The inspection took place on 24 October 2018 and was announced.

351 Maidstone 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.

351 Maidstone Road provides accommodation and or personal care for up to five people with a learning disability and/or autistic spectrum disorder. The accommodation is provided in a house with access to garden areas. At the time of our inspection four people were living at the service. People had complex care and communication needs and may present with challenging behaviours.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The service ethos is to enable people with learning disabilities and autism to live as ordinary a life as any citizen.

At our last inspection on 20 September 2017, we rated the service Good. We re-inspected this service earlier than planned due to concerns that had been raised about people’s safety. At this inspection we found that the evidence continued to support the rating of Good.

There had been substantial disruption to the service from people displaying behaviours that challenged the service, staff and other people. The disruption had reduced from the beginning of October 2018 after a change in the number of people living at the service. At this inspection we found that people continued to receive safe care. Risks associated with people's care and support were managed safely. People’s care needs were fully assessed and people were involved in the day to day planning of their care and making choices about their lives and routines.

Before this inspection allegations of abuse had been made about the service. We found that the registered manager and the provider had responded to these allegations by working with the local safeguarding team so that they were thoroughly investigated. At the time of this inspection there was no evidence or information that people in the service were at risks of harm.

The environment had been badly damaged by people displaying challenging behaviours. The decoration had suffered from damage and dilapidation. At this inspection the risks of continued damage had stopped. A maintenance team were in the process of repairing and redecorating the service.

Staff continued to minimise cross infection risks by following infection control guidance.

Behavioural management plans and interventions were based on the use of Positive Behavioural Support (PBS). PBS is recognised as one of the best way of supporting people who display, or are at risk of displaying, behaviour which challenges care services. Staff recognised that harmful behaviours were also a form of communication. Staff received specialist training to enable them to respond appropriately to potentially harmful behaviours. This work was supported by a behaviours specialist employed by the provider.

Staff understand people’s communication styles, using objects of reference, people’s moods, facial expressions and body language. The registered manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

There was a learning culture from incidents and accidents. These were recorded, investigated and checked by the registered manager and the provider to see what steps could be taken to prevent them happening again.

There were policies and procedures in place, based on nationally recognised go

The inspection was carried out on 20 September 2017, and was an unannounced inspection.

351 Maidstone Road is registered to provide residential care for a maximum of seven people with a learning disability. At the time of our inspection, four people lived in the home who had learning disabilities, autism and some with limited verbal communication abilities. People were fairly independent and involved in the way the service was run.

There was a registered manager at the home. 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.

At the last Care Quality Commission (CQC) comprehensive inspection in 04 June 2015, the service was rated overall Good with Requires Improvement in Safe domain. We carried out a Focused inspection on 30 March 2017 and rated the Safe domain Good.

At this inspection we found the service remained Good.

People continued to be safe at 351 Maidstone Road. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

Medicines were managed safely and people received them as prescribed.

There were enough staff to keep people safe. The registered manager had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect. People's privacy was maintained particularly when being supported with their personal care needs. People were supported to have 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.

The registered manager made certain that the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

The inspection was carried out on 30 March 2017 and was an unannounced inspection.

351 Maidstone Road is part of a group of homes called Voyage 1 Limited and is registered to provide residential care for a maximum of seven people with a learning disability. At the time of our inspection, four people lived in the home who had learning disabilities, autism and some with limited verbal communication abilities. People were supported to be independent and involved in the way the service was run.

At the last Care Quality Commission (CQC) inspection on 04 June 2015, the service was rated overall Good and Requires Improvement in ‘Safe’ domain.

We carried out an unannounced comprehensive inspection of this service on 04 June 2015. We found a beach of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 13 of the Health and Social Care Act Regulated Activities Regulations 2014, Safeguarding service users from abuse and improper treatment. The provider told us they would meet the regulation by September 2015.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 351 Maidstone Road on our website at www.cqc.org.uk

The service had improved since the last inspection. Potential risks to people were identified and there was detailed guidance for staff to manage risks to keep people as safe as possible.

Staff knew how to recognise and respond to abuse. Accidents and incidents were recorded and analysed to recognise any trends and stop them from reoccurring.

There were enough staff on duty to keep people safe and give them the care and support that they needed.

Staff were recruited safely, checks were made to ensure they were of good character and had the necessary skills and experience to support people effectively.

People received their medicines safely and when they needed them.

Further information is in the detailed findings below.

We inspected this home on 4 June 2015. This was an unannounced inspection.

351 Maidstone Road is registered to provide residential care for a maximum of seven people with a learning disability. At the time of our inspection, four people lived in the home who had learning disabilities, autism and some with limited verbal communication abilities. People were fairly independent and involved in the way the service was run.

There was a registered manager at the home. 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people whose behaviour may be challenging with detailed guidance for staff to follow to reduce the risk of harm. However, staff had not always followed the guidelines in the risk assessments about managing people’s behaviours. This had not always ensured that staff were able to minimise or prevent harm to people.

Staff recognised the signs of abuse or neglect and what to look out for. They understood their role and responsibilities to report any concerns and were confident in doing so.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff had been provided with relevant training and they attended regular supervision and team meetings. Staff were aware of their roles and responsibilities and the lines of accountability within the home.

The registered manager followed safe recruitment practices to help ensure staff were suitable for their job role. Staff described the management team as very open, supportive and approachable. Staff talked positively about their jobs.

Staff were caring and we saw that they treated people with respect during the course of our inspection.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made.

Medicines were administered safely to people. People had good access to health care professionals when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Health care plans were in place and people had their physical and mental health needs regularly monitored. Regular reviews were held and people were supported to attend appointments with various health and social care professionals, to ensure they received treatment and support as required.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive and inclusive atmosphere within the home and people were encouraged to be involved in their care.

Easy to read information had been developed for people to understand documentation such as the complaints procedure. People in the home were able to communicate verbally. Where there were limited understanding, the management and staff had adequate communication systems in place for people.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the commission.

You can see what action we told the provider to take at the back of the full version of this report.