1 & 2 Flax Cottages provides accommodation for up to nine people living with a learning disability, in two adjoining bungalows. At our last inspection of this service in March 2016, we gave the service a rating of 'requires improvement' and asked the provider to take action to make improvements. This was because we found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last inspection we found medicines were not always stored or recorded correctly. The provider sent us an action plan outlining the action they would take to meet this regulation. At this inspection, we found this regulation had been met and the rating had improved from ‘requires improvement’ to ‘good.’

The inspection took place on 22 and 26 June 2017 and was unannounced. This meant the provider did not know we would be visiting. We also contacted relatives by telephone on 14 July 2017 to gather their views of the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 checked the management of medicines and found improvements had been made to ensure medicines were stored and administered correctly, with clear instructions for staff.

Regular checks on the safety of the premises and equipment were carried out. The home was clean and generally well maintained. We were made aware that repairs and improvements that needed to be carried out in collaboration between the provider and separate landlord organisation, could take a long time. We have spoken to the provider about this and made a recommendation that the timeliness of repairs is monitored.

Staff received regular training including maintaining the health and safety of people and the safeguarding of vulnerable adults. Training was provided and competency assessed before staff were able to use specialist equipment used by people. Infection control procedures were followed by staff and personal protective equipment was in use.

There were suitable numbers of staff on duty and safe recruitment procedures continued to be followed. There had been a high turnover of staff but we were advised this was now settling. New staff told us they enjoyed working in the home.

Individual and general risks were assessed and a record of accidents and incidents was maintained.

Staff received regular training, supervision and appraisal and told us they felt well supported to carry out their roles. Training about specific conditions had been provided to staff to support people with particular health conditions.

The service was operating within the principles of the Mental Capacity Act 2005. People had 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 with eating and drinking. Personalised meal plans were in place which contained information about special diets and the level of support people needed. People with specialist nutritional needs were supported by relevant health professionals.

People’s bedrooms were homely and personalised. Support had been provided to allow people to display their belongings and to make their room reflect their interests and personality. Discreet and modern storage had been provided to disguise medical equipment in bedrooms to ensure the environment was relaxing and non-clinical.

Staff were caring and attentive to people. We observed staff having fun with people and supporting them to feel relaxed and safe. The privacy and dignity of people was promoted and independence encouraged.

Person centred care plans were in place and peop

The inspection took place on 18 March 2016 and was announced. We gave the provider 48 hours’ notice because staff and people were frequently out in the local community and we wanted to make sure someone would be in.

We last inspected the service in September 2014 where we found that they were meeting all the regulations we inspected.

1 & 2 Flax Cottages are a purpose built bungalow complex with an adjoining access corridor and shared laundry facilities. They provide places for up to nine people with learning disabilities who need care and support.

There was a registered manager in place. She had moved from one of the provider’s other services several weeks before our inspection. Relatives, staff and health care professionals spoke highly of her management skills and dedication to people and 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.

Relatives did not raise any concerns about their family members’ safety. There were safeguarding policies and procedures in place. Staff had completed safeguarding training and were knowledgeable about what action they would take if abuse was suspected. A local authority’s safeguarding officer informed us that there were no organisational safeguarding concerns with the service.

People’s bedrooms were personalised to meet their individual preferences. The manager told us that a range of environmental checks were carried out by the landlord who owned the property. She did not have access to the results of some of these tests at the time of the inspection. She sent us copies of the electrical installations test, Legionella risk assessment and asbestos report following our inspection. No concerns were noted.

We found some concerns with the storage and recording of medicines. The manager told us that she would address these issues immediately.

Relatives did not raise any concerns with staffing levels at the service. On the day of the inspection, we saw that people’s needs were met by the number of staff on the day of the inspection. There was a training programme in place. Staff told us that dementia care training would be appreciated. In addition, training in equality and diversity had not been completed. The manager told us that she was in the process of organising this training. We have made a recommendation that the provider sources training to meet the needs of all people who used the service.

Staff told us that they were a small supportive team. All staff told us that they felt well supported by the manager. Supervision and appraisals were carried out.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The manager was unclear whether any DoLS applications had been submitted to the local authority to authorise in line with legal requirements. She was also strengthening the service’s records with regards to the documentation of any decisions relating to mental capacity to ensure that it was clear how the MCA was followed.

People were supported to receive a suitable nutritious diet. We observed that people were cared for by staff with kindness and patience.

Support plans were in place which aimed to meet people’s health, emotional, social and physical needs. They gave staff information about how people’s care needs were to be met.

People were supported to access the local community, go on

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

Environmental risks were identified and managed through the provider's quality assurance and auditing systems. The provider's system of assessing and planning care took account of risks to people's safety and management plans were in place to address these.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Relatives told us they were consulted and one described the service as, "on the ball" concerning the care of their family member.

Is the service caring?

Staff interacted with people with warmth and good humour. Relatives of people we spoke with were extremely complimentary about the care provided at the service. One relative commented, "I am very happy with the home and the way care is given. A lot of work has been done by the new provider on the care plan. We have been fully involved in this and we are kept informed. The staff are nice and approachable, they have a great attitude."

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences and individual daily routines. Care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their relatives.

Is the service well led?

The home had a registered manager and a well-established staff team. We saw the provider had systems in place for checking the quality of the service and for taking action to make improvements where necessary.