The inspection took place on 26 January 2017 and was unannounced. At the last inspection on 10 September 2015 the service was in breach of legal requirements relating to the safety of the building, risks associated with the environment and training of care staff. We found that improvements had been made in these areas and the service was no longer in breach.

Autus Court provides accommodation with personal care for up to four people with learning difficulties and mental health needs. Four people were using the service at the time of this inspection.

The service had a registered manager in post at the time of the inspection. 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.

There were robust systems in place to safeguard people from harm. We saw where the home gathered detailed information about incidents and learned from them. Risk assessments were thorough and had practical actions in place to minimise the risk of harm occurring. The service had a positive approach to risk taking and encouraged people to take appropriate risks in a measured way.

There were enough staff on each shift to meet the needs of people, both in the home and out of the home. People had one to one staff supporting them and these were in place on the day of our visit.

Staff had a good understanding of the Mental Capacity Act 2005 and the care that was provided was in keeping with these principles. Consent documents were in place and best interest decisions were evidenced and reflected the decisions that people needed support with.

The food was healthy and people had a choice in what they ate and contributed to the shopping and cooking. Mealtimes were shared and people were happy with the food and were smiling or laughing throughout.

Staff training had improved since our last inspection and staff were suitably trained and supported to meet people’s needs.

We saw kind and caring interactions with people and people were involved in decisions about how they spent their day. People were offered stimulating and varied activities at different points in the day.

Care documents and the approach of care staff was person centred and had the preferences of the individual at the core of it.

Staff felt supported by the registered manager, had regular supervisions and shared values about how the service should support people.

The inspection took place on 10 September 2015 and was an unannounced comprehensive inspection. At our last inspection on 4 and 12 March 2015 the service was in breach of legal requirements relating to consent to care and treatment, care and welfare of people who use services, safeguarding people who use the service from abuse, management of medicines, and assessing and monitoring the quality of service provision. We told the provider to take action to ensure that these legal requirements were met. The provider produced an action plan telling us how they would achieve this.

The service provides accommodation with personal care for up to six people with learning difficulties and mental health needs. Four people were using the service at the time of this inspection.

The current acting manager had applied to become the registered manager and was awaiting a fit person interview. 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.

At this inspection we found the provider had made improvements. We saw that medicines were managed safely and appropriately and people received their medicines as prescribed. Applications for Deprivation of Liberty Safeguards were made, care and treatment was planned and delivered to meet people’s needs, planned programmes of activities were in place,

We observed good interactions between staff and people using the service. Staff knew the people they were supporting and understood their needs. However, people’s care files contained out of date information and Health Action Plans (HAP) were not always updated following healthcare appointments and referrals to healthcare professionals were not always made in timely manner, although staff felt supported by senior management and knew people’s needs, some staff had not yet received training in specialist areas such as autism awareness. Therefore they may not have up to date knowledge about people’s conditions to better help them to support people. We saw that the service had a service improvement plan which identified most of the issues we found on the day of our inspection, however, some of these actions were still to be completed.

We found the service was in breach of Regulations relating to the safety of the building and risks associated with the environment.

You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We met with all four people who live in the home and spoke with three people and some relatives, three members of staff and the deputy manager. The registered manager was not on duty at the time of our inspection.

This is a summary of what we found:

Is the service safe?

People felt involved in making decisions about their care and treatment. Their care plans had been reviewed monthly and appropriate changes had been made where their needs had changed. Staff had adhered to the provider’s policy on confidentiality.

The premises were reasonably clean and tidy. A relative said the environment was clean and they were quite satisfied with the arrangements and service provided. Equipment had been appropriately checked, such as fire equipment, which had been serviced regularly.

There was a sufficient number of skilled and experience staff to care for people. The deputy manager said the staffing level had been regularly reviewed and was based on the number of people using the service and their dependency level. This had ensured people’s needs were being met appropriately.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. Staff had received training and had an understanding of when an application should be made and how to submit one to be authorised by the local authority. There had been four cases requiring the application of DoLS since the last inspection.

Is the service effective?

People’s personal, social and healthcare needs had been closely monitored and provided for. Their care needs had been reviewed regularly and risk assessments had been carried out where appropriate.

The service had worked closely with the local authority and other healthcare professionals, including the community mental health team, to ensure people had received appropriate care and treatment.

Staff had knowledge of people’s care needs and assisted them accordingly. They had received appropriate training to help them care for people who used the service.

A member of staff said, “People are encouraged to lead an independent lifestyle. We prompt them to clean their rooms and do their own laundry. We encourage them to assist with shopping and cooking.”

However, a relative felt communication between staff and relatives could be better. They felt they could be contacted more often and could be kept informed of their relative’s progress.

Is the service caring?

People and a relative said the staff were caring. When asked about the care provided, one person said, “It’s good. They help me cook and clean my room.”

One relative said they had visited the care home and had found the staff caring and their relative well looked after.

We observed staff interacted well with people throughout the day. The staff were gentle, patient and respectful. A member of staff commented, “We try to create a family atmosphere and we all work together to improve people’s quality of life.”

Is the service responsive?

People were treated with respect and dignity and had been encouraged to get involved in making decisions. They were given choices and their preferences had been taken into account when planning the menu and activities. The weekly activity records were detailed and reflected each person’s preferences and lifestyle.

A person confirmed they had been offered cultural dishes which they liked. Care needs were met safely and appropriately. Some people required two members of staff to accompany them on trips out in the community, to keep them safe.

One person said, “Staff are good. They take me out. I go out to the shops and to the library.”

The provider had taken steps to provide a safe and comfortable environment for people to live in. A refurbishment programme was planned and work would commence in coming weeks.

Is the service well-led?

People and relatives were complimentary about the service and the care provided.

The service had an effective quality monitoring system, which included stakeholder surveys and audits.

Staff knew their roles and responsibilities. They were aware of the service’s plan and there was a clear reporting structure. Each member of staff had regular supervision and an annual appraisal. Staff said they felt supported by the management and were given appropriate training and a personal development plan.

The registered manager would shortly be taking up a new post within the provider organisation, Precious Homes Ltd. The deputy manager for the service had been appointed as the new home manager and would be applying for registration with CQC. The provider would be informing the Care Quality Commission in due course.

We undertook this responsive inspection because the Commission received anonymous concerns regarding people’s care and welfare.

Because people at the home were not always able to communicate verbally with us, we spent time observing interactions between staff and all the people using the service to see what effect those interactions had on people’s well-being.

People we spoke with were positive about the care and treatment provided at the home. One young person commented “I like this care home.”

We observed staff supporting people in a friendly, patient and professional manner. Staff understood how people expressed their needs and preferences and responded appropriately. We saw that the way staff were interacting with people had a positive effect on their well-being. Staff had a good understanding of the needs of the people they supported as identified and recorded in their care plans.

Care plans contained risk assessments for each person. These assessments acknowledged the risks faced by people using the service and included strategies for minimising those potential risks.

People we spoke with told us that they felt safe with the staff who supported them. One young person told us “the staff treat me nice.”

Staff told us about the organisation’s “whistle blowing” policy, explaining how they could report any suspicions of abuse or concerns about care practice. They told us that the management was "very open" and listened to any concerns they might have.

During this inspection we met and spoke with all of the people using the service. People we spoke with confirmed that staff communicated well with them and asked for their permission before any care or support took place. They told us that staff respected their wishes and preferences.

We asked people what they thought about the quality of care they received at Autus Court. People were positive about the service and confirmed that the management and staff often asked them for their views about the quality of care they received and if there were any suggestions for improvements.

People were positive about the care and treatment they received at the home. They confirmed that staff assisted them when they needed support and that staff were very helpful and knew their needs. One person commented, “they help me out.”

People told us they had good access to health care professionals such as doctors, dentists and opticians and we saw that staff assisted people to attend healthcare appointments when needed.

People told us that they felt safe with the staff who supported them. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the care worker if they needed to. Effective recruitment and selection processes where in place and appropriate checks were undertaken before staff began work.

We carried out this inspection following concerns raised about the quality of care provided at the home.

We considered our inspection findings to answer questions we always ask; 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. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Although staff knew what action to take should they suspect abuse, the provider failed to ensure that deprivation of liberty safeguards (DoLS) were in place for people whose liberty had been restricted.

Medicines were not managed appropriately, overall poor stock control and administration.

Is the service effective?

People had support plans and risk assessments. However, care and treatment was not always planned and delivered to meet people's individual needs.

Is the service caring?

Most of the people living at the home had complex needs and could not tell us about their experience. We observed some good interactions between staff and people

People had their privacy and dignity was respected

Is the service responsive?

People took part in activities of their choice. However, we saw that none of the people living at the home had a planned programme of activities.

Is the service well-led?

The service was not well-led.

Although there were quality monitoring systems in place, these were not effective in ensuring that medication was accurately managed. Medicines audits did not ensure that returns were monitored and balances were accurate.