22a – 26 Middlesex Road is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of six people with a learning disability. Accommodation is provided in four bungalows in a residential area close to local amenities. Two bungalows are designed for single occupancy and the remaining for two people to share.

We undertook this unannounced inspection on the 10 February 2017. At the time of the inspection there were six people living at the service.

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.

At our last inspection of the service on 25 February 2016 we found improvements were required to ensure confidential records and monies belonging to people who used the service were held securely in one of the four bungalows. We found the cupboard where personal records were stored was unlocked and the key had been left in the lock, which meant confidential files were not being stored securely. These issues meant the registered provider was not meeting the requirements of the law regarding confidentiality of records.

We found further improvements were also needed to be made to the records maintained within the service. This included allocated work sheets and hot food temperatures not being fully completed and incorrect temperatures being maintained of freezer records. Further improvements were also required to stop the practice of fire doors being wedged open and to the safe storage of disposable gloves and bags.

At this inspection we found the registered provider had fitted a keypad to the outside of the laundry room door, to prevent any opportunity for keys being left in the door and unauthorised access. This meant the registered provider had achieved compliance with the regulation. Fire doors had been fitted with electronic hold back devices and disposable gloves and bags were stored securely. A newly introduced quality assurance system was in place which audited all records maintained within the service and ensured they were kept up to date within identified timescales.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Accidents and incidents were investigated and action was taken to prevent their future reoccurrence. Staff had been recruited safely and relevant checks were completed before they commenced working within the service. Medicines were ordered, stored and administered safely and people received their medicines as prescribed.

People were supported by sufficient numbers of staff who had the skills and experience to carry out their roles effectively and who received effective levels of support, supervision and mentorship. Staff understood how to gain consent from people who used the service; the principles of the Mental Capacity Act 2005 were followed when people could not make specific decisions themselves. People were supported to eat a healthy diet and drink sufficiently to meet their needs and were supported by a range of healthcare professionals to ensure their needs were met effectively.

People who used the service and their relatives told us they were supported by kind, caring and attentive staff who knew them well and understood their preferences for how care and support should be delivered. We saw people were treated with dignity and respect throughout our inspection. It was clear staff were aware of people’s preferences for how care and support should be provided. Staff understood their responsibility to ensure people’s private and sensitive information was treate

22a – 26 Middlesex Road located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of six people with a learning disability. Accommodation is provided in four semi-detached bungalows in a residential area close to local amenities.

We undertook this unannounced inspection on the 25 February 2016. At the time of the inspection there were six people living at the service.

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.

We found improvements were required to ensure confidential records and monies belonging to people who used the service were held securely in one of the four bungalows. We found the cupboard where personal records were stored was unlocked and the key had been left in the lock, which meant confidential files were not being stored securely. These issues meant the registered provider was not meeting the requirements of the law regarding confidentiality of records. You can see what action we have asked the provider to take at the back of the full version of this report.

We found further improvements were also needed to be made to the records maintained within the service. This included job sheets and hot food temperatures not being fully completed and incorrect temperatures being maintained in freezer records.

We found the environment was clean and tidy, but improvements were required to stop the practice of fire doors being wedged open and to the safe storage of disposable gloves and bags.

People we spoke with told us they felt safe living in the home. The staff understood the procedures they needed to follow to ensure people were kept safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

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. However we found in one area of the service staff had not considered the potential for financial abuse by leaving a key in the safe of an unlocked cupboard. There were policies and procedures available to guide them.

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 people they supported.

People who used the service had assessments of their needs undertaken which identified any potential risks to their safety. Staff had read risk assessments and they were aware of their responsibilities and how to support people in order to minimise risk.

We found people’s care plans were written in a way that clearly described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for people to understand by the use of pictures and symbols. We saw evidence to demonstrate that people and their relatives were involved in their care planning.

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 support and care.

People’s nutritional needs were met and people were supported to shop for food supplies and were assisted to prepare meals. We saw staff monitored people’s health and responded quickly to any concerns. People received their medicines as prescribed and had access to a range of professionals for advice, treatment an

The inspection was carried out by an adult social care inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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 and 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 caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service and their relatives completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

• Is the service responsive?

Staff knew the people they cared for and understood their preferences and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated periodically.

• Is the service safe?

Systems were in place to make sure the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

Staff had completed training in how to safeguard vulnerable adults. This meant that people were protected from abuse as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly so people who used the service were not put at unnecessary risk.

• Is the service effective?

People’s health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in people’s care plans where required.

The home had been adapted and had specialised equipment to meet the needs of people with physical impairments.

• Is the service well led?

The service had quality assurance systems in place. Records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

We used a number of different methods to help us understand the experiences of people using the service, because the people who used the service had complex needs which meant they were not all able to tell us their experiences. One person told us that they were happy living in the home and that they like the staff who supported them.

A relative told us, “We could ask for a better place than this, they do a smashing job.”