The inspection took place on 7 March 2017 and was unannounced. We last inspected the home on 25 and 29 January 2016. At that time we found five regulations had been breached which related to risk assessments, medicines, personalised records, records and consent. We received an action plan from the provider and found progress had been made since our last inspection and the provider was now meeting the requirements of the regulations.

32 Mays Lane provides residential care for up to 5 people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were four people living at the service.

The service has a registered manager who has been registered for just over a year. 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 received consistently positive feedback about the care and support people were given. Relatives and staff told us people were well cared for and were supported to be independent and to make their own choices and decisions. Staff were described as kind and considerate.

Potential risks to people's safety had been identified and specific risk assessments identified how people should be supported to keep safe. Medicine records supported the safe administration of medicines. People received their medicines from trained care workers.

There were sufficient staff deployed within the home with less agency staff being used. The provider completed a range of recruitment checks to help ensure new care workers were suitable to work with the people living at the home. Staff felt supported in their roles and the training equipped them with the knowledge they needed to do their jobs.

The provider carried out regular health and safety checks, such as checks of fire safety, the electrical installation, gas safety, water temperatures and portable appliance testing. Incidents and accidents were logged and investigated.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). People had access to a range of health professionals, such as GPs, opticians, chiropodists, community nurses and hospital consultants.

Care records included background information about each person including details of their care

preferences. People's needs had been assessed and personalised care plans written. Care plans were evaluated monthly to keep them up to date. People had goals to work towards and progress towards achieving goals was measured periodically.

A pictorial complaints policy had been put in place and there had been one complaint since the last inspection, which had been investigated.

We were informed the service was well managed and led and a range of quality assurance audits were in place.

This unannounced inspection took place on 25 and 29 January 2016.

32 Mays Lane provides support and accommodation for up to five people who live with a learning disability or autistic spectrum disorder.

The service had a 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. However, the registered manager had also been managing another service for a period of time. This had resulted in them spending less time at this service. The service now has a new manager, working in the home on a full time basis who is going to apply to register with the Commission.

Risks associated with people’s care had been identified, but these had not always been updated or new ones created as people’s needs and risks changed. Incidents and accidents were being logged, but it was not possible to establish there was always learning from the incidents. Medicines were checked on a regular basis, but some errors were still occurring.

Staffing levels were variable with bank and agency staff being used whilst permanent staff were being recruited and working through an induction period. A training programme was available but staff had not renewed their training before it expired and new staff had not always accessed training before working in areas where they would have needed to undertake the training. Procedures in relation to recruitment of staff were followed ensuring people were kept safe.

People had developed good relationships with staff who were kind and caring in their approach. People were treated with dignity and respect. Paperwork associated with people’s care was extensive but not always up to date. Staff told us they had tried to include people in the development of the care plans but it was difficult to evidence this. People were provided with activities but these were not always matched to meet individual preferences.

There were clear procedures in place for safeguarding people at risk and staff were aware of their responsibilities and the procedures to follow in keeping people safe.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been made to the local authority. Staff demonstrated an understanding of the need for consent and an understanding of the Mental Capacity Act 2005. However, there were times when decisions had been made regarding people’s capacity without recording this. Possible restraint was not always recognised.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. People’s physical and emotional health was monitored and appropriate referrals to health professionals had been made.

Details of the complaints procedure were displayed around the home in a pictorial format. The recording of how complaints were responded to and of any learning from complaints needed to be improved.

The ethos of the provider is to have an open door policy and encourage staff to make suggestions or discuss any issues of concerns. A system of audit was in place and used to identify where improvements could be made. Action plans were developed to ensure identified improvements were taken forward.

We identified breaches in five 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 this report.

We were able to establish people were involved in the planning of their care and daily living activities. Observations showed us people were treated with respect and dignity. One person told us they were involved with decisions on the running of the home and felt respected by staff working in the home.

People had been involved in the development of their care and support plans. These plans gave clear information on people's assessed needs and preferences and how these needs should be met whilst maintaining the person's independence and safety.

We found there were appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medication. Where possible, people were encouraged to be independent and be responsible for managing part of their medication package.

From staffing records we found that all appropriate checks had been undertaken before staff began work to ensure the safety of people.

We found that there were procedures in place to monitor and assess the quality of the service provided. These included getting feedback from the people who lived in the home.

People in the home had limited verbal communication skills. As a result of this we spent time observing the care people received and spoke to care staff. People were able to communicate non directly and they demonstrated they were happy with the care they were receiving. Staff were aware of what action to take if people lacked capacity to make a decision regarding their care and treatment.

All people living in the home had assessments and health and support plans. These were individual and included relevant risk assessments. Each person had a key worker and their care and support plan was reviewed each month with their key worker.

The home had suitable information available to staff on abuse to ensure staff were aware of how to identity and protect people from abuse.

The environment of the home was clean and comfortable. Each person had their own bedroom, which had been personalised and reflected the person’s personality.

Staff told us they would know by the person’s behaviour if they were unhappy. They told us the person would not be able to verbalise a complaint but staff would try and work out what the concern was from a process of elimination.

During this visit we spoke with the Registered Manager, five members of staff and two of the people who live at the home.

Some of the people using the service were not able to verbally communicate with us. We therefore spent time during our visit observing the care and support being given and how staff interacted with people. We saw that staff communicated well with people using the service and supported them in ways that promoted their choices, control and inclusion. Staff we spoke with demonstrated their understanding of people’s needs and of the agreed strategies for meeting them.

A person who uses the service told us that staff respected their choices and that they were supported and enabled to do things for themselves. They confirmed that the service was meeting their needs and the staff treated them well. They said they liked living at the home and told us about some of the activities they took part in and enjoyed. They told us that they felt safe living in the home and that they could talk with staff about any concerns.