This unannounced inspection took place on 31 October 2018. At the last inspection on 18, 24 January 2018 and 02 February 2018 breaches of legal requirements were found. This was because repairs were required to the home environment to ensure it was clean and safe for people to live in. There was improvement required involving people in the planning of their care and delivery of personalised activities. The provider’s systems in place to assess and monitor the quality of the service provided to people were not always used effectively and also required improvement. During this inspection, we found the provider had made the necessary improvements to meet the breaches.

Charles House is a care home registered to accommodate up to 10 people who have a learning disability. The home is not purpose built or modified. At the time of our inspection five people were living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The care service has been developed and designed 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.

There was a registered manager in post at the time of the 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.

The home environment had undergone some repairs and improvements. However, there were areas of the home that required further improvement. There was also some improvement required to ensure people received equal opportunities to engage in individual and personalised interests in an environment that was suitable for people living with learning disabilities. Systems and processes in place to monitor the safety and quality of the service required further improvement.

People were protected from the risk of abuse and avoidable harm because staff knew what action to take and the provider had safeguarding systems and processes in place to keep people safe. People were supported by sufficient numbers of staff who were kind and respectful and had the knowledge they required to care for people safely.

People were also protected against risks associated with their health and care needs because risk assessments and associated care plans were in place and had been reviewed within the last 12 months. People received support from staff to take their prescribed medicines. Systems and processes were in place to ensure medicines were managed safely and only staff who had undergone training were permitted to administer medicines.

People and their relatives were involved as much as practicably possible alongside healthcare professionals, to ensure that any decisions made in respect of their care and support needs, were done so within their best interests and in accordance with the Mental Capacity Act 2005.

Where people were assessed to lack the capacity to consent to the support they received, the provider followed key processes to ensure the care being provided was in the least restrictive way possible. Applications had been made to safeguard people against the unlawful deprivation of their liberty, where necessary. People’s privacy, dignity and independence were respected.

People were supported to maintain a healthy diet with choices of different foods available and all their health needs were met with the support from staff and healthcare professionals. Staff knew people very well. The p

This unannounced inspection took place on 18, 24 January and 02 February 2018. At the last inspection on 01 and 31 August 2017 breaches of legal requirements were found and we used our urgent enforcement powers and restricted admissions into the home. We gave the service a rating of 'inadequate' under the questions of ‘is the service safe and well-led’. This meant the overall rating was ‘inadequate’ and the service was placed into special measures. This was because people had not always received the support they required to maintain their safety and well- being. Risks relating to people's healthcare needs and lifestyle had not all been assessed and the action needed to manage and reduce the risk had not always been identified or planned. The service was rated as requires improvement under the questions of ‘is the service effective, caring and responsive’. This was because some of the care observed was focussed on the tasks to be completed and not the person. The care provided did not always protect and promote peoples’ dignity. The activities offered and undertaken were not specifically tailored or planned to meet each person's needs and preferences. There was limited evidence to support that people had been involved in the planning of their care. The home had not been consistently well run because the registered manager or provider had not taken the action required to protect people, to escalate concerns, or to ensure the relevant professionals were involved. This had meant people were not consistently receiving a service that was safe and did not consistently meet their needs or comply with the requirements of the law.

During this, most recent inspection, we found the provider had made the necessary improvements to meet the breaches of Regulations 10, 12 and 13 identified at the last inspection. However, there had not been enough improvements to evidence how people were involved in the planning of their care and the activities offered to people were not always personalised to meet each person's identified needs and preferences. The provider’s systems in place to assess and monitor the quality of the service provided to people were not always used effectively and required further improvement.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

Charles House is a care home and is registered to accommodate up to 10 people who have a learning disability. At the time of our inspection six people were living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

There was a registered manager in post at the time of the 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.

Systems and processes in place to monitor the safety and quality of the service included the involvement of some people and relatives. The provider ensured that some information was available in different formats to meet the needs of people. There was a complaints process in place although there had been no complaints for more than 12 months. People and relatives were complimentary about the management and staff, although some staff felt the management team could be more supportive.

People were supported to maintain a healthy diet and all health needs were met with the support from staff. It was evident that people had developed positive relationships with staff. Staff knew people’s likes, dislikes and preferences well. However,

Charles House is a care home that is registered to provide care for up to 10 people who have a learning disability. At the time of our inspection 6 people were living at this home. At the last inspection on 30 January 2015 the service was rated good. This inspection identified that the quality and safety of the service had not been maintained. Our inspection identified six breaches of the legal regulations. (Health and Social Care Act 2008) We have taken action to protect people, and we have rated the service as inadequate. We have told the provider that further urgent improvements are needed to ensure the service people receive is safe, that it meets people's individual needs and is of a good quality. Full information about CQC's regulatory response to the more serious concerns found during inspections is added after any representations and appeals have been concluded.

There was a registered manager in place 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.

People did not always receive the support they required to maintain their safety and well- being. Some incidents of harm had occurred including people being touched inappropriately. These incidents had not been identified as potential sexual abuse and subsequently they had not been reported to the relevant agencies. The people involved had not received the support they required to keep them safe and to stop further incidents occurring. There were enough staff to support people with their personal care and day to day life, however the delegation of staff wasn’t adequate to ensure that people were kept safe. The registered provider had undertaken robust recruitment checks to ensure that new staff were suitable to work with people.

Risks relating to people’s healthcare needs and lifestyle had not all been assessed, and the action needed to manage and reduce the risk had not always been identified or planned. Staff we spoke with gave inconsistent accounts of how they supported people and the support was not always consistent with good practice guidelines. Action had not been taken to review the incidents that had occurred to ensure that people’s support plans were adjusted and action taken to reduce the likelihood of the incident happening again. In the area of risk management the registered provider and registered manager had not done all possible to ensure the likelihood of the risk reoccurring was as low as possible.

People required the support of staff to manage their medicines. Staff responsible for administering medicines had been trained and assessed and we found that people received their medicine when they needed it.

People were supported to see a wide range of health professionals, however some of the specific health needs people lived with had not been care planned, and not all specialist appointments had been attended. Staff we spoke with knew people well, and were able to identify changes in people’s wellbeing. People were provided with a wide range of meals and drinks that they enjoyed and that would ensure they maintained good hydration and nutrition.

People were supported to have some choice and control of their lives. We observed some examples of good practice, and some occasions where the opportunity to involve the person more had been missed. When restrictions on people’s liberty were necessary the registered manager had ensured the correct applications had been made to protect each person’s legal rights.

In our discussions staff demonstrated that they cared about the people they supported and many of the interactions we observed supported this. However some of the care we observed was focussed on the tasks to be completed and

We last inspected Charles House in November 2013 and found that they were meeting the five outcome standards that we inspected on that visit. During this inspection, we looked at three outcome standards that we had inspected in September 2012 and had found were not being met. These outcome standards related to consent to care and treatment, supporting staff and records. Overall we found that some improvement had been made but further improvement was needed in supporting staff and records.

At the time of our inspection nine people lived at Charles House. During our inspection we briefly met all of the people that lived there and spoke with three of them before they went out for the day to for example day centre or to visit town. We spoke with staff on duty and the registered manager.

One staff member told us, “If staff have a good relationship with a person, it helps build up trust and people are less anxious when supported with care.” We saw that care was offered to people by staff that they knew which made them less anxious and able to give consent to their day to day care and support needs.

We saw that the registered manager was aware of their legal duties to have a ‘best interests’ multi-disciplinary meeting where people may not be able to give consent to medical treatment.

We found that not all staff members had completed or received updates in the training that they needed for their job role.

We found that records were not always well organised and some records were not kept as required.

On the day of our inspection we were told that there were nine people living at the home. We spoke with two people who lived there and briefly met six other people that lived there. We were told that the manager was on leave. To get the information we needed we spoke with another manager from a nearby home and a day care manager during our inspection and a senior carer who worked at the home. We also spoke with the area manager by phone and later spoke with four other members of staff and seven relatives of people who lived at the home.

We observed that people were at ease in the company of staff. One person told us, “I like the staff and they help me.”

We saw that people's needs had been assessed by a range of health care professionals and their healthcare needs had been monitored and met.

Systems were in place to ensure that people were safeguarded from harm and the risk of abuse.

We found that checks had been completed on staff to make sure that they were suitable for their job roles. Staff told us that they felt they had the skills and knowledge to know how to safely support people who lived there to meet their needs.

One person told us that they were asked for their views about the home and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.

There were nine people living there when we visited. Nobody knew we would be visiting that day. All the people living there had gone out at the time of our inspection. We spoke with the manager, looked at the records of one person living there and

sampled the provider's records.

When we inspected the home in August 2012 we found that monitoring systems did not protect the people living there against the risks of unsafe care and treatment. At this inspection we looked at the improvements that had been made in relation to this. We saw that audits had been completed and action taken as a result of these to make improvements to the environment of the home, for example, carpets had been replaced.

Records sampled showed that the manager had identified where there were gaps and ensured the required records were in place. This helped to ensure that the people living there were protected against the risks of being supported by unsuitable staff.

We saw that the views of the people living there, their representatives and staff about the service provided had been sought. The manager told us that they planned to look at the views expressed and make improvements where needed.

There were nine people living there when we visited. Nobody knew we would be visiting that day.

We spoke with two people living there. We also spoke with the manager, four members of staff and one visitor. We looked at the records of two of the people living there and sampled the provider's records. The people living there had a learning disability and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

People told us and we saw that they were able to make choices about what they ate, drank and what clothes they wore. We saw that some people chose what activities they did during the day and how they spent their time. Staff told us how they helped people who were not able to communicate verbally to make choices.

People had not been given an opportunity to consent to the care and support they were given. There was no evidence that an assessment of their capacity had been completed to ensure that they or those that acted on their behalf made decisions that were in their best interests.

Care plans had been updated since our last inspection to show staff how to support people. We saw that some care plans needed to be clearer so that staff could ensure that people's needs were safely met.

People told us they went out with staff to places they wanted to go to and kept in touch with their family, which was important to them. We saw that some people were not involved in activities that stimulated them or gave them opportunities to promote their independence.

Staff told us how they ensured that the people living there were safeguarded from harm. They showed that they would know what to do if they witnessed people being abused and that action would be taken to ensure that people were safe.

Staff told us that appropriate checks were done before they started working at the home to ensure they were suitable to work with the people living there. We saw that these were done.

Staff told us there were enough staff to ensure that people's needs could be met on each shift. The manager told us there were two vacancies for staff but we saw that these were being filled. Staff worked extra hours to cover these so that the people living there were supported by staff who knew them.

We saw that staff had most of the training they needed so they knew how to support the people living there to meet their needs. Staff told us and we saw that they would benefit from training in how to meet people's specific needs to ensure their health and well being.

We saw that people had not been asked for their views on the service provided. Regular audits were not completed to ensure that the risks to people's safety and welfare were reduced and the service was meeting their needs.

Records did not always show how people's health needs were being monitored and how staff had ensured people were well and safe, which may have impacted on their well being.

Six of the nine people who lived at Charles House were unable to share their experiences. These six people had communication needs as part of their learning disability. We met everyone who was living at Charles House, and generally people looked very happy and settled. We visited Charles House twice as part of this inspection. We did not tell staff we were coming. We saw that people had been supported with their personal care and to dress in a style that was comfortable for them. One relative we met said, "You can't deny, people living here get excellent personal care."

We spoke with three people who could tell us something of their experiences, and they were all positive. One person said, "Yes I am very happy here." We asked one person about their life at Charles House, their bedroom, the staff who support them and the activities they can do. The person smiled and said "Yes" to all our questions.

We did not find that people were always being treated with respect and dignity. People were not able to tell us how this made them feel. We spoke to the registered manager about this, and asked them to explore this with staff, so things get better.

Our inspection took place on the 30 January and 3 February 2015. Both days were unannounced. We last inspected the home in September 2014. At that inspection we found that the provider was not meeting the regulations in relation to the care and welfare of people who use services. Following our September 2014 inspection the provider sent us an action plan telling us about the improvements they were going to make so that the care people received was safe, to protect people from abuse, to ensure people lived in a clean home, to ensure that effective systems were in place to monitor the service and to make sure that information in people’s care records were accurate. During this inspection we found that the improvements needed to comply with the law had been made.

The home is registered to provide accommodation to a maximum of ten people. The people who lived there had a range of needs related to learning disability. On the day of our inspection seven people lived there.

There was a 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 2008 and associated Regulations about how the service is run.

We saw that interactions between staff and the people who lived at the home were positive. Staff were friendly, polite and helpful to people. All the relatives we spoke with told us that they were happy with the care that their relative received.

All the staff we spoke with understood their responsibilities to protect people from harm and abuse. Staff told us that they were provided with the training that they required to carry out their role and keep people safe.

Our observations and conversations with staff and relatives confirmed that staffing numbers and the skill mix of staff was adequate to meet people’s needs and to keep them safe.

The mental capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. DoLS applications had been made for all the people living in the home and staff demonstrated some understanding of this legislation.

People who could tell us told us the food was nice. We saw that people were supported to have a nourishing diet.

Relatives we spoke with told us that family member’s needs were met. People who could tell us told us that they were happy living at the home. Relatives told us that they knew how to raise their concerns if they needed to.

We found that some quality monitoring systems were in place. Improvements had been made since our last inspection to ensure that the service was run in the best interests of the people who lived there.