We carried out an unannounced inspection of Clayton Brook House on 30 and 31 May 2018.

Clayton Brook House is a ‘care home’ which is registered to provide care and accommodation for up to seven adults with autism. The care service had been developed and designed in line with the values that underpin the CQC policy ‘Registering the Right Support’ and other best practice guidance. People in care homes receive accommodation and nursing 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. Nursing care is not provided at Clayton Brook House. At the time of our inspection 6 people were using the service.

The service was managed by 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.

At our last inspection in May 2017 the service was rated Requires Improvement. This was because the provider had failed to ensure refresher training and supervision for staff and there were insufficient complaints processes. Recommendations were also made on improving medicine management processes. At this inspection we found sufficient action had been completed to make improvements.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. At this inspection we found the evidence to support the overall rating of Good. However, we have made recommendations about infection prevention and induction training for managers.

We found there were management and leadership arrangements in place to support the effective day to day running of the service. The registered manager had made a number of improvements and the provider was monitoring the service.

Staff recruitment procedures had improved. Robust processes were in place to make sure all appropriate checks were carried out before staff started working at the service.

There were enough staff available to provide care and support; we found staffing arrangements were kept under review.

Relatives told us they felt people were safe at the service. Staff had received training on supporting people safely and on abuse and protection matters. They had also received training on positively responding to people’s behaviours. Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns.

Risks to people’s well-being were being assessed and managed. We did find a lack individual risk assessments in responses to specific needs; however the registered manager took action to rectify this matter. Systems were in place to maintain a safe environment for people who used the service and others.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

We found people were effectively and sensitively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to. People had been supported to increase their awareness of their wellbeing and health care needs.

We observed positive and respectful interactions between people using the service and staff. Relatives made positive comments about the staff team, describing them as compassionate, tolerant and friendly.

Staff expressed a practical awareness of promoting people’s dignity, rights and choices. People were supported to engage in meaningful activities at the service and in

This inspection was carried out on 3 and 4 May 2017. The first day of the inspection was unannounced.

Clayton Brook House is registered to provide accommodation, care and support for up to seven people. It specialises in providing care for people with autism. The property is a purpose built and is located in a residential area. There are communal rooms, including two lounges, a dining room and a sensory room. All the bedrooms are single occupancy and have en-suit bathrooms. There is also a self-contained flat on the first floor, at the time of the inspection this was not in use. There are car parking spaces to the front of the property with an enclosed garden area to the rear. At the time of the inspection there were six people accommodated at the service.

At the last inspection, on 7 and 8 January 2015 we found the service was meeting all the standards assessed.

At the time of the inspection the service was without 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.

During this inspection we found the provider was in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to a lack refresher training and supervision for staff and insufficient complaints processes. You can see what action we told the provider to take at the back of the full version of this report.

We have also made recommendation about improving practice in relation to medicines management.

This inspection was carried out following an unsettled period at the service. There had been changes introduced by senior managers, which had affected the provision of people’s day time activities and the arrangements for staff support. We found this had resulted in a lack of continuity of support and unnecessary disruption for people. However action was being taken to reintroduce the previous arrangements and progress was being made to provide support in response to peoples’ preferred routines and choices.

We found the leadership arrangements were in need of sustained improvement to promote a consistent management of the service.

Relatives told us they had no concerns about staff numbers and the way people were supported. They considered their family members were safe. However they had some concerns about staff turnover at the service, which they felt had an impact upon continuity of care and support.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service.

Risks to people’s well-being were being assessed and managed. We did find a lack individual risk assessments in responses to specific needs; however the acting manager took action to rectify this matter during the inspection.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff said they had previously received training on safeguarding and protection matters. They had also received training on positively responding to people’s behaviours.

We observed positive and respectful interactions between people using the service and staff. Relatives made positive comments about the staff team, describing them as kind, caring and understanding.

Staff expressed a practical awareness of promoting people’s dignity, rights and choices. People were supported to engage in meaningful activities at the service and in the community. Beneficial relationships with relatives and other people were supported.

People were supported as much as possible to make their own choices and decisions. We saw staff sensitively consulting with people and involving them in routine decisions and using their preferred way of communicating. We found the service

We were unable to speak with people who used the service, because they could not always give their verbal opinions on the service they received. However, we considered people’s overall experience of the service and perceived they were mostly satisfied with the care and support provided at Clayton Brook House.

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them.

People were supported to access resources and activities within the community and keep in touch with others.

People were supported to make choices, try new experiences and develop independence skills.

People were getting support with healthcare needs and they had access to on-going attention from health care professionals.

People were provided with satisfactory accommodation. Some areas needed improvement for the comfort and well-being of people using the service.

We found the staffing arrangements were sufficient in ensuring people received suitable care and support.

There were adequate systems in place to help support people to make complaints and raise concerns.

We were unable to speak to people who used the service because they had conditions that meant they could not always give their verbal opinions on the service they received.

However two support workers spoken with commented about the recent changes to the care records and said, “The new filing system has helped us and adjustments have been made to peoples’ health action plan” and “There is not as much paperwork to complete now” also “Any changes to peoples’ care is now shared at handover and we know where to look in peoples files for those changes”.

Staff spoken with also told us, “We work with people whose behavioural needs change frequently. We would like to be more involved in the planning of peoples care” and “We can see positive changes in the home but we would prefer to have more input into the health action plans”.

We examined the care plans of three people who used the service and found systems to gather and record information about them had been improved to protect their safety and wellbeing.

We saw an effective system in place to monitor record keeping which would help to identify any risks of non compliance with the regulations.

We were unable to speak to people who used the service because they had conditions that meant they could not reliably give their verbal opinions on the service they received. However we saw staff who used practices that reflected the needs of people who used the service.

We observed staff who showed respect to people when delivering their individual support.

Staff spoken with told us they ensured that care and support was delivered privately, was person led and reflected the care instructions detailed in peoples individual support plans at all times.

Relatives of people who used the service made positive comments about the care and support received. They said, “I have nothing but praise for the staff at the home” and “The staff are wonderful people, very caring” also “Sometimes the staff get stressed when they are short staffed”.

We considered people’s overall experience of the service and perceived they were mostly satisfied with the care and support provided at Clayton Brook House. Relatives of people using the service told us, “We are happy with the service”, “Staff take pleasure from enabling people to progress and do something different”, “They provide a stimulating environment without being pushy” and “He is in the right place, it has done him a world of good, he is happy there”.

People were being involved as far as possible in planning their support and were sensitively enabled to make choices and decisions about matters which affected them.

People were treated with respect and valued as individuals, they were enabled to make choices and develop independence skills. They were being supported to pursue learning opportunities and try new experiences.

They were supported to access resources and activities within the community and keep in touch with families and friends.

People were getting support with healthcare needs and they had ongoing attention from health care professionals. They were being supported sensitively with personal care needs. We found progress was being made in ensure peoples’ needs and preferences are more sensitively included in the care planning process.

Although we had no concerns about peoples' care and support, we found some improvements were needed to make sure proper guidelines are in place to protect people using the service.

People were being consulted about the service. We found that checks on practices and systems were being carried out and action to improve the service had begun.

We carried out an unannounced inspection of Clayton Brook House on 7 and 8 January 2015. Clayton Brook House is owned by The National Autistic Society (NAS). It is a care home which is registered to provide care and accommodation for up to seven adults with a diagnosis of Autism and does not provide nursing care.

Clayton Brook House is located in Clayton Le Moors near Accrington, Lancashire. It is a purpose built property in a residential area. There are communal rooms, including a lounge, sensory room and an activity/visitors room. All the bedrooms are single occupancy and have en-suit bathrooms. There is a self-contained flat on the first floor for respite care, however at the time of our inspection the flat was not in use. There are car parking spaces to the front of the property with an enclosed garden area to the rear. At the time of the inspection there were six people accommodated at the service.

At the previous inspection on 27 November 2013 we found the service was meeting all the standards assessed.

The service was managed by 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.

People using the service had complex needs, which meant they could not readily tell us about their care and support. However, we spent time in the company of people using the service and one person expressed their satisfaction with aspects of the service.

We found arrangements were in place to help keep people safe and secure. Relatives spoken with had no concerns about how people were supported. Risks to people’s well-being were being assessed and managed.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Proper character checks had been done before new staff started working at the service.

There were enough staff to support people properly and they had been trained on their role and responsibilities. There were systems in place to ensure all staff received regular training and supervision.

People were receiving safe support with their medicines. Staff responsible for supporting people with medicines had completed training. This had included an assessment to make sure they were capable in this task.

We found people were supported to lead fulfilling lives. They were enabled to make their own decisions and choices. Staff communicated and engaged with people, using ways which were best for their individual needs. People were supported with their healthcare needs and medical appointments. Changes and progress in people’s life and circumstances were monitored and responded to.

The MCA 2005 (Mental Capacity Act 2005) and the DoLS (Deprivation of Liberty Safeguards) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. We found appropriate action had been taken to apply for DoLS and authorisation by local authorities, in accordance with the MCA code of practice and people’s best interests.

We got the impression people enjoyed their meals. Arrangements were in place to make sure people were offered a balanced diet. Meals were provided based upon people’s known likes, preferences and requirements. People were actively involved with shopping for provisions, which meant they could make choices on purchasing food and drink items.

We observed positive and respectful interactions between people using the service and staff. People’s privacy and dignity was respected. Relatives made positive comments about the care and support their family member received. Each person had detailed care records, describing their individual needs and choices, this gave clear guidance for staff on how to provide care and support.

Each person had a personalised and varied programme of activities. People were supported with their hobbies and interests, and with activities in the local community. Their lifestyles and circumstances were sensitively monitored and reviews of their support needs were held regularly. People were supported to keep in touch with their relatives and friends.

There were satisfactory complaints processes in place. People could express concerns or dissatisfaction with the service during day to day living and within their care reviews. There was a formal process in place to manage, investigate and respond to people’s complaints and concerns.

Clayton Brook House had a management and leadership team to direct and support the day to day running of the service. There were systems in place to consult with people and regularly assess and monitor the quality of the service.