Baylis Place is a ‘care home’. People in care homes receive care and accommodation as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. This purpose built accommodation is provided in spacious single bedrooms all with en suite facilities. The accommodation is split over two floors and there are several communal areas, two dining areas, two kitchens, a laundry and a self-contained flat. There is a large secure garden to the rear of the building. The service is situated within walking distance of local shops, amenities and public transport.

At the time of our inspection on 29 March and 19 April there were 11 people living at the service. 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.” Registering the Right Support CQC policy

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 manager had registered with the CQC in July 2017.

Governance of the service had improved. Audits were in place to ensure records were fully completed and maintained in relation to people’s care. Risk assessments and behaviour support plans were found to be more detailed; identifying triggers and actions staff should take to support people, including details of when approved interventions would be used and in which circumstances.

Behaviour support plans were found to be regularly reviewed and updated and de briefing took place following each incident. All notifiable incidents had been reported to CQC in a timely way since our last inspection on 3 and 8 March 2017. We found that improvements needed to be made to ensure a more robust analysis of specific incidents was carried out and appropriate action taken to minimise the impact of risks on people using the service. We have made a recommendation about this.

Despite improvements being made to behaviour support plans, there continued to be a high number of incidents involving aggressive behaviours by people using the service towards their peers. Staff were recruited safely and in sufficient numbers, but the deployment of staff within the service did not ensure people were kept safe from harm.

This demonstrated a new breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse. You can see what action we have asked the provider to take at the end of the report.

Staff knew how to safeguard people from the risk of harm and abuse, but failed to prevent incidents within the service and people being targeted by their peers. They had completed safeguarding training and had policies in place to guide them. Staff spoken with were clear about the alerting procedures to the local safeguarding teams and had made appropriate referrals after each incident. Staff had access to a range of training, supervision, appraisal and support.

People told us staff were kind and caring and respected their privacy and dignity. People using the service had their end of life wishes detailed within their care plans. Staff had a kind and caring approach. They knew people's needs very well and supported them to maintain independence, privacy and dignity. Staff supported people to make decisions in order to maintain their

human rights. They ensured that when people lacked capacity, they included relevant people in best interest decision making.

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Baylis Place is registered to provide care and accommodation for up to 11 people with learning disabilities or autistic spectrum disorder. This purpose-built accommodation is provided in spacious single bedrooms all with en-suite facilities. The accommodation is split over two floors and there are several communal areas, two dining areas, two kitchens, a laundry and a self-contained flat on the top floor. There is a large, secure garden to the rear of the building.

We undertook this unannounced inspection on the 3 and 8 March 2017. At the time of the inspection there were 11 people living at the service.

At the last inspection on 14 July 2014, the registered provider was compliant with all areas assessed and was rated as outstanding.

At this inspection we found breaches of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and Regulation 17 Good governance. You can see what action we have told the registered provider to take at the end of the report.

There was no registered manager in post. The service is required to have a registered manager, and as such, the registered provider was not meeting the conditions of their registration. 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. When a service does not have a registered manager in place the rating in well led cannot be rated any more than ‘requires improvement’. A manager had been appointed but had not been through the registration process to become the registered manager. We have called them the ‘manager’ throughout the report.

Improvements were needed to be made to ensure complete records were maintained within the service. This included fluid intake charts and incidents records. Further improvements were also required to ensure any incidents in the service were reported to the local safeguarding team by senior staff when the manager was absent. Risk assessments and behaviour support plans needed to contain more detailed information about how approved interventions are used and in which circumstances. The organisation also needs to further consider how they will prevent inappropriate items being brought into the service which may present a risk to other people using the service.

Staff received effective levels of support, supervision and mentorship and people who used the service were supported by staff who had the skills and experience to carry out their roles effectively. People who used the service were supported to make their own decisions about aspects of their daily lives. The manager followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

People who used the service told us they liked the meals provided and were offered support to prepare their own meals when they wished to do this. Staff supported people with their nutritional and health needs and liaised with healthcare professionals, on people's behalf, if they required support in accessing their GP or other professionals involved in their care.

Records showed people had assessments of their needs and support plans were produced. These showed people and their relatives had been consulted and involved in this process. We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

Risk assessments were completed to guide staff in how to minimise risks and potential harm during activities of daily living. Staff took steps to minimise risks to people's health and wellbeing without taking away people's rights to make decisions.

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We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, this was also part of a pilot for a new inspection process being introduced by the Care Quality Commission and to provide a rating for the service under the Care Act 2014. This was an unannounced inspection.

Baylis Place provides accommodation for persons who require nursing or personal care for people with learning disabilities or autistic spectrum disorder. There were 11 people living at the home when we visited. The purpose-built accommodation is provided in single bedrooms all with ensuite facilities. The accommodation is split over two floors and there are several communal areas, a dining area, a kitchen, and a laundry. There is a large, secure garden to the rear of the building. The home is in a heavily occupied area with good access to local amenities and public transport.

The home has a registered manager.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they were happy with the care provided at the home and their care and social needs were being met. From our observations, and from speaking with staff, people who lived at the home and relatives, we found staff knew people well and were aware of people’ preferences and care and support needs. People enjoyed freedom within the home and were supported to access the local community whenever possible following robust assessments of any associated risks.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and staff followed the Mental Capacity Act 2005 for people who lacked capacity to make decisions for themselves.

The provider had robust recruitment processes in place which protected people from unsuitable or unsafe staff.

The home was meeting people’s nutritional needs; people were supported to ensure they had enough to eat and drink. People told us the food at the home was good and they had a choice. People were supported to do their own shopping and choose the foods they liked.

Staff involved people in choices about their daily living and treated them with compassion, kindness, and respect. People were supported by staff to maintain their privacy, dignity and independence. Everyone looked clean and well-cared for. People had access to activities and relatives and friends were able to visit the home at any time. People were supported to stay with relatives whenever possible.

People told us there were enough staff to give them the support they needed. Our observations confirmed this. The local authority told us they had confidence that staff had the appropriate skills to meet people’s needs. The majority of staff had received training considered mandatory and had also received specialist training, on the use of restraint for example.

We observed care was centred on people’s needs and preferences. There was a wide variety of activities available for both individuals and groups. People were encouraged and supported to access the local community.

People we spoke with knew how to make a complaint and we noted the home openly discussed issues so that any lessons could be learned. People felt they were able to express their views at any time and that they were listened to and acted on.

Leadership and management of the home was good. There were systems in place to effectively monitor the quality of the service and drive a culture of continuous improvement.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

The senior manager confirmed that they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held.

Comments included “I like it here it’s good". “The staff are good and really help me” and “The staff help us with things we can’t do ourselves, like when we are worried about something.” People were happy with the care they received and told us they saw a range of health professionals for advice and treatment.

Comments included, "We are fully involved in our relatives care. The staff work well with us, to ensure any difficulties can be overcome. It is first rate.”

People spoke positively about their care and support, comments included, "We are very happy with everything, we are in touch regularly and aware of what is going on. We also have the opportunity to ring and discuss any issues when they are at home and the staff are always happy to offer advice.”

We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.

During a check of medication we found that medicines were appropriately stored.

We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.

We spoke with three people who were resident in the home. One person showed us a portfolio of a course in home economics they had been following, pointing out how the provider had supported and facilitated the course. Another person told us of their training and subsequent responsibilities where drivers of the provider’s mini bus took their competency test and the person gave feedback to the examiners on how people were looked after during the test journey.

People told us of their general experiences, which included comments such as “I like living here, it is never boring” and “I get to see my friends in other homes.” People we spoke with told us they felt safe and when asked, people agreed that the staff helped them live in the way they wished, respecting privacy and dignity.

People we spoke to complimented the care and welfare they experienced at their home. One person told us they looked forward to the different activities on offer each day. Another person said their fellow residents and carers were a second family.