About the service:

¿ Burwell is a care home for up to eight people with learning disabilities.

¿ At the time of our inspection there were seven people living at the service.

¿ The service consists of two bungalows, each of which is home to four people. Each bungalow has four single rooms, shared bathrooms, a lounge, dining room and kitchen.

¿ It is in a residential area on the outskirts of Burwell village.

Rating at last inspection:

¿ Requires improvement. (The last report was published on 25 January 2018.)

Why we inspected:

¿ This was a planned inspection based on the last rating.

People’s experience of using this service:

¿ The care service was being developed 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.

¿ People were protected from avoidable harm by a staff team trained and confident to recognise and report any concerns. Staff assessed and minimised any potential risks to people. Staff followed the provider’s procedures to prevent the spread of infection and reduce the risk of cross contamination. The provider had systems in place to enable staff to safely manage people’s medicines.

¿ The provider had a system in place to make sure they only employed staff once they were satisfied of their suitability to work with people who used the service.

¿ The service was very dependent on agency staff to ensure there were enough staff to meet people’s needs safely. This was due to difficulties in recruiting permanent staff. There were increased risks from using agency staff, but the providers processes, including, mainly using agency staff who had worked at the service before, helped to reduce these risks. Staff worked together to ensure people were safe and well cared for.

¿ Most staff knew the people they cared for well and understood, and met, their needs. People received care from staff who were trained and well supported to meet people’s assessed needs. Staff supported people to have enough to eat and drink and to access external healthcare services. Staff worked well along with external professionals to maintain people’s physical and emotional wellbeing.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were involved in making decisions about their care and support. Where people needed addition support to make decisions, staff had referred people to external advocates.

¿ Staff supported people in a kind and compassionate way and displayed empathy for people’s fears. Staff were respectful when they spoke with and about people. Staff supported people to develop their independence. People were supported in a individualised way.

¿ Support was individualised and tailored around individual’s specific needs. People and their relatives were involved their care reviews. People’s care plans had been completely revised since the last inspection to ensure they were up-to-date, and more individualised. People’s needs were constantly reviewed, and support adapted as required. Staff supported people to take part in pastimes and interests. The provider had invested in new staff to help them support people with their interests and keep occupied.

¿ No one using the service needed end of life care at the time of our inspection. The provider had policies for staff to refer to should the need arise.

¿ The service was effectively managed by a registered manager and team leader who had been in post under a year. It was clear the new management team had brought about significant improvements in the service. They led by example and had a passion for continually driving improvements and placing people at the centre of the service. They promoted a cul

Burwell is registered to provide accommodation and care, without nursing, for up to eight adults who have a learning disability. The service consists of two bungalows, each of which is home to four people, and is located in a residential area on the outskirts of the village of Burwell. Each bungalow has four single bedrooms, shared bathrooms, lounge, dining room and kitchen.

The inspection visits to the service took place on 19 October and 2 November 2017. There were seven people living there when we visited. On 23 November 2017 we spoke with some people’s relatives.

This service has been operating for a number of years, but this was the first inspection since Voyage 1 Limited took over as the provider in November 2016.

This service requires a registered manager as a condition of its registration. 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. There was a registered manager in place but they were on leave at the time of our visits. The service was being managed by a peripatetic manager.

In July 2017 a number of concerns had been raised with the Care Quality Commission (CQC). These related mainly to staffing; staff turnover; the use of agency staff; and the ways in which some people were being supported. During the inspection we found that some of the concerns were substantiated. However, we also found that some improvements had been made and the provider was in the process of making further improvements.

We received mixed views from people's relatives about the quality of the service being provided to their family members. One person’s relative in particular was very dissatisfied with the service. This dissatisfaction had started before the current provider took over the service but the current provider had not done anything to respond to their concerns. Following the inspection we shared this relative’s concerns with the provider who took appropriate action to address any current shortfalls and to re-build relationships with this family.

We found that, although the numbers of permanent staff employed had improved in recent months, there were still not enough staff deployed to ensure that people were kept safe and that their needs were fully met.

People who lived at Burwell were not always able to communicate using words. People showed through their body language and facial expressions that they were comfortable with the staff.

Potential risks to people were assessed and minimised and staff understood their responsibility to protect people from avoidable harm and abuse. Staff were recruited in a way that ensured that only staff who were suitable to work at this service were employed. Medicines were managed safely so that people received their medicines as they had been prescribed.

Staff received training and support to do their jobs well. People were supported to have maximum choice and control of their lives and staff cared for them in the least restrictive way possible. Staff obtained consent from people when they offered care. People’s nutritional needs were met and people were supported to have enough to eat and drink. A range of external professionals visited the service to support people to maintain good health.

Staff showed they cared about the people who lived at Burwell and they treated people with kindness and compassion. Staff had good relationships with people, treated people with respect and supported them to maintain their privacy, dignity and independence. Visitors were welcomed and advocacy services were offered to people who needed the support of someone who was independent of the service to act on their behalf.

Care and support plans were in place but the support offered to each person was not always as per