About the service:

60 Cobham Road is a house located in the village of Fetcham, in Surrey. The home provides accommodation and personal care for up to six people living with learning and physical disabilities. The care provider is a national care organisation with locations of care homes across England.

People’s experience of using this service:

People living at 60 Cobham Road were safe and supported by staff who were kind and caring. Staff provided a calm and respectful approach and understood individual needs and personalities. Most people who lived at the home were non verbal in their communication. Staff knew how to communicate with each person and people were involved in day to day decision making as much as possible.

The house was suitable for people at this time and some adaptations had been made to accommodate people with mobility needs. However, there was some outstanding work to be done to make the home look well cared for and to take account of people’s needs as they aged. We made a recommendation that this work should be acted on as soon as possible.

People were supported to take part in suitable activities they enjoyed each day. People were engaged with the local community life, and participated in everyday tasks such as doing the shopping. Staff enabled people to take part in tasks at home and in their own care and promoted their independence.

Relationships with healthcare services had been strengthened to meet the needs of people as they aged. People received regular health checks, their medicines were reviewed and any individual health issues were being addressed. People took part in choosing meals and they ate healthily. Staff were aware of the risks some people faced with their nutrition and this was well monitored.

The registered manager had a good awareness of the priorities for the service, staffing and the people they supported. Improvements had been made over the last six months to ensure the service provided was good. The provider had a continuous quality monitoring cycle in place. Statutory requirements were being met. Recruitment and development of staff was an important aspect to ensure standards were maintained.

Rating at last inspection:

Our last comprehensive inspection report was published on 28 August 2016 when we rated the service as good overall. The service was rated as requires improvement in the Effective domain because they had not always followed the legal requirements of the Mental Capacity Act 2005.

A focused inspection took place and a report was published on 5 April 2017 which demonstrated that the service had made improvements in this area and was rated as good.

Why we inspected:

This was a planned comprehensive inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our scheduling guidance.

We inspected this service on 2 March 2017. The inspection visit was announced.

60 Cobham Road provides accommodation and personal care for up to six people with learning disabilities. There were five people using the service at the time of our visit. The people are supported with a full range of tasks, including maintaining their health and well-being, personal care, support with nutrition and social activities.

This was a focused inspection following the last inspection in June 2016. Despite being awarded an overall rating of ‘Good’ during the last inspection we found a breach in Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This follow up inspection on 2 March was a focused inspection to check if the service was effective.

On the day of inspection we met the 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.

During this inspection we found 60 Cobham Road to be working in line with the principles of the Mental Capacity Act 2005 (MCA). People were involved in the decision making process and when people lacked capacity best interest meetings had taken place.

People were being supported by staff who had a good knowledge of their support needs. Staff felt supported and felt they had adequate training to meet people’s needs.

People were supported effectively when it came to their nutritional needs and a varied diet was offered to people. Alternative meals were offered if and when requested by people.

People were supported to maintain good health and had access to healthcare services to meet their needs.

We inspected 60 Cobham Road on 21 June 2016, the inspection was unannounced. Our last inspection took place on the 20 May 2013 where we found the provider was meeting all of the regulations we checked.

Cobham Road is registered to provide accommodation and personal care for up to six people with a learning disability and who are neurodiverse. The home is located in the village of Fetcham, between Cobham and Leatherhead in Surrey, with convenient access to local shops. On the day of the inspection there were four people living in the home.

The service had 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.

Information about the home was accessible and understood by people who used the service. People had communication plans in place and staff followed these. People were listened to and their rights were respected and staff provided person-centred care.

Recruitment checks were completed to assess the suitability of the staff employed. Staff received suitable training and good support from the registered manager to enable them to carry out their roles. There was a suitable number of staff to meet the needs of the people who used the service.

The provider ensured the administration, storage and disposal of medicines were managed safely.

Systems were in place to effectively improve the quality of care delivered. However impartial feedback was not sought from people to obtain their views and comments regarding the service.

Suitable arrangements were in place to ensure people received good nutrition and hydration. Good food hygiene practices were followed by staff working in the home.

Staff had a good understanding of safeguarding procedures and followed protection plans to minimise the risk of harm to people. Prevention measures had been put in place to minimise future re-occurrences of any incidents.

People were supported by staff to attend health care appointments when there were changes to their health care needs or associated risks to their health. Staff did not always follow the legal requirements in relation to the Mental Capacity Act 2005. Staff understood the MCA and presumed people had the capacity to make decisions first. However, where someone lacked capacity, best interests decisions about whom else could make the decision or how to support the person to be able to make the decision was not sought.

People were supported to maintain positive relationships with their relatives and friends. Relatives were complimentary regarding the care and support provided by staff. People had access to activities that were important to them and were encouraged to be active in the community.

Relatives knew how to make a complaint and were confident any concerns would be resolved. There was an easy read complaints policy available for people.

We found one breach of regulation relating to consent. We have also made a recommendation about obtaining the views of people who use the service. You can see what action we asked the provider to take at the back of the full version of this report.

During our inspection in December 2012 we found some areas of non-compliance at this service. We carried out this visit as part of our scheduled annual inspections and we checked that the provider had carried out the necessary actions following the last visit.

We were unable to speak to the people who used the service during our visit because of their complex needs. This meant they were not able to tell us of their experiences. Instead we used a range of methods to gather information about this service which included observation, speaking to relatives and staff.

We were told by the people that we spoke with that the staff were good and knew the needs of people who lived in the home well. We were told “Yes. They know him well.” and “He responds to them.”

We were told the home was kept clean and tidy and people were always in clean clothes.

The people that we spoke with told us that they had not felt the need to complain but would know who to speak to if they wished to.

We were unable to speak to people using the service because they had complex needs which meant they were not able to tell us their experiences.

We spoke to two relatives of the people using the service. One person told us that they believed that their relative was happy at the service. They also told us that the service was always “Willing to share information.”

We found that most of the people who used the service had activies planned for them however one person who was new to the service did not have any.

All the staff we spoke to had a good understanding of most people's needs. We noted that in once instance however there were no up to date risk assessments in one person's care plan.