At the last inspection in March 2016 we found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included Regulation 15, 11 and 17. This was because the provider failed to act in line with the Mental Capacity Act. They had also failed to maintain the property and maintain appropriate care records. During this inspection we found improvements had been made to all areas.

Wendover Road is a care home that is registered to provide residential care for up to four people with learning disabilities. At the time of our inspection four people lived in the home. They had complex disabilities which included learning, physical and behavioural needs.

During this inspection we spent time with staff who worked well together and who understood the needs of the people they were caring for. They were aware of the values of the service, and from our observations they aimed to implement them. Staff knew what people’s individual needs were, including their preferences. We observed positive interactions between people and staff and it was apparent, people enjoyed spending time with staff.

We found improvements had been made to the home, with redecoration in the parts that required it. Work had also been undertaken regarding the flooding of the car park, but this was ongoing.

Staff showed respect for people and preserved their dignity and privacy. People’s safety had been considered by the home, risk assessments related to care and the environment were in place. Care plans were in place that guided staff to provide appropriate care, these were reviewed on a regular basis. Care plans reflected people choice and the control they had over their lives and had improved since our last inspection. Staff were able to demonstrate their knowledge and received training in how to identify and report concerns related to abuse.

Staff understood the Mental Capacity Act 2005 (MCA) and how this applied to their role. Where restrictions on people’s liberty were required, staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been made to the local authority.

Medicines were safely administered and stored by trained staff. Records associated to the administration of medicines were up to date and accurate.

Staff were supported through regular supervision and appraisals. Training for staff was provided and kept up to date. New staff completed induction and training. Staff spoke positively about the registered manager and the support they received. Staff meetings also took place to encourage feedback from staff and to drive forward improvements to the service.

Staff were aware of people’s nutritional needs and how to support them. Staff understood the support needed by people to eat and drink and applied this to their practice. Staff were also aware of people’s dietary needs in relation to their culture and religion, and this was respected.

Appropriate activities were in place to ensure people remained stimulated and had a good quality of life. These were in line with people’s preferences.

The home practiced safe recruitment in relation to new staff. Employment checks were carried out and records kept. This minimised the risk of inappropriate staff working with people.

Checks were made on the safety of the home and the quality of the service provided. The registered manager had an overview of the home and was working towards continuous improvement. Both staff and a relative spoke positively about the registered manager and the assistant manager.

This inspection took place on the 31 March and 1 April 2016 and was unannounced. The home was previously inspected in August 2013 when it was found to meet the requirements of the regulations.

The home is a four bedroomed bungalow. There are shared areas such as a lounge, bathroom, kitchen and dining area. The registered manager was on long term leave at the time of the inspection. The service was being overseen by an interim manager, who planned to be present at the home for two days per week.

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.

Each person had a support plan and risk assessments in place to guide staff on how to provide care and minimise the risk of harm. One person’s plan and risk assessment gave insufficient clear guidelines for staff on how to support a person with behaviour that was challenging. We have made a recommendation about supporting staff with writing support plans. Another person had a support plan for exercise, which was written in such a way as to deprive them of choice or control over participating in the exercise. This was removed following the inspection.

Although the provider carried out the necessary checks when recruiting new staff, they failed to check gaps in some candidate’s employment histories. We have made a recommendation about the recruitment of staff.

People were appropriately supported with their food and fluid intake. Where specialist advice had been sought to ensure people could eat and drink safely this had been carried out by staff. Medicines were safely stored and administered. Records were up to date and showed people received their medicines at the time they needed them.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Where restraints had been put in place to keep people safe, authorisation had been applied for from the local authority.

Staff knew how to keep people safe and how to identify and report concerns of abuse. They also understood how to respond to complaints.

Staff received training in areas they needed to know to carry out their role safely. However records of staff training were not up to date or accurate. The interim manager did not have access to all the staff training records at the time of the inspection. This meant they could not assess the safety of the service in relation to the skills and knowledge of staff.

We found some areas of the home were in need of redecoration due to peeling and stained paint work, damaged wood work and structural defects within the parking area. Other parts of the house were well maintained and were well decorated such as people’s bedrooms and the lounge area.

People participated in activities both in the home and in the local community. People were assisted to maintain their health through regular contact with the relevant health professionals, for example, GP and dental practices.

Staff worked well as a team. We observed them to be caring and sensitive in their approach to supporting people in the home. They were focussed on supporting the people well and supporting each other. They knew how to preserve people’s dignity and privacy and communicated well with people.

Audits and checks were undertaken to ensure the safety of the service and drive forward improvements. We noted that the areas we found in relation to the writing of support plans had not been identified by senior staff during their audit. We have made a recommendation about the providers audit process.

Staff were positive about the skills and knowledge of the interim manager covering the registered manager’s position whilst they were on leave. The staff appeared to work well together and

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We sought evidence of how people who had used the service understood the care and treatment choices available. We saw arrangements for an individual 'link worker' for each person. We spoke with staff who told us 'Because [the people] can't communicate verbally the link worker is an important way of making sure they understand choices; we get to know people pretty well.'

We looked at how risk assessment was planned and delivered in a way that was intended to ensure safety and welfare. We saw how this confirmed compliance with a policy which stated that the service should adopt 'a positive approach to risk taking' and that 'people should not miss out on opportunities.'

It was clear from discussion that staff understood what might alert them to a Safeguarding concern or where they might be required to use the confidential reporting policy.

We saw evidence that had opportunities for further professional development, and to obtain further relevant qualifications.

It was clear that residents' meetings had been taken seriously and staff meetings had included discussion about a range of quality issues, where action to minimise the potential for any adverse re-occurrence had been considered.

We spoke to a member of the families of two people using the service. Both expressed a high level of confidence in the service. Their comments included “The care [name] is getting is astounding” and “They’ve done wonders with [name]”. We were told that staff were attentive, had a good understanding of people’s needs, and kept in touch with families. The service was described as very well run and very efficient. The people we spoke with said they had no concerns about the care of their relative in the service.

We found that people were treated with respect. People’s health and social care needs were met. The environment was suitable, well maintained and had been adapted to meet people’s needs where required. Staff were provided with the training required to support people. Complaints were considered and action taken where required.

A social care professional told us that the home was “now much better all round” and had greatly improved over the last couple of years. They went on to say that they would have no hesitation in making a referral to this service.

A carer (relative of a person using the service), who was visiting, told us that the home had improved “beyond belief over the last few years”. The carer said that the staff “were doing their best” for the person using the service and that as far as they could tell the same was true for the other three people as well. The carer told us that currently they had no concerns about the care and welfare of people using this service.

An advocate told us that two advocates were currently linked to the service. The advocate told us that in their view the home was now very well managed and had “improved beyond recognition” over the last few years.