This comprehensive inspection took place on 12 September 2017. At our previous inspection on September 2016, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated Requires Improvement. The breaches related to an absence of sufficient systems in place to support people who lacked capacity to make their own decisions. People did not have personalised care plans which identified their specific care needs and how these should be met by staff. Sufficient systems were not in place to effectively assess and improve the quality and safety of the service provided.

After our last inspection, the provider sent us an action plan to say what they would do to meet the legal requirement. This , had been signed by the registered manager as completed in November 2016.

At this inspection, we found the provider had made the required improvements as outlined in their action plan. The service was now compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

13a Repton Drive is registered to accommodate six people with profound and multiple learning and physical disabilities. People are accommodated in a purpose built bungalow. At the time of our inspection, the service was providing care and support to six people.

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 and associated Regulations about how the service is run.

During this inspection, we found that medicines were managed safely by trained staff. Staff received regular competency checks to ensure they had the correct skills for administering medicines.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Systems were in place to minimise risk, to ensure that staff supported people as safely as possible.

The provider had systems in place to deal with foreseeable emergencies and there were safeguarding adult's policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. Pre-employment checks had been carried out to ensure staff were suitable to work with people safely. There were appropriate numbers of staff to meet people's needs.

Staff were knowledgeable about people's individual needs and how to best meet these needs. Staff had access to support, supervision, training and on-going professional development that they required to work effectively in their roles. The training and support they received helped them to provide an effective and responsive service.

Staff had received Mental Capacity Act 2005 (MCA) training and understood the systems in place to protect people who could not make independent decisions. The service followed the legal requirements outlined in the MCA and the Deprivation of Liberty Safeguards (DoLS).

People received a person centred service and had detailed personalised plans of care in place. They were supported by kind, caring staff who treated them with respect. Their cultural and religious needs were respected and celebrated.

People were supported to maintain good health and nutrition.

People and their representatives knew how to raise a concern or make a complaint. Effective systems were in place to manage complaints.

People lived in an environment that was suitable for their needs. Specialised equipment was available and used for those who needed this.

The quality of the service was monitored by the service's operations manager and the registered manager. The service had a positive ethos and an open culture.

This unannounced inspection took place on 13 September 2016. At our previous inspection in September 2014, we found that the provider was meeting the regulations we inspected.

The service is registered to accommodate people with learning and physical disabilities. People are accommodated in a purpose built bungalow. At the time of our inspection, the home was providing care and support to six people.

The provider of the service is an organisation (The Avenues Group). The home had 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.

Although people received the care they needed, the care plans were not person centred and records did not show how they were encouraged to develop and contribute to their care plans. The care plans were not regularly reviewed and updated according to people’s changing needs.

There was an absence of sufficient systems in place to support people who lacked capacity to make their own decisions. People who may lack mental capacity did not have sufficiently detailed mental capacity assessments or best interests checklists as laid out in the Mental Capacity Act 2005 in their care plans.

People were safe at the service and were cared for by staff who were knowledgeable about safeguarding people. They knew how to report concerns.

The recruitment process was robust to make sure that the right staff were recruited to keep people safe. Staff confirmed and personnel records showed that appropriate checks were carried out before they began working at the home.

Medicines at the service were managed safely by staff who were trained and assessed as competent to administer medicines as prescribed.

Staff were supported through regular supervision and received an annual appraisal of their practice and performance.

There were sufficient qualified and experienced staff to meet people’s needs. Staff received the support and training they needed to provide an effective service that met people’s needs. The staffing levels were flexible to support with planned activities and appointments.

People were supported to have a nutritionally balanced diet and had adequate fluids throughout the day to promote their health and wellbeing.

People were supported to see specialist healthcare professionals according to their needs in order to ensure their health and well being were adequately maintained.

People were looked after by staff who understood their needs, were caring, compassionate and promoted their privacy and dignity.

A pictorial complaints procedure was available. People’s relatives were made aware of the complaints procedure and they knew who to speak with if they had any concerns.

Systems were in place to evaluate and monitor the quality of the service. Improvements were needed to ensure there was continued monitoring of the progress made where actions were identified.

We found three 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 the report.

A single inspector carried out this inspection. During the inspection we had a limited conversation with one person who used the service. We spoke with the senior care worker and two other care workers. We reviewed the care records for three people and reviewed a selection of other records, including audits, policies and procedures.

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found.

Is the service safe?

Risk assessments of people had been documented in their care records together with guidance on action to take to protect people. There was documented evidence that staff had been provided with essential training such as first aid and health and safety to enable them to care for people safely.

Staff received training and guidance regarding the requirements of the Mental Capacity Act (MCA) 2005. The manager demonstrated to us their knowledge of the Deprivation of Liberty Safeguards (DoLS) and the MCA requirements. No recent applications had been submitted.

We checked the premises during our inspection and found it provided a safe and suitable environment for good care to be delivered.

Staff had been suitably checked and the provider had an effective recruitment procedure in place. The recruitment policy needs revising to reflect current practice.

Is the service effective?

Feedback from people who used the service was limited due to the nature of their learning disability. People's care needs had been assessed with the help of their relatives and/or representatives. Their choices and preferences were documented and staff we spoke with were aware of these. One staff member said, "We have plenty of information in the care plans to support people." This enabled staff to respond effectively when caring for people. Care plans had been prepared in detail. These were up to date and were regularly reviewed.

Is the service caring?

We observed the staff treating people with respect and dignity. The staff were kind and caring in all the interactions we observed during the inspection.

Is the service responsive?

The senior care worker informed us the provision of services and care was regularly reviewed and if there were problems or suggestions made, they would respond. When we needed information regarding the care provided and the management of the service, this was promptly provided by all the staff.

Is the service well-led?

The staff who were present during the inspection were knowledgeable regarding their roles and responsibilities. There were arrangements for monitoring the quality of care provided. The senior care worker said they had been given good support and plenty of training to do the job. Staff were aware of the policies and procedures in place.