so that there was some variety for the person. People were supported to take part in a range of activities according to their interests. One person told us about how staff had supported them to visit a local music festival and showed us photographs of the event.

The home operated a key worker system where each person had a nominated member of staff who coordinates their care. People had weekly meetings with their worker during which they discussed aspects of their care and expressed their views. We observed positive relationships between staff and the two people we met at the service.

People’s privacy and dignity was respected. People were able to spend time in their rooms alone. Staff told us they enabled people to have privacy in their rooms whilst keeping close in case they were needed. Staff were aware of issues of confidentiality and did not speak about people in front of other people. When they discussed people’s care needs with us they did so in a respectful and compassionate way. Care records were written in a respectful and appropriate language.

Relatives told us they visited regularly and that staff also supported people to visit them on a regular basis.

Staff were responsible for cooking and cleaning duties. The registered manager told us and rotas confirmed there was often an extra staff member at the home to help with these duties. The registered manager told us that people often helped staff prepare meals and if there was not enough time for staff to cook, then a take-away meal would be brought in.

People told us they felt safe at the home. One person said they felt “very safe”. Throughout the day people approached staff in a comfortable manner, smiling and laughing. This indicated they felt safe in the company of staff.

Since our last inspection concerns had been raised about the conduct of a member of staff. The concerns had been investigated by the local safeguarding team and the registered provider and measures put in place to protect people.

People were protected from avoidable harm because the service had policies and procedures in place which staff were aware of and followed. Staff were confident they would be able to recognise any signs that abuse was occurring and would know how and where to report any suspicions they may have. The registered provider had robust recruitment procedures in place to minimise the risk of unsuitable staff being employed at the service. Staff files contained evidence that references and criminal record checks had been obtained.

People’s risk assessments contained good details on how risks were to be minimised and managed. However, one person had been assessed as being at risk of choking and there was conflicting information on their care plan with regard to the type of food they should receive. However, staff were well aware of the type of food the person should have. Other risks that had been assessed included financial exploitation and self-harm. There were clear directions to staff on how to manage these risks.

People’s medicines were managed well and were stored safely and appropriately. There were clear instructions for staff regarding administration of medicines where there were particular prescribing instructions. For example, when medicines needed to be administered at specific times. Information was available about each medicine and their possible side effects.

All accidents and incidents were recorded and the information sent to the registered provider’s head office. The information was then collated and analysed to look for any trends. No trends had been identified recently. People were protected because there were arrangements in place to deal with emergencies.

Some people did not have the mental capacity to make some decisions. Staff understood people’s rights under the Mental Capacity Act 2005 (MCA) and in relation to depriving people of their liberty. When people were assessed as not having the capacity to make a decision, a best interest decision was made involving people who knew the person well and other professionals, where relevant.

People were supported to maintain good health from a number of visiting healthcare professionals. Records confirmed people received regular visits from GPs, dentists, physiotherapists and speech and language therapists. People had yearly health checks from the NHS. People were supported to receive a healthy balanced diet whilst enabling them to make choices for themselves.

Some areas of the home had been decorated in late 2014. However, the hallway was rather shabby and in need of re-decoration. Some corridors were dark and needed better lighting. There was a large garden to the rear of the property which was accessed through a side door and down steps. However, one person had limited mobility and had difficulty accessing the garden independently. The registered manager was to raise these issues with the registered provider.

There was a system in place to enable people to raise concerns. A complaints procedure was displayed in the hallway. People were able to raise concerns at their weekly key worker meetings and the group meetings for all people living at the service. Staff, relatives and visiting professionals described the registered manager as very open and approachable. They told us that things had improved at the service since the registered manager had worked there.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care. Where improvements were needed action had been taken to improve matters. A series of in-house audits were undertaken weekly, including fire alarm checks, water temperatures and housekeeping issues such as checking if bedding had been changed. The registered provider had carried out a self-audit of the service using the Care Quality Commission’s (CQC) guidance for providers on meeting the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They had identified any shortfalls and put plans in place to address them.

There was no registered manager at the time of the inspection. The current manager was in the process of registration with the commission.

Records showed that people had the opportunity to access the amenities in the local community. On the day of our visit we saw different people who used the service leave the home to participate in an activity off site.

We observed staff supporting a person whose anxieties had increased. Staff spent time engaging and distracting this person, explaining what was happening throughout. Staff remained calm throughout the intense support they provided. This was done without impacting on other people living in the home.

Appropriate arrangements were in place in relation to obtaining, storage, administering and disposal of medicine. Only competent staff were authorised to administer medication to people who were unable to self medicate

Warwick House had a recruitment process in place which included ensuring that relevant checks were carried out before a person commenced employment.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The registered person did not ensure that service users were protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them. Care plans and risk assessments were not reviewed and updated regularly. Records were not maintained as intended.

We spoke with three people who use the service at Warwick House. They told us that “we choose what we do here; we have a monthly plan which we agree with our key worker”. People told us that the staff are very approachable and helpful when discussing their support needs. This means that people’s needs, wishes and preferences are placed at the centre of planning and delivery of care and support.

People told us that they enjoyed meeting with their key worker to develop their support plans. We saw that plans of care, treatment and support are implemented flexibly, regularly reviewed and kept up to date in recognition of the changing needs of the people using the service. We saw that there was continuity of care, treatment and support as a result of effective communication between all those provide it, including other providers.

We spoke with three people who used the service. They told us that they felt safe at Warwick House and knew that they could speak to their key worker, the manager, or any member of staff if they had any concerns.

We found that staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

We saw computerised records which showed us that there were good systems for assessing and monitoring the quality of service provision which protect people using the service against the risks of inappropriate or unsafe care, treatment and support.