The inspection took place on 1 November 2016 and was unannounced.

Cabot House provides accommodation and personal care for up to nine people with a learning disability and complex needs, including behaviour that challenges. Six people were supported at the service on the day of our visit and were aged from 18 to 40 years. They required support with personal care and had additional communication needs. Accommodation was arranged across three floors of a large house. The service is one of three residential care homes run by Pathway Healthcare Ltd, a specialist provider of care, support and housing services.

The service had a registered manager. A registered manager is a person who has registered with the 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 home is run.

We found the following areas of practice required improvement. The registered person had not completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Providers should have this information readily available to them through the internal systems they are required to have to monitor and improve the quality of their service. The registered person had not supplied the requested information within the deadlines we provided.

Care documentation was not always adopted, completed or updated in a timely manner. The provider’s policies and procedures about the care and support provided to a person were not followed or used consistently. There were detailed behaviour management plans in place and these included clear indicators and possible triggers to behaviours that challenged, methods used to diffuse situations and appropriate staff responses. However, documentation used in conjunction with the use of ‘safe holds’, to safely manage behaviours that might cause harm was not used by the management of the service.

People, their relatives and healthcare professionals were positive about the quality of care and support provided to people at the service. One relative told us, “They do really care for [my relative], I know they are happy. It’s a worry because they are very vulnerable, but I have no concerns at all.” Another relative said, “Staff know [my relative] really well. Their key worker is simply brilliant, so caring, but just so sensitive to needs and their change of moods.” People’s keyworkers worked to identify goals and achieve greater independence. The registered manager sought to involve people, relatives and healthcare professionals to ensure people received the support they required.

Staff had detailed knowledge of people’s needs and had the skills to provide support effectively. The registered manager carried out regular supervision sessions and appraisals. Staff felt well supported and understood their roles and responsibilities to ensure a quality service was given. Staff understood how to manage risks to people’s health and welfare and supported them to develop and reach their full potential. Staff had guidance on how to increase choice and control, reduce restrictive practice and improve quality of life. One member of staff said, “It can sometimes be very difficult if people are not using verbal communication. It is about getting to know the person very well and understanding the differences in their body language, for example one person uses the same movement to say different things. We use people’s individual communication methods and take the time to understand what people are telling us”.

People and staff celebrated achievements and milestones, including birthdays and cultural calendar events. A relative of a person said, “They had an open day, they had everything there; entertainment, an ice cream van, there was lots on. It ga

This inspection was unannounced and was carried out on 15 January 2015. Cabot House is a service which is registered to provide accommodation for nine people with a learning disability who require personal care. On the day of our visit there were four people living at the home. Care is provided over three floors in a large house.

The service is run by Pathway Healthcare Ltd. There was no 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 and associated Regulations about how the service is run. An experienced manager who worked for the provider had been appointed to manage the home in October 2014 and was present at the inspection. Their application for registration was in process.

The last inspection of this home was in July 2014 and at that time we asked for improvements in two areas, with respect to care and welfare of people and quality assurance systems. The provider submitted an action plan telling us how they would meet the requirements of the regulations. At this inspection, we found these had been addressed, however further improvements were needed to quality assurance and we have made a recommendation about this.

People were safe and well looked after at the home. There were policies and procedures regarding the safeguarding of people and staff had a good awareness of the correct procedures if they considered someone who they provided care to was at risk of potential harm. There were suitable procedures in place to ensure medicines were stored, handled and administered safely.

People enjoyed the food at the home and were given choices. People had meetings where menus and food requests were discussed. People were supported to shop and cook. People’s specific dietary needs were catered for.

There were up to date and relevant care plans that reflected people’s individual needs. People were involved in care planning and in decisions about their care. The staff involved other professionals and families where appropriate. Care plans were personalised to reflect individual’s needs and preferences. Staff understood people’s care and support needs, and were kind and friendly. They treated people with dignity and respect.

Staffing levels were adequate to meet people’s needs safely and staff were competent and confident in supporting people’s individual needs. Recruitment procedures were being followed to protect people from being supported by unsuitable workers.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and provider understood when an application should be made and how to submit one. We found the requirements of DoLS were not being fully met, however the manager was aware of this and had a plan in place to address it. People’s human rights were properly recognised, respected and promoted. Staff had a good understanding of the Mental Capacity Act 2005 and consent and how this affected people who lived there, however not all mental capacity assessments had been carried out where appropriate by the provider. We have made a recommendation about the need to address this.

There was a relaxed and friendly atmosphere in the home. Staff and people said they could speak to the manager if they had any concerns and felt involved in the running of the home.

The appointment of an experienced manager has improved the quality of the service. However, further improvements were needed to monitor and maintain standards and we have made a recommendation about this.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

Cabot House provides support and accommodation to a maximum of nine people with a learning disability. At the time of our inspection there were six people living at the home.

During our visit we spoke with three of the six people who lived at the home. Due to the nature of people's learning disability we were not always able to ask direct questions to people. We did however, chat with them and were able to obtain their views as much as possible. We also spoke with the Nominated Individual (NI), the providers compliance manager, a senior carer and two members of staff.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had risk assessments in place to assist staff in minimising any known risks, however not all identified risks had assessments in place.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The providers compliance manager told us staff had received training with regard to the MCA and DoLS.

Is the service effective?

Each person had a plan of care and support. We saw support plans explained what support people needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people and care staff we spoke with were aware of people's needs and the preferences of people they cared for in how people wanted care to be delivered. We saw staff offered advice and support and enabled people to make their own choices and decisions as much as possible.

Is the service caring?

People were treated kindly and with dignity and respect by staff. We observed staff speaking to people appropriately and they used people’s preferred form of address; We observed that staff were patient in their approach.

We saw care workers taking time to chat with people. They responded promptly to peoples request for assistance and had a good understanding of people’s needs.

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw that care plans showed alterations to people’s plans of care as people’s needs had changed.

We saw people were able to participate in a range of activities. Staff told us that they encouraged and supported people to participate in activities to promote and maintain their well-being.

Is the service well led?

Cabot House did not currently have a Registered Manager. The provider’s compliance manager was working from the home and was overseeing the day to day management of the service.

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These including a number of audits including health and safety, medicines, cleaning and infection control. However not all of these audits were regularly completed and the homes quality assurance procedures were not yet imbedded in practice.

Staff meetings took place every one or two weeks and we saw minutes of these meetings. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

We inspected Cabot House on the 27 October 2015. This was a focussed inspection looking and asked the question ‘Is the service safe?’ This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cabot House on our website at www.cqc.org.uk.

Cabot House provides accommodation for up to nine people living with severe learning disabilities, complex needs and associated challenging behaviour. On the day of our inspection five people aged from nineteen to forty three years lived at the service.

A manager was in post but who was not registered with the Care Quality Commission. They had submitted an application which was in the process of being reviewed. 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 and associated Regulations about how the service is run. The person in day to day charge of the service is referred to as the manager throughout the report.

The home had been through a period when there was a lack of consistent managerial oversight. Since the new manager had been in post, they had identified areas where improvements could be made. Not all notifications were being made when required to The Care Quality Commission. We saw that actions had been taken but that it was recognised that further improvements were required to ensure people were safely supported.

Staffing levels were determined by assessing people’s support needs. There were staff vacancies at the time of our inspection. Agreed staffing levels had been maintained the majority of the time but on occasions when agreed staffing levels had not been achieved it was evident that this was due to last minute unforeseen circumstances and contingency plans were put into place in response. These shifts were all attempted to be covered by the manager of the home so that the home was kept to the level of staff required. Interviews were held to fill vacancies in line with the provider’s recruitment procedure. Expected leave was planned for and accommodated within the rota. Staff told us staffing was sometimes an issue due to sickness. We heard the provider had taken steps to try to cover these shifts but had not always been able to do so. People’s needs had been met and no harm had occurred as a result of them operating short staffed. However, we have assessed this as an area of practice that requires ongoing improvement.

Cover for staff vacancies and staff expected leave was planned for. Agency staff were used to cover shifts. Whenever possible the same agency staff were used on a regular basis. The use of agency staff had not impacted on the quality of support delivered to people. All agency staff underwent an induction to the service before they worked unsupervised and were aware of people’s needs.

People felt safe and were supported by staff who knew about abuse. People’s safety risks were identified, managed and reviewed. Risks had been appropriately assessed as part of the care planning process and staff had been provided with guidance on the management of identified risks.

People had their medication administered safely by staff who were trained and competent in their role.