The inspection took place on 19 July and 7 August 2018 and was unannounced.

The last inspection of this service took place in August 2016 when we found the provider was not meeting the requirements of Regulation 9 : Person-centred care of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because people and their representatives were not always involved in reviews of their care. The service had also failed to notify us of the events as required by law. The service had been rated as Requires Improvement and submitted an action plan to demonstrate how they would address these shortfalls.

Brockholes Brow - Preston (Brockholes Brow) provides accommodation for up to 34 people who are deaf and have a range of learning disabilities, physical disabilities, and/or mental health problems. There are four separate houses, one being for people needing intensive one to one care. All rooms are of single occupancy and there is a communal lounge, kitchen and dining room in each of the four houses.

The home had a newly appointed manager who had applied for registration with CQC to be the registered manager. 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 checked the action plan sent in after the last inspection and found that the service was now meeting the regulations.

Plans of care were based around the individual preferences of people as well as their medical needs. We saw how people and their representatives were involved in reviews of their care, to ensure it was of a good standard and meeting the person's needs.

Staff were kind and caring and treated people with respect. We observed many positive and caring interactions throughout the inspection. Staff knew people's likes and dislikes which helped them provide individualised care for people.

The provider used a robust recruitment procedure which ensured people received support from staff vetted as suitable to work with vulnerable people. People were involved and contributed to the recruitment process of potential staff. All staff used British Sign Language (BSL) and deaf staff were recruited as much as possible to act as positive role models. This had included the recent appointment of the new manager. Staff were skilled in communications including BSL, to maximise engagement with people.

A number of new staff had recently started work and the senior management team had under gone a restructure. Staff and people in the home told us they were feeling very positive about these changes.

People were safe living at the home because they were supported by a sufficient number of staff who had the right skills and knowledge to meet their needs. Staff understood their responsibilities with regard to reporting suspected abuse, in order to safeguard people.

The service had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

Staff received induction and on-going training to enable them to meet the needs of people they supported effectively. Staff were supported by way of regular supervision, appraisal and access to management.

Effective systems were in place to ensure people's medicines were managed safely. Only trained staff were allowed to administer medicines.

We have made a recommendation that the provider ensures that the records for administration of 'as and when' medications (PRN) include written protocols for their use.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People wer

The inspection took place on 17 August 2016 and 06 September 2016, and was unannounced.

The last inspection of this service took place on 11 June 2014, when we found the provider was not meeting the requirements of the regulations with regard to Records, but was meeting the requirements of all other regulations we inspected against. We inspected again on 19 November 2014 and found sufficient improvements had been made with regard to Records.

Brockholes Brow provides accommodation for up to 34 people who are D/deaf and have a range of learning disabilities, physical disabilities, and/or mental health problems. All rooms are of single occupancy and there is a communal lounge, kitchen and dining room in each of the four houses. The service is located on the outskirts of Preston city centre, with easy access to the motorway network, public transport links and a range of amenities. Ample car parking spaces are also available within the grounds of the home.

The home had a registered manager, however they had been on extended leave at the time of our inspection. 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.

Plans of care were based around the individual preferences of people as well as their medical needs. However, people and their representatives were not always involved in reviews of their care, to ensure it was of a good standard and meeting the person's needs. This was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were systems to assess, monitor and improve the quality of service provision. However, in the absence of the registered manager, these had not been operated effectively. The provider had employed a dedicated member of staff to oversee quality assurance. On the second day of our inspection, they had implemented systems around auditing and notifications which gave us assurances the quality of the service would be assessed and monitored effectively. The lack of statutory notifications regarding significant events at the service was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Staffing levels at the home appeared adequate to meet people's needs at the time of our inspection. However, staff commented that they felt stretched to deliver meaningful activities for people, because of sickness absence among staff. We have made a recommendation about this.

People were safe living at the home because they were supported by a sufficient number of staff who had the right skills and knowledge to meet their needs. Staff understood their responsibilities with regard to reporting suspected abuse, in order to safeguard people.

The service followed safe recruitment practices to ensure only suitable candidates were employed to work with people who lived at the home.

The service had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

Staff received induction and on-going training to enable them to meet the needs of people they supported effectively. Staff were supported by way of regular supervision, appraisal and access to management. However, senior staff had not been receiving regular supervision since the registered manager began their period of sick leave.

Effective systems were in place to ensure people's medicines were managed safely. Only trained staff were allowed to administer medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity A

We carried out this inspection to follow up on concerns that were identified when we last inspected the service in June 2014. During our last inspection we found that some people's records were not kept accurate and up to date. We also found that staff appraisal and supervision records and the plans in case of an emergency could not be located and provided for inspection.

During this inspection we checked a random sample of people's records, staff supervision and appraisal records, the business continuity plan and a random selection of risk assessments and service records. We found the records we looked at were accurate and up to date. Records were kept securely and could be located promptly when requested.

During our visit to this location we were able to speak with four people who lived at Deafway. We were not able to obtain any verbatum comments. However, everyone we spoke with, in general provided us with positive responses to questions asked. They were complimentary about the facilities available and the services provided. People told us their needs were being appropriately met by a kind and caring staff team. They said they felt safe living at the home and the environment was suitable for their needs.

We identified a minor concern in relation to care and welfare, which made this outcome area none compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The plans of care and the delivery of support were not always individualised. There was a lack of personalised guidance for staff to follow regarding supporting people with challenging behaviour. Clear guidance would promote a more consistent approach. Some arrangements did not promote person centred care and support. There was no guidance provided for staff about the management of some prescribed medications. Individual guidance would help to promote consistency of use and ensure medication was given when needed. The current arrangements did not always ensure that medication was administered as prescribed. Together these areas created the potential for people to not consistently receive the care, treatment and support they needed.

During our inspection we were able to speak with six people living at the home, through British Sign Language interpreters. Those we spoke with, in general provided us with positive comments about life at Deafway. They told us they felt safe living there and their needs were met by a kind and caring staff team. They said they were able to make decisions and choices about what they wanted to do, whilst living at the home.

Comments received from those living at Deafway included:

"(Name removed) helps me a lot. He is my keyworker. We get on very well."

"On Sunday I go to the gym. It is fine here."

"I work four days a week mowing the lawns in the grounds. I get paid and I'm saving up."

During our inspection we assessed standards relating to care and welfare and how people were supported to give consent to care and treatment provided. We also looked at how they were safeguarded from abuse. Standards relating to recruitment of staff and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

We were able to speak with three of the residents and the relative of another, as well as to four staff members who in general, provided us with positive feedback about Deafway. They told us privacy; dignity and independence were important aspects of the support provided. They felt their assessed needs were being met by staff who were competent to do their jobs and who ensured they were protected from harm.

A relative told us “This is a fantastic place”.

Whist comments from residents included:

“The staff are quite bright they talk to us and look after us”.

“The staff help me”.

“If there’s anything I need I let the staff know and it happens”.

Staff we spoke with told us:

“…One thing I’ve really liked is to assess the level of care for clients and this is one of the best jobs”.

“We’ve just had big management change…I think personally for the good, always good to have someone new ideas, fresh approach”.

In general we received positive comments from those living at Deafway about the care and support they received. Several people told us about their typical day. One person said, "I get up in the morning, have my breakfast and medication, but don't do much else. I just walk around and chat to people, but I like it here and the staff are good".

Another resident told us "I like living at Deafway. The staff help me very much. My boyfriend comes to stay with me sometimes. I don't get bored as I have lots of things to do. I like knitting and making gifts to sell. I also like other activity clubs, such as computers, cooking, arts and crafts. I love shopping and sometimes I go out with my key worker shopping. I like to buy beauty products".

One person we spoke with told us that she was performing in the Christmas pantomime, which is put on by the people living at the home each year. She said "It keeps us busy as we make all our own props and the pantomime is filmed".

This inspection was completed by two Adult Social Care inspectors. The inspectors gathered evidence against the outcomes we inspected during the course of two working days, to help answer our five key questions; 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. We visited the home, spoke with people who used the service - via a British Sign Language interpreter - and looked at records. We also spoke with staff employed by the service. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found that people who used the service and their relatives had been fully involved in decisions made around their care.

People we spoke with said they felt safe and well looked after.

We found that safeguarding procedures were in place and staff understood how to protect people they supported. Staff we spoke with had a good understanding of safeguarding procedures for vulnerable adults.

Staff felt well supported by the manager and senior staff and were confident in reporting any concerns.

Is the service effective?

The health and care needs of those who used the service had been thoroughly assessed.

We saw from records that regular contact had been maintained with other health and social care professionals in order to provide safe and effective care.

People we spoke with had been involved in the preparation and review of care plans.

Is the Service caring?

We spoke with people who used the service. We asked about the care they received. All of the feedback given to us was positive. People told us staff were caring and they were happy.

Staff we spoke with told us they enjoyed their job and they felt well supported by management.

We observed caring interactions between staff and people who used the service throughout the inspection.

We looked at care files for people who used the service and found that information was recorded in a person centred way in some places. However, parts of care plans were written in the first and third person, which was inconsistent. Some support plans did not contain sufficient detail in guidance for staff to deal with certain circumstances.

Is the service responsive?

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

We observed that staff responded to people well, by anticipating their needs appropriately. Care plans contained a description of people’s likes and dislikes.

People were able to raise concerns with staff and felt they would be listened to and acted on appropriately.

Is the service well-led?

The service worked well with other professionals to make sure people received care in a joined up way.

The manager held regular meetings with people who used the service and staff.

Checks and audits were carried out. The resulting actions to address any identified shortfalls were not recorded.

The provider had implemented an appropriate complaints policy.

Some records were not accurate and up to date. The registered manager was not able to provide some of the records we asked to see during the inspection.