We carried out an unannounced comprehensive inspection of this service on 21 December 2015 and 8 January 2016. Four breaches of legal requirements were found at that time. We undertook a focused inspection on 11 August 2016 to check that they had followed their plan and to confirm that they now met legal requirements. We found the registered provider had met most of the assurances they had given in their action plan and were no longer in breach of the majority of the relevant regulations. However, some audits had not identified issues we found at inspection about the service’s safety. We carried out our latest inspection to check if further progress had been made in improving audits.

This inspection took place on the 14 March 2017 and was announced. As this is a small service we gave 24 hours’ notice to ensure someone would be in when we called.

Alexandra Villa provides accommodation and personal care for up to two people with needs related to their mental health or learning disability. Accommodation is provided over one floor in two single bedrooms. At the time of the inspection one person was using the service.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was on an extended period of leave, the registered provider had notified us of this and made arrangements for another of their registered managers to cover this service. This covering manager supported the inspection on the day.

The person living at Alexandra Villas told us they felt safe and were well cared for. Staff knew about safeguarding vulnerable adults and to report concerns to a designated person within the provider organisation.

The home was domestic in scale and design. It was adequately decorated and maintained and outstanding issues from the last inspection had been resolved.

At the time of our inspection the levels of staff on duty and on call arrangements were sufficient to ensure safe care. New staff were subject to thorough recruitment checks. The registered provider had now recruited adequate staff to ensure the service had its required compliment.

Appropriate systems were in place for the management of people’s medicines. People were encouraged to maintain their independence, for example through retaining responsibility for managing their own medicines.

Staff were supported through the provision of mentoring, training, supervision sessions and annual appraisals, although recording of this was not always robust. Staff confirmed they felt well supported in their roles and spoke positively about the covering manager and their leadership and management of the home.

The service worked within the principles of the Mental Capacity Act 2005. People’s capacity to make decisions about their care and treatment was assessed and where appropriate, “best interest” decisions were made on people’s behalf. These involved relevant healthcare professionals as well as people’s friends and family members.

People were complimentary about the caring nature of the staff team. Staff had developed strong, caring relationships with the people they supported and were very knowledgeable about their individual needs, likes and dislikes.

People’s needs were assessed prior to them joining the service. Detailed, person-centred care plans were produced which guided staff on how to care for people. These included details of any preferences people may have. People and their representatives were actively involved in their care planning and were also encouraged to voice their opinions about the service in general.

People’s needs were reviewed on an on-going basis and action taken to obtain the input of other healthcare professiona

We carried out an unannounced comprehensive inspection of this service on 21December 2015 and 8 January 2016. Four breaches of legal requirements were found at that time. These related to breaches of regulations regarding safety, restrictions imposed on a person which were not subject to appropriate legal authorisation, staff training and governance (management) arrangements. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements.

We undertook this focused inspection on 11 August 2016 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 these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Alexandra Villa on our website at www.cqc.org.uk.

Alexandra Villa provides accommodation and personal care for up to two people with needs related to their mental health or learning disability. Accommodation is provided over one floor in two single bedrooms. At the time of the inspection there was one person accommodated in the home.

The service had a manager who had commenced the process of becoming registered with CQC. At the time of this inspection they were on extended leave. After the inspection the provider notified us that a registered manager for another service would oversee this home on an interim basis. 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 the provider had met most of the assurances they had given in their action plan and were no longer in breach with the majority of the relevant regulations.

Inappropriate restrictions were no longer imposed and the person concerned told us they could come and go freely. Staff training had commenced and a new manager had been appointed and was in the process of registering with the CQC. Some fire safety improvements had been implemented, although further work was required to ensure the fire alarm system was audible in all areas of the home. Quality and risk assurance arrangements had failed to incorporate and prompt improvements in relation to fire safety.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to relating to governance (quality assurance). You can see what action we told the provider to take at the back of the full version of this report.

We found that, where they were able, people living at the home agreed to their care and treatment. Where they could not give consent, formal processes were followed to make decisions about care that were in their best interests.

People were supported by sufficient numbers of skilled and experienced staff who understood their needs. They received care that was properly planned to ensure their safety and welfare, and that was adapted to meet their changing needs.

There were appropriate arrangements in place for people to be given their medication safely.

The provider had introduced more robust systems to keep check on the quality of the service that people received.

We spoke with one of the two people who use the service who told us she was happy at the home. She said she liked the staff, felt safe and got to do lots of activities that she enjoyed. The other person was not able to communicate with us and was out at a day centre at the time of our visit. We reviewed care records and spoke with staff to help us understand people’s experiences. We found that they were provided with personalised care and support to meet their needs and ensure their safety.

We carried out an inspection of Alexandra Villa on 21 December 2015 and 8 January 2016. The first day of the inspection was unannounced. We last inspected Alexandra Villa in September 2013. At that inspection we found the service was meeting the legal requirements in force at that time.

Alexandra Villa is a two bed care home that provides care and support to people with learning disabilities. Nursing care is not provided. At the time of the inspection there was one person accommodated there, with a second person accommodated on an emergency basis for one night at the time of our second visit.

The service did not have 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.

The person living at Alexandra Villas told us they felt safe and were well cared for, although they wanted to move to a more independent setting. Staff knew about safeguarding vulnerable adults and to report concerns to a designated person within the organisation.

The home was domestic in scale and design. It was adequately decorated and maintained, but fire safety issues identified during August 2015 remained outstanding.

At the time of our inspection, the levels of staff on duty were sufficient to ensure safe care. However, because there were only two staff employed there this meant they worked three days on and three off over a continual basis; including sleep-ins. One staff member was working elsewhere, meaning there was one permanent member of staff. New staff were subject to thorough recruitment checks.

Medicines were managed safely with records completed correctly.

As Alexandra Villa is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found the overseeing line manager was familiar with the processes involved in the application for a DoLS, although we were told this was not required. Attempts by a staff member to impose restrictions on specific occasions had resulted in escalations in behaviour that challenged the service. Learning from these incidents appeared limited. Financial restrictions were subject to arrangements previously agreed with the Court of Protection.

The permanent worker had received no training since their recruitment in May 2015. Importantly, training on adult safeguarding, behaviour management, other care related topics and training on the Mental Capacity Act and DoLS had not been undertaken. They received supervision and support from a visiting line manager.

Staff kept nutritional records and helped support the person’s health needs, working with external professionals where necessary. This ensured the person’s medical needs were met.

Activities were arranged in the community, including volunteering and leisure activities which were regularly accessed. We observed staff interacting positively with the person living at Alexandra Villas. We saw staff were respectful and ensured privacy and dignity was maintained. The staff member was able to explain the person’s needs and we saw care plans were person centred.

We found there were systems to assess and monitor the safety and quality of the service, which included feedback from the person receiving care. These required refinement to make them more effective and for reflection and learning from incidents to take place. There was no registered manager in post. We had not been notified of changes in management when the previous registered manager left this post and then later left the organisation.

We made a recommendation about staffing deployment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to relating to safety, consent, staff training and governance. You can see what action we told the provider to take at the back of the full version of this report.