White Leaf Support provides care and accommodation at 8 and 10 Priory Avenue for up to 13 people with either learning disabilities or autistic spectrum disorders. At the time of our inspection 13 people used the service. One house accommodated people who were more independent and the other house supported people with more complex support needs.

The inspection took place on 11 and 13 July 2018 and was unannounced. At our last inspection the provider was in breach of regulations this was in relation to Regulation 9 HSCA RA Regulations 2014 Person-centred care. Visual communication tailor made for the people who used the service was not available. Regulation 12 HSCA RA Regulations 2014 accidents and incidents were not always recorded or followed up to keep people safe. Regulation 17 HSCA RA Regulations 2014 Good governance. The service did not have effective systems to regularly monitor the quality of care people received.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in safe, effective, responsive and well led to at least good.

At this inspection we found improvements had been made and the provider was now meeting these regulations

White Leaf Support 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 is required to have a registered manager to manager 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. At the time of our inspection a registered manager was in post.

Parents reported the service had improved in the last three months and the atmosphere was much more positive and upbeat. One parent told us, “Staff are brilliant, and their hearts are in the right place. I can really feel how conscientious, professional and warm hearted the staff are.”

Staff understood their responsibilities in relation to reporting concerns and incidents. Systems were in place to manage medicines, safeguarding people from abuse and managing behaviours that challenge.

We saw there were sufficient staff available to ensure people’s safety was protected. Recruitment procedures were robust to only appoint suitable staff with the right skills and attitude.

Staff were trained, supervised and appraised. There was an induction and development programme which supported staff to gain the relevant knowledge and skills.

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 supported this practice.

People were supported to eat and drink to meet their needs and to make informed choices about what they ate.

People were supported to take part in a range of social activities to provide stimulation, and social contact. On both days of our inspection people were supported to attend community activities and social events.

The service had a comprehensive maintenance programme to ensure the service was a safe place to work and live.

Regular on-going health checks were carried out and people were supported to attend appointments. The service was responsive to people’s needs and staff referred people to health pr

White Leaf Support provides care and accommodation at 8 and 10 Priory Avenue for up to 13 people with either learning disabilities or autistic spectrum disorders. At the time of our inspection 13 people used the service. One house accommodated people who were more independent and the other house supported people with more complex support needs.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

The registered manager was not available during our inspection. A deputy manager managed the service while the registered manager was unavailable. We meet with the director of the service on the third day of our inspection.

Relatives provided us with feedback about the service. We received mixed views about the service. Comments included, “It’s hard to keep a tab on what’s going on. I am happy at the moment; I am keeping an eye on how things go.” Other comments were, “I am 50% happy and hope things improve.”

Relatives felt their family members were safe from harm and abuse. One family member told us, “[Our family member] is safe because it is a secure place.” Staff were trained and knew their responsibilities in relation to safeguarding. Staff told us they would not hesitate to report any concerns they had. The service had sufficient staff to meet people’s care needs and keep people safe. Supervisions were undertaken on a six to eight week basis. Staff told us they felt supported in their role.

Staff told us “It’s good here. The more I’m here the easier it gets” and, “It’s been busy; it’s like jumping in at the deep end.” All staff we spoke with told us they felt supported.

Safe recruitment processes were used when appointing new staff which included checks of criminal history of new staff using the Disclosure and Barring Service (DBS).Staff were trained and understood their responsibilities in relation to safeguarding.

Relatives told us there was a high turnover of staff and staff did not always understand the specific needs of the people living at the service. Comments included, “I am unimpressed. We were promised additional speech therapy for [name] but, we are still waiting. One comment we received was, “I met a member of staff by chance who used to work at White Leaf. They said the reason they left was because they felt ‘out of their depth’ in terms of looking after people.” However, other families told us staff were well trained and knew their relative well.

We found the service acted in accordance with the Mental Capacity Act 2005. Consent was sought from people or their members who had legal authority to give it. People were supported at meal times. However, care records did not always contain information about each person’s dietary needs.

Relatives did not always feel the support was individualised. Comments we heard were, “They have stalled in terms of moving him forward. There is not enough focus on moving on to the next stage”.

Care plans did not always capture preferences, interests and aspirations. One care plan we reviewed was not completed in ‘goals and hopes for the future’. Care plans and risk assessments were not regularly reviewed and kept up to date. One care plan we saw had a review due date of December 2016. However, this had not been completed at the time of our inspection.

Risk assessments did not always give staff clear advice and guidelines to follow.

Medicines were not always managed in accordance with best practice guidelines. For example, medication administration records (MAR) did not always show what medicines were given. We looked at MAR charts and found a total of 41 missing signatures over a period of time. Daily stock checks of medicines were undertaken. However, audi

People who used the service, family carers and social care professionals told us the standard of care they saw or experienced was very good.

Where there had been incidents which challenged the service, action had been taken promptly to protect people who used the service, staff and others from harm.

We saw care and support records were centred on the needs and interests of the person concerned. They included assessments of any risks to their health, safety and welfare and set out how these were to be eliminated or managed.

Staff told us they were effectively supported through supervision and training. This meant they were provided with the skills and support they needed to provide a high standard of care to people who used the service.

We found there was a very open culture within the home. We saw records of different meetings and reviews which showed people who lived in the home, family carers, social care professionals and staff were able to raise concerns, discuss issues of interest and promote a high standard of care.

We spoke with people who used the service and with health and social care professionals who supported them. They told us from their own experience or from what they saw, people were involved in decisions about their care and support. All the feedback and information we received was very positive. People told us they felt well cared for. The health and social care professionals said they had no current concerns about the service. They told us they had confidence in the quality of care and support provided.

We saw staff were considerate of each person's needs. The interaction we saw was positive and appropriate. We noted staff calmed and encouraged any person who used the service if they became agitated or showed any sign of being distressed. We spoke to members of the staff team. They confirmed they had been subject to a rigorous recruitment process.

We looked at three support plans for people who used the service. These were specific to the person concerned and were centred on them as an individual. They included a very detailed assessment of the person's needs and set out clearly how these were to be met.

We saw people who used the service were involved in regular meetings where they were able to raise issues, with support if necessary to help them do so. We saw records of key worker review meetings where people individually discussed their care and support. This showed people could influence how their care and support was provided.

During the visit one person using the service spoke to us. This person said ‘it was alright’ living at the home and ‘staff were ok’ and that if he had any concerns he would approach a member of staff. He told us staff had supported him when going out food shopping, planning his weekly menu and when preparing meals. We were also told that he had taken part in activities such as football, bowls, snooker and badminton.

This person said he had participated in making decisions relating to their care and treatment. He also told us that he could see a GP and his last visit to the dentist had taken place prior to his placement at the home in December 2010.

The inspection took place on 18 November 2015. This was an unannounced inspection. The last inspection for White Leaf Support was 12 November 2013 when we found the service was meeting the requirements of the regulations in place at that time.

White Leaf Support Limited provides care and accommodation at 8-10 Priory Avenue for up to 13 people with either learning disabilities or autistic spectrum disorders with an age range of 18 to 30 years old. At the time of our inspection there were four people living in number 10 and seven people living in number 8 Priory Avenue

The service has a 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 2008 and associated Regulations about how the service is run.

We saw people were well cared for, and were comfortable in the home. The person we were able to speak with commented. “I love it here I can do what I want”. Care records were personalised and up to date and accurately reflected people’s care needs. The care plans included information about people’s likes, interests and background and provided staff with sufficient information to enable them to provide care effectively. The service did not capture people’s end of life care. However, this is something the service is in the process of reviewing.

The service followed robust recruitment procedures . Staff received appropriate induction supervision and training.

Where risks were identified the appropriate assessments were in place to ensure people’s safety.

Care plans showed how care was carried out to each individual and were regularly updated and reviewed.

People were supported to maintain good health and had access to healthcare services.

We observed people were cared for compassionately and with respect. People were cared for by a motivated and well trained staff team. The manager and provider provided effective leadership to the service with regular family meetings this ensured people were involved in the running of the home. The atmosphere in the home was warm, friendly and supportive, we saw staff chatting and laughing with people. People were able to plan the menu with staff and were involved in the preparation and cooking of the meals.

People were actively involved with the local community, staff encouraged people to engage in a wide variety of activities within the home and outside.

Professionals who worked regularly with the service told us that staff were responsive to the needs of the people who live there.

New staff had recently been appointed to drive improvements throughout the home.