The inspection took place on the 9 October 2018 and was unannounced.

20 Windlesham Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 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. Care and support is provided for up to five for people with a learning disability or autistic spectrum disorder. At the time of the inspection five people were living in the service. The service is situated in a residential area with easy access to local amenities and transport links.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the last inspection on 22 September 2015 some of the records we looked at had not always been fully completed. At this inspection we found improvements had been made. However, the testing of the fire alarm system in between the regular maintenance by external contractors continued to be an area in need of improvement. People continued to be supported to have their medicine safely when they needed it. However, storage of medicines did not meet current guidance. There were some omissions in the recording of administration of prescription toothpaste.

Systems had been maintained to keep people safe. The building and equipment had been subject to regular maintenance checks. Infection control procedures were in place. People remained protected from the risk of abuse because staff understood how to identify and report it. People’s care and support plans and risk assessments continued to be developed and reviewed regularly.

Staff spoke of a difficult period with a number of staff absences and vacancies. To maintain the right level of staff support and a safe service support to maintain staffing levels had been provided from other of the provider’s services and there a high use of the providers bank staff. There was ongoing recruitment to address this

People and their relatives told us they had continued to feel involved and listened to. The culture of the service remained open and inclusive and encouraged staff to see beyond each person's support needs. The registered manager worked with care staff to develop the service with people at the heart of the service.

Staff continued to have the knowledge and skills to provide the care and support that people needed. Staff told us they had received supervision and appraisal’s. They had been supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively.

People continued to live in a service with a relaxed and homely feel. They were supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent.

People were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health and access healthcare professionals when needed.

Staff and relatives told us the service continued to be well led. Staff told us the registered manager was always approachable and had an open-door policy if they required some advice or needed to discuss something. Senior st

This inspection took place on 5 April 2016 and was unannounced.

20 Windlesham Road has up to five people with a learning disability living in the service.

At the time of the inspection there were four women living in the service whose behaviour could be complex. People have single bedroom accommodation and a range of communal facilities they can use. The service is situated in a residential area with easy access to local amenities, transport links and the city centre.

The service had a registered manager, who was present throughout the inspection, they had been in their current post for a number of years and knew the service well. 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 service was going through a significant period of review, where the provider and local stakeholders were looking at the service provision and what was needed and how the service would best be provided in the future.

Care staff and relatives told us they felt the service was well led. Staff spoke of a particularly difficult time due to staffing and the high use of agency and bank staff. They told us that some systems had been subject to slippage in the agreed timescales, for example, record keeping and health and safety checks. Records we looked at had not always been fully completed, for example for one new person living in the service their care plan had not been started. We spoke with one member of bank staff who told us their essential training was up-to-date. However, there was no record of the training completed by all the bank staff who regularly worked in the service. There were records that the fire equipment had been checked by external contractors. However, there had been periods when the fire equipment had not been routinely checked by care staff in the service to meet the providers requirements. Although staff told us that medicines guidance had been reviewed guidance in place for when PRN (as and when) medicines were to be administered did not always detail a review had been completed. We found this had not impacted on the care provided to people, however this is an area in need of improvement.

Relatives told us people were safe in the service. People were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans and risk assessments were up-to-date, were detailed and reviewed regularly. One relative told us when asked what the service did well, “They make a happy family type atmosphere. I think that’s really important. The residents all get on well together.”

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. Referrals had been made for Deprivation of Liberty Safeguards (DoLS) and we could see that staff understood how these were implemented.

People were supported

The registered manager had left the service. A new manager had been recruited to the service and an application for a new registered manager has been made to the CQC.

We undertook this inspection to review infection control policies and procedures. This was following non-compliance, which had been identified at the last inspection on 16 January 2014. The provider subsequently submitted an action plan outlining the steps they intended to take to rectify the issues identified. The action plan identified how the service would make improvements.

Our inspection team was made up of one adult social care inspector. We answered our question; Is the service safe? Below is a summary of what we have found. The summary is based on our observations during the inspection. Four people were resident in the service at the time of our inspection. We looked at staff records and records relating to the management of the service. We spoke individually with the manager and a care worker.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was safe, clean and hygienic. Infection control policies and procedures had been updated, shared with staff and implemented in the service.

20 Windlesham Road was recently refurbished and the staff and three people who used the service from another of the provider’s services had just moved into the service. The registered manager had just left the service. But their name remains on the report until an application has been made to remove this. The provider has told us that the post was in the process of being advertised and recruited to.

There were three people who used the service at the time of our visit. We used a number of different methods to help us understand the views of the people, who had complex needs, which meant they were not all able to tell us about their experiences. We reviewed records including staff training records, quality assurance documentation, incidents and accidents records, the complaints log and documentation in relation to the running of the service. We looked at systems and looked at the environment and how this impacted on the service delivery. We observed the care provided, and looked at supporting care documentation. We spoke with the deputy manager, and two care workers. We spoke with one person who used the service, and two relatives of two people who used the service.

This told us people or their relatives had been able to express their views about the care provided, and where possible had been involved in making decisions about their care and treatment. People’s care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Care workers had a good understanding of people’s care needs. Comments from relatives included, “I feel very lucky that ***(name) is being cared for where she is,” “***(name) is happy and it all seems to have gone very well,” and “She seems to really enjoy living there.”

Observation during the inspection and feedback received confirmed that the service was clean. However, infection control policies and procedures were not in place to fully protect people.

People’s care had been provided by care workers who understood their care needs. There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service.

Appropriate arrangements were in place to ensure people were cared for in an environment

that was adequately maintained.

We found that there were processes in place to enable people to raise any concerns about the care provided.

There was one person who used the service at the time of our visit. We used a number of different methods to help us understand the views of this person, who had complex needs which meant they were not able to tell us about their experiences. This consisted of looking at supporting care documentation and reviews of the care provided, health and safety records, we spoke with the manager, two care workers on duty during our visit, a visiting healthcare professional and observed the care provided. This told us:

The person’s care needs had been assessed, and care and treatment had been planned and delivered in line with their individual care plan.

Care had been provided by care workers who understood the person’s care needs.

Currently the registered manager is not working full time in the service and was being supported by the deputy manager who had been appointed manager for their absence. We spoke with the registered manager for the service as part of this review, and who is refered to as manager within the report , two care workers and a visiting healthcare proffessional. The care workers told us that the team worked well together and that they had received the training and support they needed to meet the person’s care needs.

Because people living in the home have highly complex communication needs it was not possible for them to tell us about the care they receive. However, we observed people engaging with staff who were attentive, observed their wishes and treated them with dignity and respect.