About the service: Community Integrated care (CIC) - 4 Seafarers Walk is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 4 Seafarers Walk is registered to provide accommodation and personal care for up to four people and predominantly supports people living with a learning disability and autism.

At the time of the inspection there were three people living at the service. Best practice guidelines recommend supporting people living with a learning disability in settings that accommodate less than six people. The service model at 4 Seafarers Walk was aligned to the principles set out in Registering the Right Support. Outcomes for people using the service, reflected the principles and values of Registering the Right Support including; choice, promotion of independence and inclusion. People's support was focused on them having as many opportunities as possible, to have new experiences and to maintain their skills and independence.

People’s experience of using this service:

People living at 4 Seafarers walk had limited ability to have verbal conversations with us. However, when asked if they liked living at the home, people responded with a smile or said, “Yes.”

The staff demonstrated that they knew people well.

Quality assurance processes were robust and risks to people and the environment were managed safely. The service was clean and infection control audits ensured that cleaning tasks were completed and any issues were identified and acted upon quickly.

Staff recognised people’s individual needs and supported them to make choices in line with legislation.

Care plans were detailed and person centred. People were involved in deciding how they wished to be supported and in reviewing their care plans when needed. Information was available in a format they could understand.

Staff were kind, patient and responsive to people's needs. People were treated with dignity and staff respected their privacy.

Staff were well trained and received regular supervision to help develop their skills and support them in their role.

Rating at last inspection: The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 21 August 2018.

Why we inspected: This was a planned inspection based on the previous inspection rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 26 July 2018 and was unannounced.

4 Seafarers’ Walk is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

4 Seafarers Walk accommodates up to four people in one adapted building. At the time of our inspection there were three people living at the home. 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.

A registered manager was 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.

People were supported by staff who knew and understood the risks to their health and wellbeing. However, recorded risk assessments were not always in place to ensure guidance was available for staff should this need to be relied upon. Action was taken during the inspection process to address this.

Staff had not always followed guidance in place to prevent people from experiencing a deterioration in their health. This guidance had been put in place following a safeguarding incident and failure to follow this guidance could result in significant harm to people. No one had come to any harm because of the omissions that we found and the registered manager took immediate action to implement a more robust monitoring procedure to prevent a reoccurrence.

People medicines were managed safely. However, records for medicines that were unwanted or unused were not kept to check these medicines for disposal were handled properly. A returns book was introduced following our inspection.

The home appeared clean and free from malodour, however the arrangements in place for the assessment, prevention and control of the spread of infections did not meet current guidance. The registered manager has addressed this following our inspection.

The Duty of Candour is a Regulation which aims to ensure providers are open and transparent with people and those acting lawfully on their behalf in relation to the care and treatment provided to people and when things go wrong. Robust systems and processes were not in place to ensure the provider identified whether incidents met the threshold for the Duty of Candour. We have made a recommendation about seeking advice and guidance on the Duty of Candour regulation.

At our last inspection in June 2017 People's finances were not always managed safely and systems to manage people's finances were not always correctly followed. At this inspection, we found that improvements have been made to the management of people’s finances and these were managed safely. A system was in place to investigate and learn from incidents and accidents and make improvements to the service.

Staff understood their responsibilities to protect people from abuse and how to report and act on any concerns. Staff were recruited safely and the relevant checks were made to protect people from the employment of unsuitable staff. There were sufficient staff to keep people safe and meet people’s needs.

People’s needs were assessed and guidance and training was available to staff to support them to meet people’s needs effectively. Staff completed an induction into their role and ongoing refresher training. Some staff training was outstanding and being progressed at the time of our inspection.

People were supported to have maximum choice and control of their lives and staff suppo

This inspection took place on 27 June 2017 and was announced.

4 Seafarers Walk is situated in a quiet residential area to the south east of Hayling Island. The home is a bungalow which was purpose built to provide accommodation and care to five people with learning and physical disabilities. At the time of this inspection there were four people living in the service. There were eight permanent support workers, which included two senior support workers, three agency support workers and one registered manager who was the service lead.

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 2015 we made a recommendation for the provider to refer to the Mental Capacity Act 2005 and its codes of practice. This was because mental capacity assessments had not been reviewed in line with legislation. At this inspection we found the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed.

Financial checking systems in place were not always safely followed and audits in place did not always prevent people’s money from being at risk of loss or being taken without permission. We have made a recommendation to the provider to ensure staff review and follow their policy on managing peoples monies.

Staff knew what they should do to keep people safe from harm and safeguarding concerns and incidents were reported and investigated. Risk assessments were completed for each person which identified risks to themselves and others. There were enough staff to meet peoples needs and keep them safe. Safe recruitment, medicines and fire practices were followed.

Staff were skilled and experienced to support people at the service, felt well supported and attended regular supervision, appraisal and training sessions. People were supported to eat and drink in line with their support plans and health needs. People regularly accessed external health and social care services.

Staff were kind and caring and respected people's dignity and privacy whilst providing personal care. People received an individualised and personalised service and staff knew them well. People’s preferences were taken into consideration and people were supported to be as independent as possible and consent to their care. Positive compliments had been received into the service thanking the staff for the support they provided to people

Support plans were in place, sufficiently detailed and reviewed regularly. Complaints had not been received into the service. People took part in meaningful activities.

Staff felt the manager was approachable and communicative and encouraged them to develop their skills. Audits to analyse the quality and safety of the service were in place and mostly effective.

We carried out an inspection on 9 July 2013. On the day we inspected there were four people living at the home, one person was away visiting relatives on a short break.

During our inspection we spoke with the manager, two staff members, one relative and two people who use the service.

We saw that the home was clean and well maintained. People were able to personalise their rooms with their own possessions and each room was clearly identified for the individual using photographs and personal items in the doorway. People could access their rooms whenever they chose and could close the door for privacy.

There was a clear plan for each person regarding activities they participated in for the week though this was flexible and offered choice to people. We observed one person listening to their favourite music in their room. During our visit two people went for an outing to the local town supported by two staff members. People were able to participate in activities in the communal areas of the home including watching television, listening to and making music and dancing.

We saw that the home had clear care plans in place to provide personalised care for people. These identified goals for people to achieve and maintain their independence. We saw people being actively encouraged to maintain their independence in all activities. We saw that people had their care discussed and agreed with them or their representative.

We found that people living at the service were safe, happy and relaxed. They benefitted from being supported by staff who knew them well and treated them with kindness, respect and dignity. People were offered choices and their views and wishes were listened to and acted on.

The provider had a system of quality monitoring in place and we saw evidence to show that it highlighted deficiencies in the service and action plans were put in place to address these. Relatives told us that they were consulted on their views and felt listened to by the staff and management. For example one relative was very happy with the service and another felt they had to continually monitor things or they didn't happen.

We saw that records were accurate and stored securely, however, they were not all kept up to date.

On this occasion we did not seek the views of people who use the service.

We did not, on this occasion, speak to people who use the service so cannot report their views.

We did not, on this occasion, speak to people so cannot report their views.

On this occasion we did not seek the views of people who use the service.

This inspection took place on 18 and 19 May 2015 and was unannounced.

4 Seafarers Walk is situated in a quiet residential area to the south east of Hayling Island. The home is a bungalow which was purpose built to provide accommodation and care to five people with learning and physical disabilities. At the time of this inspection there were four people living in the service.

There was no registered manager in post at the time of the inspection, however there was a service lead in post who was responsible for the day to day running of the service and was applying to become the registered manager. The service had not had a registered manager for more than six months. 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 were safe, happy and comfortable when being supported by staff. Relatives felt people were safe, treated as individuals and were encouraged to raise concerns about their relatives care. Staff had received training in safeguarding adults and knew how to keep people safe from harm and would report any concerns to the service lead. Systems were in place to ensure people’s money had been managed safely. Safeguarding concerns were raised and reported by management to the local authority and the Care Quality Commission (CQC) had been notified of these concerns.

Risk assessments were completed for each person which identified risks to themselves and others. Risk management plans were implemented to ensure people and those around them were supported to stay safe. Staff were trained in the Management of Actual or Potential Aggression (MAPA). This enabled staff to safely disengage from situations that presented risks to themselves, the person or others without the use of restraint. Premises and equipment were managed to keep people safe.

There were enough staff to meet people’s needs and for them to be supported in the community to access activities or healthcare appointments. Safe recruitment practices were followed. There were clear procedures for supporting people with their medicines safely

Positive comments were received from relatives about people’s care. One relative told us what they liked about the service was the knowledge the staff had of their relative. Staff demonstrated a good understanding of people’s support needs, behaviours and likes and dislikes.

Staff received an induction when joining the home, had received regular supervision, felt supported and could request any additional training that would help them meet the needs of people. A training plan was in place and on the day of the inspection training courses were being booked for staff to attend and update their knowledge and skills.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, we found that the service lead understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Where people lacked the mental capacity to make decisions the home was mostly guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. Mental capacity assessments were not updated in line with the MCA code of practice. We have made a recommendation for the provider to read and address this in line with the MCA 2005 code of practice which refers to the reviewing of mental capacity assessments.

People were supported to have enough to eat and drink. People were given a choice and were involved in decisions about their meals. People who required a specialised diet were supported with this following referrals to the appropriate healthcare professionals. People regularly accessed healthcare services

People and their relatives were positive about the care and support received from staff. One relative said, “Everyone seems to be really warm and caring.” There were positive and caring interactions between members of staff and people. Staff spoke to people in a kind and respectful manner and people responded well to this interaction by smiling and responding verbally using words or excited sounds.

People were encouraged to do as much for themselves as possible. We saw people answer the door whilst being supported by a member of staff and welcome visitors into their home. People were supported to do what they wanted to do and staff would use different communication methods to support people to make a choice. People’s privacy and dignity was respected

People’s needs were regularly assessed and reviewed by staff and they were involved in the assessment of their needs. Staff knew about the people they were supporting. People were able to communicate by speaking or making sounds and noises or by pointing to an object, person or picture and using body language. Communication books and handovers between shifts were used to communicate any information about each person for that day. Activities were personalised and people were supported to carry out the activities they enjoyed.

Relatives confirmed they had never needed to make a complaint about the service and felt confident to express concerns. The complaints procedure was displayed in the hallway of the home and an easy read summary including pictures was also displayed showing people how they could make a complaint about their care.

There was a clear vision and a set of values that involved putting people first and staff were aware of the vision and values of the service. The service lead had an open door policy and was approachable to staff. Staff confirmed this and said management were very good and very supportive. Staff were supported to question practice and they demonstrated an understanding of what to do if they felt their concerns were not being listened to by management.

The service lead had a good knowledge of people’s needs and personalities. They demonstrated a good understanding of their role and responsibilities and were proactive in identifying development needs of the service.

There was a system in place to analyse, identify and learn from incidents, and safeguarding referrals. A number of audits had been completed to assess the quality of the home. A business continuity plan was in place to provide guidance for staff on how to continue to deliver a service in the event of an emergency.