1 Lansdowne Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 14 people in one adapted building. At the time of our inspection 13 people were living at the home.

We checked to see if the care service had been developed and designed in line with the values that underpin ‘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 should be able to live as ordinary a life as any citizen. The registered manager did not have good knowledge of this guidance, and this was reflected in our findings during this inspection.

At our previous inspection in August 2015 we rated the service as ‘good’ in all five of the questions we ask. At this inspection we found the service was now rated ‘requires improvement’ in each of the five questions. This was because we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We also identified a number of areas that, although not breaches of regulations, required improvement to meet with current guidance about good practice for services for people with learning disabilities or autism.

This unannounced inspection took place between 17 January 2018 and 21 February 2018. We visited the service on 17 January 2018 and between 05 and 21 February, we reviewed information sent to us by the registered manager and spoke with the relative of a person who used the service.

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.

Risk Assessments were not adequately detailed or individualised. Some risk assessments had not been recorded when decisions had been made to put restrictive practices in place.

Medicines were not managed safely because stock taking processes were not effective and protocols were not in place to ensure ’as required’ medicines were administered as intended by the prescriber.

Although the premises were sufficiently clean, effective measures to control and prevent infection had not been taken. The arrangements for managing clean and dirty laundry, the storage of cleaning materials and the auditing of infection control measures required improvement.

People felt safe living at the service, with the staff and with the support the staff gave them. People were protected as far as possible from abuse and avoidable harm by staff who were trained and competent to recognise and report abuse.

There was a sufficient number of staff to make sure that people’s needs were met safely. There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed. Staff were clear about their responsibility to report accidents, incidents and concerns.

Assessments of people’s support needs were carried out before the person came to live at the service to ensure that their needs could be met. Mobile phones for use when people went out unescorted were available to people. However, the use of technology had not been explored beyond this and opportunities were lost to determine whether or not people might benefit from this.

Staff received induction, training and support for them to do their job well. However, knowledge of the Mental Capacity Act 2005 was not strong across the staff team and this had an impact on how people were supported to make decisions about their care.

People had enough to eat and drink

This inspection took place on 6 August 2015 and was unannounced.

1 Lansdowne Road provides care and support for up to 14 people with a learning disability. There were 11 people living at the service when we visited.

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.

There were systems in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been trained to recognise signs of potential abuse and to keep people safe. People felt safe living at the service.

Processes were in place to manage identifiable risks within the service and to ensure people did not have their freedom restricted unnecessarily.

The provider carried out recruitment checks on new staff to make sure they were suitable to work at the service.

Staff had been provided with essential training and support to meet people’s assessed needs.

People’s consent to care and support was sought in line with the Mental Capacity Act (MCA) 2005.

People were supported to eat and drink and to maintain a balanced diet.

People were registered with a GP. If required they were supported by staff to access other healthcare facilities.

Positive and caring relationships had been developed between people and staff.

People were encouraged to maintain their independence and staff promoted their privacy and dignity.

Pre-admission assessments were undertaken before people came to live at the service. This ensured their identified needs would be adequately met.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to.

There was a positive, open and inclusive culture at the service.

There was good leadership and management demonstrated at the service, which inspired staff to provide a quality service.

There were quality assurance systems in place to monitor the quality of the service provided and to drive continuous improvements.

We carried out an inspection of 1 Lansdowne Road on 7 August 2013. During this visit we spoke with 10 of the 12 people living there. We found people who used the service looked well cared for, and were happy with the care and support they received. They told us the staff were “fun”. We observed a relaxed atmosphere in the home, and saw that staff offered support at a level which encouraged independence and assured their individual needs were met. People told us they were advised in making choices and consented to anything they did. One person said, “I can do what I like but sometimes staff tell me what would be better for me but they leave me to make the choice.

We found there were sufficient staff on duty, and those we spoke with told us they felt well supported. We found that they had been correctly recruited and were checked as being safe to work with vulnerable adults.

The home had a complaints procedure which we observed had been adhered to. We saw that complaints had been logged, investigated and responded to correctly and in a timely fashion.