Care Management Group- Carlton Avenue is care home which is registered to provide accommodation and personal care for a maximum of 9 people who have profound learning disabilities, all of whom have physical needs. At the time of this inspection there were 8 people living in the home.

At the last inspection on 26 May 2016, the service was rated Good. At this inspection we found the service remained Good.

Staff engaged with people using the service in a positive way. Staff were respectful and showed a good understanding of each person’s complex needs and abilities. Person-centred care records ensured that the service met people’s individual needs and preferences.

There were arrangements in place to keep people safe and to help safeguard people from the risk of abuse. Staff understood their responsibilities in relation to safeguarding people, whistleblowing and reporting all concerns to do with people’s safety.

Risk assessments were in place to minimise the risk of people and staff from being harmed. Checks and appropriate service tests had been carried out to make sure that the premises were safe.

Appropriate recruitment procedures were in place to help protect people from the risks of being cared for by unsuitable staff.

Staff received the training and support that they needed to carry out their responsibilities in delivering care that was effective and responsive.

Medicines were stored securely and managed safely by staff assessed as competent to do so. Staff supported people to maintain their health and to access healthcare services when needed.

People's wide range of dietary needs and preferences were supported by the service.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS]. 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.

There was a management structure in the service which provided clear lines of responsibility and accountability. The provider had effective systems in place to assess the quality of the service. Regular checks and audits were carried out on the quality of care and safety of people and improvements were made when needed.

Further information is in the detailed findings below.

This unannounced comprehensive inspection of Care Management Group - Carlton Avenue took place on the 31 May 2016.

On the 23rd March 2016 we carried out a focused inspection of the health and safety arrangements of the service and found the service met the regulations inspected.

Care Management Group - Carlton Avenue is a care home that is registered to provide accommodation and care for up to nine people with profound and multiple learning disabilities. On the day of our visit there were seven people living in the home. Public transport and a range of shops are located within walking distance.

The service currently does not have a registered manager. However arrangements for managing the service were in place and we were informed that a new manager had been recruited and would be commencing their post in June 2016 and would apply to register with us. 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.

People were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People told us staff were kind to them. Staff respected people’s privacy and dignity.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care to minimise the likelihood of them being harmed.

Care plans reflected people’s current needs. They contained the information staff needed to provide people with the personalised care and support they wanted and required. People were supported to make choices and to take part in a range of activities they enjoyed.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was upheld and promoted. People were provided with the support they needed to maintain links with their family and friends.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. People were supported to make choices about what they wanted to eat and to be involved in the preparation of their own meals. People had their specific dietary needs met by the service.

Staff were appropriately recruited and supported to provide people with individualised care and support. Staff received a range of training to enable them to be skilled and competent to carry out their roles and responsibilities. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We undertook this unannounced inspection on 23 March 2016. Care Management Group - Carlton Avenue is a care home that is registered to provide accommodation and care for up to nine people with profound and multiple learning disabilities. At this inspection there were seven people living in the home.

At our last focused inspection on 11 September 2014 the service met the regulation we looked at.

Prior to this inspection, we received recent information of concern regarding the health & safety arrangements of the service. At this inspection we looked at arrangements for health and safety. This report therefore only covers our findings in relation to the health & safety of people who used the service.

The home had a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

At this focused inspection, we found that the provider had followed their action plan for improving health & safety in the home. We found that the provider had taken action to rectify deficiencies related to the provision of hot water. This included daily temperature checks on the hot water temperatures and repairs to the thermostatic mixer valves (TMV). There was evidence of maintenance checks carried out on the bath on the ground floor to ensure it was in good working order. We however, noted some areas where improvements were needed. A small window in a bedroom on the ground floor facing the road did not have a restrictor. There were three unsecured sandbags on the flat roof of the lounge at the back of the house. The regional director informed us that action would be taken to rectify these deficiencies.

We carried out an inspection on the 29th April 2014 and found the provider in breach of Regulation 11 (1) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The registered person was not making suitable arrangements to ensure that service users were safeguarded against the risk of abuse by taking reasonable steps to identify the possibility of abuse before it occurred and was not responding appropriately to allegations of abuse.

The purpose of our inspection on the 11th September 2014 was to assess compliance with Regulation 11 (1) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. People who used the service were not able to tell us about their experience of the service because of their complex learning disabilities. We found from checking records, talking to three care staff and the registered manager that the registered person had taken appropriate steps to ensure that people were safeguarded against the risk of abuse and that staff knew how to respond to any allegation of abuse.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

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

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

This is a summary of what we found:

Is the service safe?

People were not able to engage in discussion about their experience because of their complex learning disability needs. The four family members of people using the service told us they felt their relative was safe in the care of the staff. Some staff did not understand safeguarding procedures completely, which meant that people could be put at risk.

The registered manager was aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had been submitted. However, we saw people living in the home needed continuous supervision and control.This may mean deprivation of liberty authorisations were required. Everyone had been assessed as lacking capacity to make decisions about their care and treatment.

We saw evidence of systems which had been put in place to ensure staff learnt from events such as accidents and incidents. Staff learnt from events at staff meetings.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding adults.

Is the service effective?

People’s health and care needs were assessed and the assessment involved them and their family members. People’s family members’ views were taken into account in writing care plans. Staff told us care plans assisted them to meet people’s needs.

We saw that processes were in place to support staff with regular supervision and an annual appraisal. We saw that equipment was safe and suitably maintained.

Is the service caring?

Care workers showed patience and gave encouragement when supporting people. We asked family members their views on the staff. All the feedback was positive. For example, “Trained, qualified and experienced staff” and “Excellent staff, absolutely brilliant.”

People’s preferences, interests and diverse needs were recorded and care and support was provided in accordance with wishes of people using the service and their families.

Is the service responsive?

People took part in activities within the home and the wider community.

All the family members told us they knew how to make a complaint.

Is the service well-led?

This service has quality assurance systems to identify problems and address issues.

All members of staff we spoke with told us they were clear about their roles and responsibilities.

The people who use this service have very complex needs, so we used a tool called the Short Observational Framework for Inspection (SOFI). We observed good interactions between staff and people who use the service. We saw that staff understood people's different communication needs and used Makaton signing, pictures, objects and touch to reinforce the words they used. We saw that staff seemed to know the people who use the service and their specific communication needs very well.

We saw staff being caring towards people and meeting their individual needs on the very hot day we visited. We saw people laughing and joking around with staff, and being supported to make choices about their day-to-day lives such as the activities they do and the clothes they wear. When people declined an activity, we saw that staff respected their decision and supported them to choose something else.

We observed staff supporting people to be independent, for example one person was having difficulty eating their lunch and staff showed them a better way to hold the fork rather than trying to feed them. Where people needed higher levels of support, we saw that this was provided with dignity and respect.

Due to the complex needs of people who use the service, we were only able to speak to one person. Therefore we also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

The person we spoke with was happy with the care they were receiving. They said they enjoyed the activities that were provided and that staff catered for their needs.

We observed good interactions between staff and people. Staff communicated with people using a variety of methods such as using objects and pictures as well as using signing tools such as Makaton which is a form of sign language. Staff reassured people while communicating such as holding their hand or touching their shoulder. Staff were calm and explained thing when they communicated. We observed people enjoying themselves with staff while participating in activities, with both staff and the people they were supporting laughing and joking.

We observed people being supported to be independent. For example, one person could manoeuvre their wheelchair by themselves but when they struggled, such as if they were in a small space and were trying to get out of someone’s way, staff offered them support. .

We observed staff supporting people to make decisions regarding their care. For example, staff asked people whether they wanted to go out or to chose what they wanted to wear and people were able to make a decision regarding what was asked. Staff respected decisions by people who use the service, even if the person declined care at that time.