The inspection took place on 2 February 2017 and was unannounced.

The service is registered to provide care and support for up to six people with learning disabilities and conditions related to their mental health. At the time of our inspection six people were using the service.

There was a registered manager in post but they were on a period of extended leave, which they had previously notified us about, and the service was being managed by their deputy. 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.

Staff were trained in safeguarding people from the risk of abuse and systems were in place to protect people from all forms of abuse including financial. Staff understood their responsibilities to report any safeguarding concerns they may have. Appropriate action had been taken in response to safeguarding concerns.

Risks had been assessed and actions taken to try to reduce these risks.

Staffing levels matched the assessed safe levels. Recruitment procedures, designed to ensure that staff were suitable for this type of work, were robust and there was ongoing recruitment to fill current vacancies as a priority.

Medicines were administered safely and records related to medicines management were accurately completed.

Staff training was provided but some had not been appropriately updated, according to the provider’s own schedule. Some relevant training related to the management of acquired brain injury, epilepsy and mental health had not been provided to all staff.

Staff had received training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS), although some staff had not had this for several years. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. One application had been made to the local authority but locks and keycodes for the main doors meant that others were effectively being deprived of their liberty and the manager has since begun the process of assessing people’s capacity to consent to this to ensure it is lawful.

People were supported with their eating and drinking needs and staff helped people to maintain good health by supporting them with their day to day healthcare needs.

Staff were very caring and treated people with kindness, making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for.

People, and their relatives, were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Some care plans required further updating were in to reflect people’s current needs.

People had opportunities to follow a range of outside interests and hobbies, although these were currently somewhat limited due to a lack of drivers for the service vehicle.

There was a complaints procedure in place but no formal complaints had been made. Informal concerns had been managed well.

Staff understood their roles and felt well supported by the acting manager.

Effective systems were in place to assess the quality and safety of the service and action had been taken to address any concerns. There was clear management oversight of the day to day running of the service. The manager had submitted all the required notifications regarding health and safety matters to CQC. Record keeping was acceptable, although some records needed further updating to reflect current needs.

The inspection took place on 3 November 2015 and was unannounced.

The service provides care and support to six people with the dual diagnosis of learning disability and mental health 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always administered safely and stocktaking procedures were not robust. Where errors had occurred staff had not highlighted a concern to the manager or senior staff. Some staff had not received training in administering buccal midazolam which is given to someone who is having recurrent epileptic seizures.

Staff were trained in safeguarding people from abuse and systems were in place to protect people from all forms of abuse including financial. Staff understood their responsibilities to report any safeguarding concerns and were clear about the process to do this.

Risks to people and staff were assessed and action taken to minimise these risks. People were encouraged to remain as independent as possible and any risks related to this were assessed.

Staffing levels meant that people’s needs were met. Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. New staff received training which was regarded as essential before they started to work at the service.

Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for. Staff were supported by the manager through supervision and appraisal.

People gave their consent before care and treatment was provided. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests , although we did find in one case that not all procedures had been followed..

People were supported with their eating and drinking needs and staff helped people to maintain good health by supporting them with their day to day physical and mental healthcare needs.

Staff were caring and treated people respectfully making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for.

People were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Care was subject to on-going review and care plans identified people’s particular preferences and choices. People were supported to play an active part in their local community and follow their own interests and hobbies.

No formal complaints had been made but informal issues were dealt with appropriately and to people’s satisfaction.

Staff understood their roles and were well supported by the management of the service. The service had an open culture and people felt comfortable giving feedback and helping to direct the way the service was run.

Quality assurance systems were in place and audits were carried out regularly to monitor the delivery of the service.

We identified a breach of regulations during this inspection, and you can see what action we told the provider to take at the back of the full version of the report.