The inspection took place on 6 September 2017 and was unannounced. We visited to complete the inspection on 8 September and this visit was announced. 7 Eworth Close offers accommodation and personal care for up to six people with learning disabilities.

The service was last inspected on 6 and 12 February 2016. During that inspection we found safeguarding adult procedures were not always followed. We found people had not been involved in decisions about managing their diet. People's capacity to make specific decisions had not been assessed. Best interest decisions were not made and the least restrictive option used. Deprivation of Liberty Safeguards (DoLS) applications had not made to the supervisory body. People had little autonomy and their care plans were not developed in a manner that respected their rights. They lacked detail and were not individualised.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. We asked the provider to send us a report saying what action they were going to take. The provider had told us that they would complete all the actions required to meet the regulations by the end of October 2016. During this inspection we found that the provider was meeting the regulations.

The service had a registered manager in place. 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. The day to day running of 7 Eworth Close was overseen by a manager based at the house.

People who used the service felt safe and relatives had confidence in the ability of staff to keep people safe. Staff had received training on safeguarding adults and understood their responsibilities. Risks had been appropriately assessed and control measures in place to minimise the risks.

People received their medicines as prescribed. Staff had training and were checked to ensure they continued to be competent when administering medicines.

Recruitment processes were designed to ensure only suitable staff were selected to work with people. There were sufficient numbers of staff to meet the needs of people who currently used the service.

New staff were supported with an induction when they commenced work in the service, including shadowing opportunities. Relevant training had been received such as managing medicines, food hygiene, health and safety and first aid.

Staff were supported through annual appraisals and meetings with staff took place as per the company policy. Staff told us that they felt supported by the manager and that communication was effective.

Staff were aware of their duties under the Mental Capacity Act 2005. They obtained people's consent before carrying out care tasks and followed legal requirements where people did not have the capacity to consent to their care.

People who used the service and relatives consistently told us staff were caring, patient and upheld people’s dignity. People confirmed staff encouraged them to maintain and improve their independence on a day-to-day basis.

People felt consulted and listened to about how their care would be delivered. Care plans were personalised and centred on people's preferences, views and experiences as well as their care and support needs.

People who used the service knew how to complain. Complaints were investigated and responses given which were satisfactory to the complainant.

The manager and staff were described in positive terms by people who used the service and relatives.

The manager had worked hard to improve the service since the last inspection. This had resulted in an improved service for people. Auditing and quality assurance systems were improving to enable the provider to identify trends.

This is the first inspection for 7 Eworth Close since the changes in registered provider. This service offers accommodation and personal care to six people with learning disabilities.

The manager in post had applied for registration with us and the process was in progress. 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.

The provider information return submitted on 28 October 2015 stated “each person has a Person Centred Plan (PCP) that they complete, along with their Key Worker and other staff. The PCP has details about them that they wish to share including their likes, dislikes, wants, wishes and aspirations.” The manager had also identified PCP as an area for improvement over a 12 month period. However, the four PCP files we reviewed were incomplete which showed little improvements had taken place. The photographs and “all about me” information were not drawn together into a plan which gave staff guidance on how to deliver care in the persons preferred manner. For example, their routines and how to help people achieve their goals.

Care plans lacked detail and did not centre on the person. Staff lacked an understanding of person centred care. People were not involved in the planning of their care and their preferred routines, their likes and dislikes and life stories were not gathered. This meant people’s care and treatment was not delivered in people’s preferred manner. House rules were rigid and did not give people an opportunity to have control over their care and treatment. For example, there was little flexibility with meal times, where people were able to eat their meals and visitors.

Members of staff knew how to minimise the risk to people but risk assessments were not respectful to people’s rights. Action plans were not always clear on how staff were to minimise the risk or to enable people to take risks safely.

People’s capacity to make specific decisions was not assessed. For example, people were not given access to some records and did not to participate in the development of their behaviour management plans. The decision not to give people access to records was made despite people being present while their behaviour was discussed at review meetings arranged by their care manager.

Some people at times presented with behaviours others found difficult. Members of staff described the actions they took to prevent the situation from escalating. People’s capacity to be part of the development of their behaviour management plans was not assessed. The plans in place were not person centred and people were not valued as an individual. For example, staff were to sign “bad” to a person although in bracket it was stated the behaviour was “bad” not the person. Health and social care professionals provided guidance on managing situations for one person in a person centred manner but the guidance was not used to develop a care plan. This meant the staff were not working within the principles of the Mental Capacity Act (MCA) 2005 as decisions were not made in the person’s best interest and in the least restrictive manner.

With the exception of one person, people were subject to continuous supervision in the community. People were accompanied by staff in the community but Deprivation of Liberty Safeguards (DoLS) application to the supervisory body were not made. This meant there was a lack of understanding of the MCA principles.

People’s rights were not always respected. Records showed the terminology used by staff was patronising to people. There was a strong emphasis on diet and there was a lack of choice given to people on weight management plans. People were not assisted to have privacy in some of their relationships. Visits had to