About the service: All Hallows is a residential care home that provides accommodation and personal care for up to six people with learning disabilities and autism. Five people lived at All Hallows when we inspected. Each person had their own bedroom and shared the lounges, dining room and other facilities. The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service:

People who lived at All Hallows had limited verbal communication and comprehension. They were not able to converse in any depth with us. We were contacted by two families who were very positive about the care and support staff provided at All Hallows. One relative said, “Despite setbacks, [family member] has made amazing progress since first joining All Hallows and clearly loves and trusts the staff.” We also spent time with people and observed interactions with staff, spoke with social care professionals and looked at comments made on the home’s surveys. This helped us to understand people’s experience at All Hallows.

The registered manager was on long term leave when we inspected. An acting manager was managing the home until the registered manager’s return.

People indicated they felt safe and enjoyed living at All Hallows and staff were kind and friendly.

Care planning involved people, gave them choice and guided staff in how to provide care that met people's needs. Staff supported people to manage risks and to stay safe. Medicines were managed safely and according to national guidance.

People were cared for by staff who had been recruited safely, appropriately trained and supported. Staffing was sufficient to provide safe care. Staff had skills, knowledge and experience to support people with their care and social needs. People had opportunities to be involved in activities and leisure interests of their choice and were known and involved in the local community.

People were helped to eat and drink the right amount to keep them healthy. Meal times were relaxed and organised around people's individual daily routines. People were supported to attend healthcare appointments to assist their health and wellbeing. Staff understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. Their end of life wishes were recorded so staff were fully aware of these.

The house was clean and maintained and staff practised good infection control. People had been able to personalise their rooms with their own furniture and personal effects.

People were helped 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. Staff assessed people's capacity to make decisions and supported them with making decisions. Staff were given guidance in how to manage complaints. Although people were unable to formally complain, information was available for their representatives. Also staff often knew through people’s non-verbal communication when they were unhappy with something.

Staff worked in partnership with other organisations to make sure they followed good practice and

people in their care were safe

The inspection visit took place on 28 February 2018 and was unannounced. All Hallows is a care home which provides care for up to six adults with autism and associated learning disabilities. It is a large detached property, in the Bispham area of Blackpool. The provider of All Hallows is Autism initiatives, a national care organisation which supports people with Autistic Spectrum Disorders and associated learning disabilities. At the time of our inspection visit on 28 February 2018 five people lived at the home. People supported in All Hallows had complex care needs and limited verbal communication and were not able to converse with us. Neither were families available to speak with us. However we spent time with people and observed interactions between staff and people who lived at All Hallows and spoke with social care professionals.

“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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.”

There was not a manager registered with CQC. The previous registered manager had left the service in November 2016. The service had attempted to recruit and register a new manager since this time. They had recruited three managers who had left before completing the registration process. This had left staff without stable leadership over this period and had affected the governance of the home.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 inspection on 20 November 2015 the service was rated Good.

At this inspection carried out on 28 February 2018 the service was rated Requires Improvement. This is the first time the service has been rated Requires Improvement.

Care plans were personalised and involved people and their families, but some important health information was not documented or was not available on inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.

The management team completed audits to assess and monitor the quality of the service. However these had not always been effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the provider had failed to ensure methods to assess and monitor the quality and safety of the service and mitigate the risk to the health, safety and welfare of service users provided accurate information.

The service had not discussed with people and documented their preferred end of life wishes.

We have made a recommendation about this.

There were procedures in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. We saw risk assessments were in place which provided guidance for staff in how to safely support people. This minimised potential risks.

People indicated with their relaxed and cheerful reactions and responses to staff that they were comfortable and content at All Hallows. We observed staff spoke with people in a respectful way and were sensitive and caring when supporting people. They responded promptly when people needed assistance. Professionals spoken with were confident people were supported in a caring and responsible way.

There were enough staff to support people with personal care and social and leisure activities. People

This inspection took place on 20 November 2015 and was a short notice inspection. This meant the staff and provider knew 24 hours before the inspection we would be visiting. This was because as a small home for people with learning disabilities, people are usually out during the day and we wanted to arrange a time when it would be convenient to speak with people who lived at the home.

All Hallows is a care home which provides care for up to six adults with autism and associated learning disabilities. It is a large detached property, in the Bispham area of Blackpool. Accommodation is provided in six single bedrooms. There is a garden at the rear of the home. The home is close to shops and local amenities. At the time of our inspection there were six people who lived at the home.

The service was last inspected in April 2014. The service was meeting the requirements of the regulations that were inspected at that time.

There was 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.

During this inspection, there were procedures in place to protect people from abuse and unsafe care. This minimised risks to people. People indicated they were safe and happy at All Hallows. Relatives said they felt their family member was safe and well looked after at All Hallows.

We looked at how the home was being staffed. We saw there were enough staff to provide safe care and support in the home and the local community.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working in the home. Staff had the skills, knowledge and experience needed to care for people.

Staff managed medicines safely. They were given as prescribed and stored and disposed of correctly. People were supported to be able to manage their own medicines if they were able to do so safely. People felt staff gave them their medicines correctly and when they needed them.

The home and equipment had been serviced and maintained as required. The home was clean and hygienic when we visited with no unpleasant odours.

Staff understood the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). We saw staff were working within the law to support people who lacked capacity to make their own decisions.

People were offered a choice of healthy and nutritious meals. Staff made sure people’s dietary and fluid intake was sufficient for good nutrition. One person said, “The tea is good. I like it.”

People had health action plans which provided information about the person’s health needs. They also had a hospital passport to provide information to hospital staff if people went into hospital. We saw people had regular health checks to assist them to remain healthy.

We saw there were a variety of activities available geared towards people’s likes and dislikes. A relative told us, “There are lots of different activities for [my family member] to do.”

We observed interactions between individuals and staff. Staff ‘listened’ to and observed non-verbal communication and to any changes in behaviour which helped them understand if a person was unhappy.

We asked relatives if they knew how to raise a concern or to make a complaint if they were unhappy with the care their family member received. They said they felt confident any member of staff would deal with any concerns appropriately.

There was a transparent and open culture that encouraged people to express any ideas or concerns. Senior staff sought people’s views and dealt with any issues of quality quickly and appropriately.

The inspection was led by one inspector. Information we gathered during the inspection helped answer our five 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 is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

There were six people living at All Hallows when we inspected. They all had communication difficulties and were unable to have a detailed conversation about the care and support they received. However where possible we talked with people in a general way and we observed how people were supported by staff.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Relatives told us they felt that their family member was safe and their rights and dignity were respected. They told us they were receiving safe and appropriate care which was meeting their needs. One relative said, “We are sure our son is safe and happy at All Hallows. The staff are kind and supportive and want the best for everyone.” Another relative commented about their family member’s care, “We feel happy that All Hallows is the best place to meet all his needs.”

The home had policies and procedures in relation to the Mental Capacity Act and best interests meetings had been carried out to assist with particular decisions. Staff were aware of Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Is the service effective?

People’s health and care needs had been assessed with them, or where appropriate their relatives. Specialist dietary needs had been identified where required. We saw that care plans were up to date and reflected people’s current needs. Relatives confirmed that they were able to see people in private and that they could visit whenever they wished. One relative told us, “We see him frequently and can just turn up at the home at any time.” There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Is the service caring?

People were supported by kind, attentive and informed staff. We saw that staff showed patience and gave encouragement and guidance when supporting people. Good care practices were observed. We saw people expressing pleasure when interacting with staff. Relatives were very happy with the support their family members were receiving. One relative told us, “The staff have always been very approachable and we are welcome to discuss anything at any time.” Another relative said, “They manage any behaviour really well, they do not make a drama out of issues. Any incidents are dealt with calmly and positively.”

Care plans had been maintained, recording the care and support people were receiving. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We found a range of meaningful work, educational, social and leisure activities were organised to encourage skills and enjoyment. We observed people getting ready to participate in these and they were enthusiastic about them. Relatives said how much they benefitted their family members. One relative said, “There is always so much going on. Staff also make sure that they support our son so he is always involved in all our family occasions and celebrations.”

Relatives said they were happy with their family member’s care and had no concerns or complaints. One relative told us, “The staff have always been very approachable and we are welcome to discuss anything at any time.”

Is the service well-led?

The service had a quality assurance system in place. Records showed that any identified problems were addressed promptly. Staff reflected on whether any incidents could have been managed more effectively or if lessons could be learnt. As a result of these measures the quality of the service was continuously improving

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. Staff meetings were held regularly so staff could discuss support needs and any changes in care or routines. Staff also received regular supervision to assist with their development. This helped to ensure that people received a good quality service at all times.

Relatives were complimentary about the care and support their family member received. One relative said, “The manager has been in post for a number of years. She is very approachable and involves us fully. We can talk to her or to any of the staff to discuss anything.”

There were six people living in the home when we visited. All had communication difficulties and were unable to have a detailed conversation about the care and support they received. However where possible we talked with people in a general way and we observed how people were supported by staff. We met all six people.

We observed staff communicating with people. We saw that they were able to communicate effectively together. We observed people being treated with respect and dignity

Person centred care records were in place providing information about people. These were updated frequently and showed that people were involved in decisions.

All Hallows was maintained and decorated for the comfort of the people living there. Bedrooms were personalised according to people’s wishes.

Relatives felt the home was staffed well enough to provide their family member with individual and group activities and outings. They felt there were always enough staff available

There were six people living in the home when we visited. All had communication difficulties and were unable to have a detailed conversation about the care and support they received. However where possible we talked with people in a general way and we observed how people were supported by staff. We met five people, spending more time observing and interacting with two of the people. We observed people being treated with respect and dignity and being encouraged to carry out tasks in the way which they wanted to. We spoke with relatives of some of the people who lived at All Hallows. They said that their family member was treated with respect and that they were involved in decisions about care. They told us routines in the home were flexible and people were encouraged to make their own decisions about their daily routine and chose what activities they wanted to get involved in. One person told us they were having a meal out then going out playing golf which they really enjoyed.

We spent some time with two people, one of whom showed us their bedroom which was well personalised and clearly showed their choice of hobbies and activities. People were clearly involved in choices of work opportunities and leisure activities they were involved in. This included volunteer work they carried out at a farm centre and at a recycling centre. One person told us a little about his job at the farm and how he enjoyed it. He also said, “I like golf.” And indicated he had hit the golf balls a long way on the driving range.

Relatives that we spoke with told us they were very happy with the care provided to their family member. One relative told us “We have been delighted with the care and support at All Hallows.” Another relative said, “They have given our son his confidence and self esteem back.” Relatives said the staff were kind and supportive and encouraged their family member to try new activities and experiences. A relative said, “The staff are really good here. They support people really well and also communicate well with parents.”

Relatives said the staff were good and they felt their family member was safe and well looked after at All Hallows. They told us that they would tell the manager if they were concerned about anything and had every confidence that any issues would be dealt with. One relative said, “I have never had any concerns about the staff or the care at All Hallows, but I would feel comfortable talking to the manager or staff if I was not happy with the care they provided.” Staff were clear on their responsibilities regarding safeguarding. One member of staff said, “I am not afraid to challenge and I will challenge if I think something is wrong”. Another member of staff said, “I am very happy with the way we support people here but if I saw anything wrong I would report it immediately. If needed, I would keep on reporting it until it was dealt with”.

Staff told us they had an intensive induction when joining the company, which taught them how to support people well. They also said they had frequent opportunities for training and were encouraged to develop their skills and knowledge. One member of staff said, “The training here is excellent and the management so supportive”. Relatives said they felt the staff were very well trained and knowledgeable.

Relatives spoken with said that people were well supported by the manager and staff. They said staff communicated well with people and their relatives. They also told us that staff observed the non verbal communication and behaviour of people to check if they were worried about anything or wanted to do things differently. Relatives and staff said that the manager was very approachable and supportive and always there if they needed her. Staff said they felt well supported by the management team.