This inspection took place on 15 January 2019 and was unannounced.

Autonomy: Victoria and Elizabeth is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to nine people across two adapted buildings.

Autonomy: Victoria and Elizabeth provides care and accommodation to up to nine younger adults. The service is based in two separate buildings, one called Victoria and the other Elizabeth. It specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs. Accommodation is provided in a range of apartments situated on a private residential estate. At the time of our inspection there were eight people using the service.

At our last focussed inspection in July 2018, we rated the service as requires improvement. The service was rated as requirements improvement in Safe and inadequate in Well-led. This was because risks to people were not always assessed and people's safety not always monitored. Safeguarding incidents had not been reported to CQC as required. There were no comprehensive systems in place to monitor the quality of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-led to at least good.

At this inspection we found the provider had made some improvements but the overall rating has remained as requires improvement.

There was 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 quality of the service was monitored through limited audits carried out by staff and the management team. These had not been effective at identifying the areas of concern we found.

Staff recruitment processes did not always protect people from being cared for by unsuitable staff. Records did not demonstrate that recruitment checks had always been completed before staff started work.

Safeguarding incidents that had occurred within the service were not always notified in a timely manner to CQC to ensure appropriate action was taken to prevent the risk of future harm for people.

Medicines were in the main managed safely. Further improvements were needed to ensure recordings were detailed and systems were in place to ensure medicines were stored safely.

Risks to people were assessed and monitored regularly. Records included detailed guidance and information on the measures staff needed to follow to keep people safe.

People felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

There were sufficient staff to meet people's needs. People received care from a consistent staff team who had the knowledge and skills to meet their needs.

People's health and well-being was monitored by staff and they were supported to access health professionals.

People were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and staff. Staff supported people to achieve as much independence as possible and were respectful of people's diversity and dignity.

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 support this practice.

People's care and support needs were monitored and reviewed to ensure care was provided in the way they needed. People had been involved

We carried out an unannounced comprehensive inspection of this service on 7 February 2017. No breaches of legal requirements were found and the service was rated as ‘Good’. On 17 July 2018, in response to concerns we received relating to the ‘Safe’ and Well-led’ areas of this service, we carried out an unannounced focused inspection. This was to check the provider continued to meet their legal requirements in order to provide a ‘Safe’ and ‘Well-led’ service.

This report only covers our findings in relation to ‘Safe’ and ‘Well-led’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria and Elizabeth on our website at www.cqc.org.uk.

Victoria and Elizabeth is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Victoria and Elizabeth provides care and accommodation to up to nine younger adults. The service is based in two separate buildings, one called Victoria and the other Elizabeth. It specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs. Accommodation is provided in a range of apartments situated on a private residential estate. At the time of our inspection there were eight people using the service.

The service has a registered manager. This 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.

Ineffective quality monitoring systems had failed to pick up and address shortfalls at this service. Some care plans and risk assessments were not always complete and had not been reviewed and updated as planned or following serious incidents. Serious incidents reports did not always show appropriate action being taken following each incident.

Safety issues at the premises and fire and food safety concerns had not always been addressed despite the registered persons being aware of these. The registered persons had failed to notify CQC about incidents that affected the people using the service.

It was difficult to ascertain the actual staffing levels at the service as staff told us people often declined their allocated one-to-one or two-to-one hours and there were no records of what staff were doing at these times. Staff were not always been safely recruited. Medicines were mostly well-managed.

Staff had good relationships with the people using the service and people and staff were relaxed in each other’s company. Staff reassured people and had a positive approach toward them. The service had an open and inclusive culture. People trusted the registered manager and sought him out if problems arose. People and relatives told us they were satisfied with the service provided.

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

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

This was an unannounced inspection that took place on 7 February 2017.

Victoria and Elizabeth provides care and accommodation to up to nine younger adults. The service specialises in the care of people diagnosed with learning disabilities, autistic spectrum disorders, and mental health needs. Accommodation is provided in a range of one- to six-bedded apartments situated on a private residential estate. At the time of our inspection there were eight people using the service.

The service has a registered manager. This 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.

People said they felt safe using the service. There were enough staff on duty to keep people safe, meet their needs, and enable them to take part in activities. The staff were experienced, well-trained, and knowledgeable about the needs of the people they supported. People told us the staff were caring and kind.

Staff supported people to be independent. People had progressed since coming to the service, for example some people had begun to use public transport independently. Records showed that activities were central to the support provided and people took part in educational and leisure pursuits on a daily basis.

Staff were knowledgeable about people’s emotional states and any triggers that might cause their anxiety to increase. They worked closely with mental health, learning disability, and other relevant professionals to provide people with consistent ongoing support. They understood people’s healthcare needs and enabled them to access healthcare services when they needed to.

Each person had their own individual food and drink budget and chose, shopped for, and prepared their own meals with staff assistance where necessary. We observed one staff member assisting a person to prepare their own meal. The atmosphere was calm and the setting homely and domestic. The staff member and person appeared to have a good, trusting relationship and to enjoy each other’s company.

Staff treated people with dignity and respect. The design of the environment helped to ensure people’s privacy was promoted. Each person had a spacious bedroom with a double bed, an ensuite toilet with a shower or bath, and a large television set. This meant that if people wanted to spend time away from others they could do this in comfort with the facilities they needed at hand and private to them.

People were involved in how the service was run. They had the opportunity to talk with managers and staff every day and share their views with them. The service had an open and friendly culture. Managers and staff were welcoming and enthusiastic about their work. They were keen to discuss ‘best practice’ and to listen to people’s suggestions about the service. This had led to a number of positive changes being made to the environment, activities, and access to the wider community.

Some improvements were needed to the service. Staff supported people to manage risks but appropriate risk assessments were not always in place. Care plans provided good information with regard to people’s behavioural issues but needed more detail when non-behavioural issues were being addressed. Improvements were needed to the way medicines were managed and how staff recorded incidents.