This inspection was carried out on the 24 and 26 November 2016. Wraxall Road provides accommodation, nursing and personal care for 14 people. People who live at the home have learning and physical disabilities. There were 14 people accommodated at the time of the inspection. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

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.

Many of the people living in Wraxall Road had a profound physical disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection. Staff were caring and attentive to people.

The areas identified at the last inspection in November 2015 had been addressed which included two showers being refurbished and the majority of the home being redecorated. The provider had taken appropriate action to address the breaches in regulation.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that described how each person would like to be supported. Consideration should be taken to ensure all information was accessible to staff to enable them to get a full picture of how people would like to be supported. The registered manager was reviewing how staff record information to make it more streamlined and avoid duplication. Other health and social professionals were involved in the care of the people. Safe systems were in place to ensure that people received their medicines as prescribed. People were supported to take part in social activities both in their own home and the community. Annual holidays were arranged for those people that wanted to go away.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Learning had taken place in respect of any allegations of abuse to improve the service for people living at Wraxall Road ensuring their safety.

Systems were in place to ensure people were safe including risk management and safe recruitment processes. Sufficient staff were deployed to ensure people’s care and support needs were met. Staff spoke very positively about the recruitment initiative that had been completed which meant the home was now fully staffed and less reliant on agency and bank staff.

Staff were caring and supportive and demonstrated a good understanding of their roles in supporting people. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager. The registered manager had devised an action plan to aid improvements in this area. Staff were committed to providing a service that was tailored to each person they supported. Staff had received training to enable them to meet people’s needs.

People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

Systems were in place to ensure that complaints were responded to and, learnt from in order to improve the service provided. The views of relatives were sought to improve the quality of the service and were involved in the service provision.

People were provided with a safe, effective, caring and responsive service. The registered manager was aware of the importance of reviewing the quality of the service and was aware of the improvements that were needed to enhance the service.

During our inspections we set out to answer a number of key questions about a service: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We found during our last inspection some aspects of the service was not well led. This was because whilst there were some systems in place to assess and manage the risks to the health, safety and welfare of people who use the service and others. These were not always fully analysed to enable the quality of the service to be reviewed to ensure improvement.

We returned to the service and found that the provider and the registered manager had made the necessary improvements.

The purpose of the inspection was to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions the staff supporting them and looking at records.

Many of the people living in Wraxall Road had a profound physical disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans were person centred and detailed the individual's personal preferences and information to keep them safe. Risk assessments were seen covering all areas of daily living. This included support with moving and handling, personal care, accessing the community and eating and drinking. This meant that staff had guidance to support people safely.

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This minimised the risks to people and helped the service to improve and ensure people’s safety.

We found that the home was safe, clean and hygienic ensuring that people were protected from the risks of cross infection. Checks were completed on the environment to ensure they were safe and any risks were minimised.

Staff received suitable training to enable them to support people safely and understand different people’s needs including supporting people with a physical disability.

Staff were observed supporting people appropriately with moving and handling. Staff had suitable equipment to safely support people with a physical disability. This included moving and handling equipment and specialist baths. Staff had received moving and handling training providing them with the knowledge to support people safely.

Is the service effective?

People’s health and care needs were assessed and a plan of care was put in place. Staff were aware of the needs of the individuals living in the home enabling them to support people effectively.

We saw that people received the care set out in their care plan and people received the support that they needed.

Two people using the service told us they were happy with the care and support they were receiving. Relative surveys indicated that they were happy with the service being provided, their relative’s needs were being met and they were kept informed of any changes.

Is the service caring?

We observed staff meeting the needs of the people they were supporting. Two people told us they were happy in the home. They told us that they were going out with staff to the theatre and out for lunch. Both of the individuals knew who they were going out with and they were looking forward to their trips out. It was evident they had been informed about who was supporting them.

We saw that staff spoke to people in an appropriate manner and they were attentive to their needs.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People were supported by other professionals including speech and language therapists and physiotherapists. Referrals to other health professionals had been made and their recommendations were included in the plan of care for the person.

Care files included information about how the staff were supporting people with their health care needs and staying healthy. People were registered with a GP and had access to a dentist, chiropodist and optician. Where people’s needs had changed, care plans had been reviewed and amended.

Specialist bathing equipment was available to support the staff in providing personal care to the people living in the home. This demonstrated that the service had suitable equipment to respond and assist people with a physical disability.

Is the service well-led?

There was a manager in the service that was registered with the Care Quality Commission.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff received regular training to enable them to fulfil their roles and this was kept under review. However, the frequency of supervisions for staff was not in accordance with the policies of the organisation. This meant that staff may not be receiving suitable support and guidance in respect of their roles.

The service had a quality assurance system in place. The records that we looked at evidenced that where shortfalls had been identified they had been addressed. However, we saw that the provider’s arrangements to visit the service every two months were inconsistent. This meant that the provider quality monitoring was compromised and there was a risk that the quality of the service may deteriorate as shortfalls in the delivery of care may not be identified.

Many of the people living in Wraxall Road had a profound physical disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection.

Staff were respectful with people and told us about the importance of respecting people's dignity and how they ensured this. It was evident that staff knew each individual, their likes, dislikes and care needs. We saw that peoples health care needs had been assessed and care was delivered in accordance with this. Whilst there were care plans for people's social and emotional needs these plans had not always been reviewed or updated but staff were able to describe people's current needs.

People had enough to eat and drink and any support needed was provided. People saw the speech and language therapist and dietician as needed. The home co-operated with other professionals and made appropriate and timely referrals.

The home was mostly clean but the bathrooms had dirty stained floors and this had not been identified and remedied.

The home had not adhered to Brandon Trust's recruitment policy and employed apprentices before checks had been carried out. The complaints system was not effective for people who did not communicate verbally.

Many of the people living in Wraxall Road had a profound physical and learning disability and therefore did not communicate verbally. From talking with staff and reading care records it was clear that they had a good understanding of the people they supported. This included how people expressed themselves if they were unhappy with the care or indicated their refusal.

We looked at three people’s care records, spoke with four members of staff and the registered manager during our visit. We also observed people being supported.

People were being supported in a sensitive manner. The support given by staff was unrushed and responsive to people’s needs.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were knowledgeable about the needs of the people they were supporting.

Care was person centred and tailored to the individual. Staff had received training relevant to the needs of the people living at Wraxall Road.

People were protected by the medication systems that were in place.

Systems were in place to monitor the quality of the care provision including making improvements.

People could be confident that their records reflected their current needs. However, there was a minor improvement for one person and assurances were given that this was being addressed.

The individuals living at Wraxall Road have a learning disability and complex needs. This meant that it was difficult to seek their views as many of the individuals used non verbal communication. However, those that could let us know told us they were happy living in the home.

We observed individuals being supported throughout our visit and during these times people were supported in a sensitive and positive manner.

The purpose of this visit was to review the progress from the visits in March and August 2011 and to ensure ongoing compliance with the Health and Social Care Act 2008.

People can now be confident that the care is planned taking into account their needs, the wishes of the person with better safeguards in place in respect of record keeping and ongoing monitoring.

People can be confident that they were being listened to and involved in decisions. Where people lacked capacity decisions were being made in accordance with current guidelines.

People can be assured that there is now clear guidance in respect of supporting them with expenditure of their personal finances and what is included in the fees.

People now benefit from a staff team that have received training relevant to their roles.

The individuals living at Wraxall Road have a learning disability and complex needs which meant that it was difficult to seek their views as many of the individuals used non verbal communication. However, those that could let us know told us they were happy living in the home.

We observed individuals being supported throughout our visit and during these times people were supported in a sensitive and positive manner.

People living in Wraxall Road have benefited from the improvements that have been put in place since our last visit in March 2011. The purpose of this visit was to review the progress of the action plan that the service had developed to address areas of non compliance. This has included a review of how care was being delivered to ensure it was tailored to the individual and that staff were consistent in their practice. People can now be assured there are improved safeguards in respect of their personal finances with clear documentation about the decision process in respect of expenditure.

People will benefit from the training plan that was in place for staff that covered all aspects of providing care and support to people based on their assessed needs. This was still work in progress with training courses planned over the next few months. Other areas that remain outstanding were the review of people’s care plans to ensure they were clear and reflected the needs of the person. Whilst some work has been completed in this area it remains outstanding. An action plan has been developed and this, along with the training provision, will be subject to another review by the Care Quality Commission in due course.

The individuals living at Wraxall Road have a learning disability and complex needs which meant that it was difficult to seek their views as many of the individuals used non verbal communication. However, those that could let us know told us they were happy living in the home.

We observed individuals being supported throughout our visit and during these times people were supported in a sensitive and positive manner. However, there were concerns that the practices of the staff were not consistent which could mean that people were at risk.

People’s finances were not being looked after in accordance with the policies and procedures of the organisation. There was a lack of activities for people and involvement in their care.

This inspection was carried out on the 25 and 26 November 2015. Wraxall Road provides accommodation, nursing and personal care for fourteen people. People who live at the home have learning and physical disabilities. There were fourteen people accommodated at the time of the inspection. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

There was a registered manager in post. They commenced in post in April 2015 and they were supporting a new manager. The new manager was planning to make an application in December 2015 when they were leaving. 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.

Many of the people living in Wraxall Road had a profound physical disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection. Staff were caring and attentive to people.

Some improvements were required to the environment to ensure it was safe and meeting the needs of people. Areas were cluttered with equipment no longer in use, staff possessions and paint tins from a bedroom that had been decorated the week before. Some areas of the home needed to be redecorated and two shower rooms were not fit for purpose as the majority of people were unable to use these areas due to their physical disability.

People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was generally positive in respect of the staff’s approach to people and delivery of care. However, some professionals had told us that not all their advice and recommendations were followed or shared with the team.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

Sufficient numbers of staff supported the people living at the service. There were 11.6 staff vacancies and these were being covered by regular bank, or agency staff. Arrangements were in place to recruit new staff including recruitment fairs and advertisement in the local area. To ensure some continuity agency staff were being block booked. Staff had received sufficient training to enable them to support people effectively.

People had a care plan that described how they wanted to be supported in an individualised way. These had been kept under review. Care was effective and responsive to people’s changing needs. Staff used different forms of communication to enable them to build relationships with people. This was important as many of the people used non-verbal communication to express how they were feeling. People were supported to maintain contact with friends and family and take part in activities both in the home and the local community. Staff could improve on the recording of the activities that people take part in.

People were treated in a dignified, caring manner which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. The registered manager had submitted applications to the appropriate authorities to ensure people were not deprived of their liberty without authorisation.

The service was well led and an action plan was in place to continue to drive improvement ensuring people had a personalised service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.