The inspection took place on 09 November 2016 and was unannounced.

Brent Cottage is registered to provide accommodation and personal care for up to five people who live with complex learning disabilities. There were five people accommodated at Brent Cottage at the time of this inspection.

The home had 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.

When we last inspected the service on 29 July 2015 we found breaches of regulations 9, 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to provide care and treatment that was always appropriate to meet people’s needs, people’s medicines were not always managed safely and people were not always protected from improper treatment. We had also found there was no effective system in place to assess the quality and safety of the services provided, the legal requirements of the Mental Capacity Act 2005 had not always been followed and notifications of incidents had not always been made when required.

Following the comprehensive inspection, the provider wrote to us on 22 September 2015 to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements to help ensure that care and support was provided safely for people in accordance with the fundamental standards of quality and safety.

People felt safe living at Brent Cottage. Staff understood how to keep people safe and risks to people's safety and well-being were identified and proactively managed. People's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from the registered manager which made them feel supported and valued. People received support they needed to have a healthy diet and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care as much as they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People’s relatives were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

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

We spoke with the relatives of four people, who told us they were pleased with the care and support the service provided. One person said, “My [relative’s] physical care has improved greatly since they have lived in Brent Cottage. They are able to do so much more independently now.”

Relatives we spoke with all said that the staff team were very responsive and communicated clearly with them about their relative’s care and support. Comments made included, “They talk to us….a lot, I visit weekly” and another person said, “We do have input, they do listen to us.”

Relatives of people who used the service told us that they felt comfortable to raise any concerns they may have directly with the staff and management team. One person told us, "If I have any issues concerning me I would ring up and speak with someone, they always sort it out for me."

We looked at records during the course of our visit to Brent Cottage on 5 December 2012. We found that there was good detail with care plans to support the care workers to provide individualised care for the people living there.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2014 and to look at the overall quality of the service.

Brent Cottage is registered to provide accommodation and personal care for up to five people who live with complex learning disabilities. At the time of our inspection five people lived at the home. A manager was in post however they had not registered with the Care Quality Commission (CQC). 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.

People felt safe at the home. Staff were knowledgeable about the risks of abuse and procedures for reporting any concerns. However incidents were not routinely reviewed or investigated.

We found there were sufficient staff available to meet people’s individual care and support needs. Safe and effective recruitment practices were followed.

There were not suitable arrangements for the safe management of people’s medicines.

We found that where people lacked capacity to make their own decisions, consent had not always been obtained in line with the Mental Capacity Act (MCA) 2005. Where MCA’s had been completed for people they had not been reviewed regularly.

The CQC is required by law to monitor the operation of the MCA 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS were not always in place where required to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection not all applications had been made.

Staff received appropriate, training and support to enable them to provide effective care and encouraged further professional development.

People had access to healthcare professionals such as GP’s, community nurses and mental health specialists when needed.

People were given appropriate levels of support to maintain a healthy balanced diet.

People told us that staff were kind and gentle. We saw that staff knew people well and met their needs in a patient, individual and caring manner.

People were not always supported to take part in individual meaningful activities or to visit family members.

People had been involved in discussions about how their care was assessed, planned and delivered. People’s relatives and health professionals were positive about the management of the home and felt the manager was receptive to suggestions for improvement.

We saw that a system of audits surveys and reviews were not used to good effect in monitoring performance and managing risks.

At this inspection we found the service to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.