21 Potterill Lane is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of four people with a learning disability. Accommodation is provided in a large detached house with parking at the front of the building and a garden to the rear. The service is situated in the village of Sutton, close to local amenities.

We undertook this unannounced inspection on 28 November 2016. There were three people using the service at the time of our inspection. At the last inspection on 23 April 2015, the registered provider was compliant in all areas we assessed.

At this inspection we found there was a registered manager in post. The service is required to have a registered manager. 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.

We found improvements were required to ensure monies belonging to people who used the service were held securely. During our inspection we saw a number of safety deposit tins were stored in an unlocked safe.

We found improvements also needed to be made to ensure records were accurately maintained in the service. This included fridge and freezer temperatures and food temperatures not being fully completed. The quality monitoring system had not been effective in identifying these shortfalls.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff and relatives involved.

The environment was found to be clean and tidy throughout, but improvements were required to ensure the safe storage of disposable gloves.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns.

Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people. This included training considered essential by the registered provider and also specific training to meet the needs of the people they supported.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked the capacity to agree to it. When people were assessed as not having capacity to make their own decisions, meetings were held with relevant professionals and other people with an interest in the care such as family members to discuss options and make decisions in the person’s best interests.

Medicines were ordered, stored, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

We found staff had a caring approach and found ways to promote people’s independence, privacy and dignity. Staff provided information to people and included them in decisions about their care and support.

People who used the service had assessments of their needs undertaken which identified any potential risks to their safety. Staff had read the risk assessments and were aware of their responsibilities and the steps to minimise risk.

We found people’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. People who used the service received care in a person centred way with care plans describing their preferences for care and staff followed this guidance.

Menus were varied and staff confirmed choices and alternatives were available for each meal

We were unable to gain the views of all the people who used the service when we visited due to their complex needs. Therefore we also observed how support was provided, reviewed records and spoke with staff to help us understand their experiences.

We found people were involved as much as possible in decisions about care and treatment. Decisions were made in people’s best interest when they were assessed as not having capacity to make the decision. We saw staff offering assistance and communicating with people. It was clear that people consented to the practical care given.

We found people received the care and support they needed. Each person had a care plan which detailed the support they required and how they liked it delivering. The files we saw also outlined their preferences and any risks associated with their care. People were involved in a variety of social activities and carried out day to day living skills, such as shopping.

There were systems in place to make sure people received their medicines safely and we saw staff had completed training in this subject.

We found sufficient staff were available to meet the needs of the people who used the service.

We saw there were systems in place to gain people’s views and check if staff were following company policies.

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people’s needs and provided reassurance and guidance when needed.

21 Potterill Lane is registered to provide care and accommodation for four people who have a learning disability. It is located on the outskirts of Hull; local facilities and amenities are within walking distance.

This inspection took place on 23 & 24 April 2015 and was unannounced. At the last inspection on 29 August 2013, the registered provide was complaint with all of the regulations that we assessed.

The service had 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 people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care to help us understand the experiences of people who could not talk with us. We saw positive interactions between people who used the service and staff throughout the inspection process. It was evident people were supported by staff who knew the needs and preferences for how care and support was to be delivered. People appeared calm and content in their surroundings.

People who used the service were supported to make decisions about aspects of their daily lives. Staff were aware of the need to follow the principles of the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS]. This is legislation that protects people who are not able to consent to care and support and ensures people are not unlawfully restricted of their freedom or liberty. The Care Quality Commission is required by law to monitor the use of DoLS. DoLS are applied for when people who use the service lack capacity and the care they require to keep them safe amounts to continuous supervision and control.

People who used the service were protected from abuse and avoidable harm by staff who knew how to keep them safe and had been trained to recognise the signs of potential abuse. Relevant checks were carried out to ensure staff had been recruited safely and had not been deemed unsuitable to work with vulnerable adults.

Staff we spoke with said they completed an in-depth induction programme and were supported during team meetings and supervisions from their line manager. We saw that staff completed a range of training to enable them to meet the specific needs of the people who used the service.

People were supported to maintain a healthy, balanced diet and to receive adequate nutrition. Staff completed food and fluid intake charts and contacted relevant health care professionals when concerns were identified.

Medicines were ordered, stored, administered or disposed of safely. People were supported to self-medicate when possible and when this was not possible people received their medicines as prescribed from staff who had completed relevant medication training.

Staff we spoke with described how they treated people with dignity and respect during their interactions. We observed staff interacting with people in a positive, kind and enabling way. People were encouraged to be as independent as possible and were given choices about which staff supported them.

A complaints policy was in place at the service which was also available in an easy read format which made it more accessible for the people who used the service. We saw when complaints were received they were responded to and appropriate action was taken to improve the service when required.

People who used the service were supported to give their views about the care, treatment and support they received which was used to develop the service when possible.

The registered manager understood their responsibilities and reported accidents, incidents and other notifiable incidents as required.