30 Richmond Road is residential care home for up to five people, who have a diagnosis of learning disabilities and / or are on the autistic spectrum. The service is registered to provide accommodation in addition to personal care with a condition that no nursing care is delivered to people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The home offers five bedrooms with communal bathrooms, a dining room, communal lounge, sensory room and access to the kitchen. A spacious rear garden further offers additional space for people to use, including the development of vegetable beds. Floors are accessible by stairs.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good

The service continues to keep people safe. Recruitment procedures continued to ensure suitable staff were employed to support people and help keep them safe. Risk assessments continued to consider least restrictive options to enable people to continue engaging in activities that enhanced their well-being. Care documents supported the risk assessments currently in place.

Medicine management continued to be provided in a safe way. Audits illustrated that people received their medicines in a timely manner and how they wished. Medicines were correctly stored, disposed of and ordered to ensure that people were not without their medicines at any point. Two recent pharmacy inspections rated the service highly, with no recommendations or improvements suggested. The service was commended on their medicine management.

Staff training was kept up to date, and a rolling training programme was in place. Staff received frequent supervisions and annual appraisals that enabled them to discuss their performance.

People's needs were assessed initially upon admission, and thereafter reviewed monthly to ensure care was the most appropriate. People were involved in their care planning process as far as possible, with relatives and professionals consulted where necessary and agreed. People’s rooms were personalised in a style that they preferred, with furnishings that brought a personal touch to their rooms.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. This included making decisions about their care as far as possible, food choices as well as activities. People received responsive care. Staff had a thorough understanding of people’s needs and focused on developing people’s skills through personalised and responsive care. External relationships were encouraged, and developed. Staff encouraged and assisted on family holidays

Staff approach remained caring. People were supported by a staff team that knew them well, and ensured they enabled them to maintain their dignity at all times People communicated in their preferred way, with records clearly highlighting communication methods, including the use of body language and facial expressions.

The service continued to be well-led. There was a clear vision and direction from the senior management team that reflected on staff practice. Staff spoke positively of the registered manager, stating an open-door policy was practiced, which enabled staff to approach the management team and discuss any issues.

Good community links were created, and the service worked efficiently with visiting health professionals. The service continued to have good governance and reflective practice, ensuring compliance with the regulations.

Further information is in the de

This inspection took place on 5 May with follow up telephone interviews on 9 May 2016, and was unannounced.

The service provides residential support to people who require personal care, and have a primary diagnosis of Learning Disabilities and associated behavioural needs. The home is registered to provide support to five people, the location currently does not have any vacancies. The bedrooms are located on both the ground and first floor, with a communal lounge, open kitchen, dining room and a quiet room.

The home is required to have a registered manager, and has had the same manager in post since 2014. 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.

People were kept safe by a staff team who had an understanding of the importance of reporting concerns promptly. Robust systems were implemented to recruit suitable staff to work at the service, whilst protecting people against the risk of abuse. There were sufficient number of trained and experienced staff working on shift to ensure people’s needs were appropriately met.

People were supported by trained and competent staff in the administration and management of medicines. These were safely secured and managed. Protocols for as required medicines were in place so to ensure these were only given as needed.

Good caring practice was observed. Relatives of people using the service reported that staff were caring in their approach, and supportive of people. Care plan on the individual and how to meet their needs effectively. These were reviewed with people and their relatives, and if applicable with any professionals involved in the person’s care.

People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty.

People received care and support from a staff team who had the appropriate skills and knowledge to care for them. Staff received a comprehensive induction and training programme. New staff obtained support from experienced members of staff. All staff felt supported by the registered manager and said that they were listened to if concerns were raised.

The quality of the service was monitored regularly by the registered manager and by one of the organisations operation managers. These detailed timescales for any identified actions required. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service.

The inspection team who carried out this inspection consisted of one inspector. They gathered evidence against the outcomes we inspected to help answer our five key 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 describes what we observed, the records we looked at and what staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home had risk assessments for all aspects of care that posed a risk to people who lived in the home. These assessments helped identify, address and minimise the risks to the individual.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

The provider had appropriate systems in place to effectively assess and monitor the quality of care they provided to people who use the service.

People’s personal records including medical records, staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People's needs were assessed and care was planned and delivered in line with their individual care plan.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had regular training, supervision and appraisal.

Is the service caring?

During the inspection we observed care workers supporting people who use the service. Staff were respectful and caring. Care workers understood how people communicated and how people would express their likes and dislikes during the care planning process.

Is the service responsive?

We saw people’s care records and risk assessments had been recently reviewed and updated. People who use the service, their relatives and health care professionals had been involved as appropriate. If any changes to people’s needs were identified these were made.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment. The provider had a robust quality audit system in place. We saw evidence that when issues had been identified, they were managed appropriately.

At our last inspection we identified concerns about people’s personal records, because they were not accurate. At this inspection we looked at two people’s care records. We found they had all been updated with the correct information about each person's care needs. Records were also being stored correctly.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

We looked at the care records of all five people who live at the home. One set of care of records was up to date and contained all the relevant information about the person. Two sets of care records had minor discrepancies in the dates recorded for future appointments, but were otherwise up to date and accurate.

However, we found the records for two other people who use the service did not contain all of the relevant information to ensure their care and welfare needs were met. There was a risk that people would not be protected against experiencing unsafe or inappropriate care and treatment because accurate records were not being maintained

The provider did not store archived records in an accessible way that allowed them to be located quickly. There was a risk that records would not be located promptly when required.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

We looked at four people's care records. All of the records showed evidence of a recent medical review with each person's GP, as well as other appropriate medical tests. People’s optician and dental appointments were all up to date.

However, the provider did not ensure that people who use the service were protected against the risk of unsafe or inappropriate care and treatment because they did not maintain accurate records for each person.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

Some people who use the service needed to be weighed regularly to monitor the outcome of their nutritional intake. We saw that where this need was identified, monthly weight checks had been completed. Where weight change had been identified, this had been managed appropriately.

At our last inspection, we identified an individual that had been recommended a best interest meeting to decide on the most appropriate medical treatment for them as they were unable to make this decision for themselves. We saw evidence this had been organised and discussions about appropriate action to be taken for that individual were ongoing.

The acting manager told us they had put plans in place to identify when people who use the service required follow up appointments with health professionals such as the GP. These included writing appointments in a 2013 diary, 2014 planner and summary sheet for each person's appointments in their care plans.

However, when we reviewed these records we found individual’s appointments had not been made when they were due. The provider was not monitoring and planning appointments that had been recommended by health professionals. There was a risk people who use the service would not experience safe and appropriate care.

People who use the service were unable to communicate verbally. We used observation where we could to help us understand their experiences and views of the service provided. We spoke with relatives who told us they had been involved in the planning of people's care. Relatives were very complimentary of staff. One person said “I can’t praise them enough”. Another said “the care is of a very high quality”.

Health action plans we looked at showed the provider was not monitoring when people were due follow up appointments with health care professionals such as the dentist or a best interests meeting. People’s weights were not being assessed regularly as recommended.

People who use the service had the opportunity to undertake activities in the community. Relatives told us people felt safe. Staff were able to demonstrate a good knowledge of recognising the signs of abuse and what actions to take if they had any concerns.

Staff had regular training and told us they felt well supported by managers. Appraisals and supervision sessions were not always done regularly and the provider did not monitor when appraisals or supervision were due. The provider had appropriate procedures in place to monitor the quality of the service they provided.

At the time of this inspection there was no registered manager at this location. When we spoke with the nominated individual they informed us they were currently in the process of recruiting to the position.