The inspection took place on the 8 and 12 June 2018 and was unannounced.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

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.

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.

The service did not have a registered manager in post. However a manager was in post and has started the process of registration with CQC. 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.

Following the inspection of March 2017 and August 2017 we had rated the service as requires improvement overall. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, caring, responsive and well led to at least good.

At this inspection we found the service was now rated Good overall. However, the rating for Well led remained Requires Improvement.

Why the service is rated Good.

During the last comprehensive inspection in March 2017 we found the areas of caring, responsive and well led required improvement with breaches of Regulation.

At that time the design and delivery of care was not in all cases person centred and did not demonstrate people's needs were met appropriately. People’s privacy and independence was not in all cases respected and promoted and people were not always protected by effective governance to help ensure the quality of the service was maintained. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of caring, responsive and well led to at least good.

We went back to the service in August 2017 and carried out a focussed inspection after the provider had informed us about concerns relating to the conduct of staff and an incident of medicines missing at the service. At that inspection we found the areas of safe and well led required improvement. We found the provider did not have sufficient systems in place to identify where quality and/or safety were being compromised and to respond appropriately and without delay. Also people were not always protected by the safe management of medicines. Medicines audits were not robust and had failed to identify discrepancies in the amount of medicines stored in the home. People were also not fully protected by staff who fully understood how to escalate concerns about abuse outside of the organisation. We asked the provider for a report and they sent a report telling us what actions they would take to put this right.

At the inspection in August 2017 we found although improvements were underway on the breaches found in March 2017, they were not at the time of that inspection, August 2017, completed. Therefore, it was not possible to see if the improvements and actions taken would be sustained and continue to improve the quality of the service.

At this inspection, we found that the provider had followed their action plans and that steps had been taken to ensure improvements had been met or nearly met.

We met and spoke to both people during our visit. However people who lived at Coolhaze had some communication

The focussed inspection took place on the 07 and 10 August 2017 and was unannounced.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

We carried out an unannounced comprehensive inspection of this service on 14 & 15 March 2017. Since that inspection the provider had informed us about concerns relating to the conduct of staff and an incident of medicines missing at the service. In response to this we undertook a focused inspection to look into those concerns, and to see if people were safe. We also reviewed concerns from the last inspection relating to the management of the service. We found some improvements had been made. However, it was too early to know if these improvements would be sustained. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Coolhaze) on our website at www.cqc.org.uk.

The provider had an action plan in place to address issues raised at the last inspection. The quality lead for the organisation had responsibility for ensuring these improvements were actioned within the agreed timescales. Following recent concerns the provider had increased their visits to the service and reviewed quality auditing processes to help ensure people remained safe and appropriately supported.

We looked at medicines to make sure they were managed safely. Regular monthly medicines audits were undertaken by the manager and senior staff. The provider also completed audits of the service, which included medicines. However these audits had failed to identify medicines missing from the service. Actions had been taken by the provider and manager to prevent this from happening again, and to make sure that any discrepancies in stock levels would be identified and addressed in a timely manner. At the time of the inspection these improvements were underway, but not in all cases fully completed. When they have been fully implemented they should help to pick up any problems in a more timely way.

Medicines were stored safely and securely. Some were kept in locked cupboards in people’s flats, and a new medicines cupboard had been fitted in the office to store medicines waiting to be used the following month. All medicines in the home were given by staff who had received regular and updated training.

At the time of the inspection a new manager was in post and was responsible for overseeing the day to day running of the service. The manager was in the process of registering with the Care Quality Commission. 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.

.Staff undertook training in how to safeguard people from abuse and had a good understanding of the different types of abuse that could occur. However, not all staff understood how to escalate concerns outside of the organisation. This could mean that people would not be fully protected from the risks of abuse. This was raised with the acting manager at the time of the inspection and they told us they would speak to all staff to ensure they had the information they needed to safeguard and protect people.

Staff were employed in sufficient numbers to keep people safe. Any concerns relating to staff were dealt with appropriately by the provider to help ensure people using the service were kept safe. Staff had a good understanding of people’s needs and how to support their daily routines.

Staff understood and managed risk appropriately in relation to people’s care and the environment.

The acting manager had previous experience of supporting people with complex needs

The inspection took place on the 14 and 15 March 2017 and was unannounced.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

The inspection was prompted in part by notification of an incident involving a person using the service. Other organisations are looking at this incident. During this inspection we looked at risks and if people were safe.

The service had 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. At the time of the inspection the registered manager also had responsibility for another home, which was located within close proximity of Coolhaze. A deputy manager was also in post at Coolhaze to assist with management tasks.

The inspection in 2015 raised concerns about inconsistencies in management. At this inspection we found the inconsistency in management had still not improved. At this inspection there was a registered manager who had been in post for seven months, however, they were soon to leave. Prior to the current manager and since our last inspection there had been two different acting managers overseeing the service.

Staff said these frequent changes in management had been confusing and unsettling. Comments included, “We just get to know one manager and how they work then they leave, it must affect the people living here and the quality of care”. Staff said admissions of new people needed to be overseen by a consistent and skilled management team, “People have been admitted by one manager and then they leave, a new manager has to pick up where one left off”. Staff said they did not feel this was a safe way of admitting people who could have very complex care needs.

Although the regional manager who had only been in post a month prior to the inspection said they had recognised that Coolhaze required consistent, skilled management this had not been recognised and appropriately addressed by the provider as part of their quality monitoring of the service.

The service was not always responsive to people’s individual and specific needs. Some parts of the environment did not meet people’s needs and did not promote their privacy and independence. One person used a wheelchair in the home, however, the environment had not been adapted sufficiently to promote the development of skills and independence. The layout of the person’s flat meant they could not always undertake personal care tasks independently or in private.

We saw risk assessments and risk management plans were in place. These assessments included detail of any potential or predictable risks and how these should be managed and minimised. Risk assessments related to the environment and people’s particular needs and lifestyle choices. We saw following a serious incident risk assessment and management plans had been reviewed and updated to help ensure people were safe. These reviews and changes had been agreed in liaison with other relevant agencies, including the specialist learning disability team.

People living at Coolhaze had complex care needs and required a high level of support with daily care needs inside and outside the home. Staffing levels had been agreed with the funding local authority and documented as part of a person’s plan of care. We saw staffing levels and how people were supported was discussed and reviewed regularly. Staffing levels had been increased when required to ensure they remained appropriate and safe.

The provider had clear and effective recruitment procedures in place and carried out checks of all staff working in the h

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led.

Below is a summary of what we found. The summary describes what staff and other agencies told us, what we observed and the records we looked at.

Is the service safe?

We saw that support plans were individualised and included information about people’s preferences and choices. We observed the care being provided and saw that staff had a good understanding of people’s needs and communication methods. Staff were able to use their skills to support people promptly and to prevent behaviours escalating in a way that may be unsafe or distressing for people who used the service.

Risk assessments were detailed and ensured that people could develop their skills and independence whilst remaining safe and protected. Staff had a good understanding of issues relating to abuse and training regarding the safeguarding and protection of vulnerable adults was regularly updated.

Sufficient staffing levels were in place to meet people’s assessed needs and staff said they felt well supported by their colleagues and management.

Records confirmed that when a person lacked capacity to make decisions, the service had acted appropriately to ensure their best interests and rights were taken into account and protected. A representative from the specialist Learning Disability service in Plymouth said “ The staff understand about how they may restrict people and how this could impact on people’s rights and freedom”.

Is the service effective?

The staff we spoke to were knowledgeable about the people they cared for and were well supported in their roles. People’s care plans were individualised and considered all aspects of their health and social care.

One staff member said “I think the support plan is a true reflection of that person’s needs and provides staff with the right information they need”. The service monitored people’s health needs and liaised appropriately and promptly with healthcare professionals when required.

Is the service caring?

We observed that people were happy and relaxed within their environment. We saw that people looked to the staff to support them when they wanted help and staff responded promptly and in a way that the individual trusted and recognised. Staff we spoke to were passionate about their role within the home and expressed a clear wish to do their very best for the people they supported. Staff showed a genuine fondness for people they cared for, whilst recognising the need to enable people to develop and move on when required.

We spoke to a representative from the specialist learning disability services in Plymouth who said “The staff know people very well and are always very caring and kind”.

All the staff we spoke to said that despite an unsettled period within the home due to changes in management they still felt well supported by their colleagues and the organisation.

Is the service responsive?

Support plans were based on people’s individual health and social care needs. The service liaised regularly with external agencies and updated support plans to reflect any new guidelines or changes in need. Staffing levels were organised to meet the needs of individuals and these were reviewed regularly to ensure they remained appropriate and safe.

We saw that the service considered people’s short term goals and long term needs and wishes. Arrangements were in place to support one person in relation to their future living arrangements and staff were aware of how this person may need to be supported during this period of change.

We saw that the service closely monitored people’s health needs and responded promptly and appropriately to any changes or concerns.

Is the service well led?

At the time of the inspection the Registered Manager was absent from the service. The provider had made the Care Quality Commission (CQC) aware of this situation and the arrangements in place to manage the service during this time.

During the inspection we were able to meet the acting manager as well as the Regional Manager for the organisation who was also working in the service providing support to the management and staff team.

Staff told us that they understood their roles and responsibilities and felt confident to seek advice from colleagues and management.

The Regional Manager said that he had been spending regular time in the home supporting the acting manager and reviewing records relating to the service. He said that visits to the home had increased following the last inspection to ensure that the concerns and areas of non- compliance were fully addressed.

We saw that a range of audits had been carried out in the home to assess and monitor the quality of the service. This had included a recent audit of people’s personal finances, medication and safeguarding. We saw that any recommendations made to improve systems within the service had been completed, such as updated safeguarding training and more robust procedures for checking and recording people’s personal finances.

People using the service had complex needs associated with their autism and learning disability. This meant that it was difficult for people to tell us about their experience of the service. During our inspection we were able to meet all the people who used the service and observed the care and support being provided to them.

We saw that staff encouraged people to make daily decisions, such as what they wanted to eat, what they preferred to wear and activities they wanted to be involved in during the day. When people did not have the ability to make decisions the service involved others so that decisions were made in people’s best interests.

Staff we spoke to had a good understanding of people’s needs and we observed staff supporting people in a dignified and appropriate manner.

We saw that the needs of one person were not being fully met due to the behaviours and support arrangements of other people using the service.

Staff we spoke to had a good understanding of issues relating to abuse and understood what they needed to do if they thought anyone using the service had suffered abuse or was at risk of abuse occurring.

Improvements had been made to the environment since the last inspection, and we found the service to be clean and well maintained throughout.

Some of the records within the service were out of date. The way records were organised did not in all cases provide clear and up to date information about people’s needs.

People using the service had complex needs. This meant it was difficult for people to tell us what they thought of the home and the care they received. During our inspection we were able to meet people who used the service and observed the care and support being provided to them.

We saw that staff spoke to people respectfully, and ensured that their privacy and dignity was maintained. Staff had a good understanding of each person’s communication methods and used this knowledge to encourage people to make choices about their care and lifestyle. Staff had access to the information they needed to meet people's needs.

Concerns were raised about the use of locks on doors within parts of the home. Records did not demonstrate that correct procedures had been followed to ensure that people’s rights, freedom and liberty were protected.

The environment had been organised in a way that ensured that people’s individual care needs could be met. However, some parts of the home were not well maintained and did not provide a homely, stimulating environment for the person to live in.

Sufficient staffing levels were in place to meet people’s assessed needs and staff undertook training relevant to their role and the needs of people they supported.

Systems were in place to regularly review the quality of the service. We were told about and saw examples of further improvements being made to the way the provider checked and monitored the quality of the service provided.

People living in Coolhaze have limited communication and were unable to communicate with us, however we did meet with one person living in the home and observed the interaction between them and the staff working in the home. Information about people experiences in the home was given to us by the staff and management of the home.

During our visit we observed one person enjoying their rest time and interacting positively with the staff supporting them.

The inspection took place on the 22 and 28 April 2015 and was unannounced.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection three people were living in the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

At the time of the inspection the service did not have a registered manager. We were told that the previous registered manager had left the service approximately four months before the inspection and a new manager had been appointed to oversee the day- to- day running of the service. We were told an application had been submitted to CQC to register a new manager. Following the inspection a representative from the organisation contacted us to say that the new manager had left the organisation and the application to register with CQC would be withdrawn. The provider told us about the arrangements to manage the service whilst a new manager was appointed.

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 observed that people were relaxed and happy with the staff supporting them. People went to staff for company and reassurance, which showed people felt comfortable and safe. There was a calm and pleasant atmosphere in the home. Staff had clearly formed positive and trusting relationships with people they supported.

We saw many examples of caring staff, who respected and promoted people’s privacy and dignity. We saw staff considered people’s privacy when supporting them with personal care tasks and maintained their dignity at all times. Staff spoke to people in a way that made them feel valued and encouraged independence when possible.

Staffing levels had been organised in a way that met people’s specific care needs and kept them safe. Staff said they felt there were sufficient staff to support people safely.

People’s risks were managed well and monitored. Relatives said they felt improvements had been made in how risks were managed and this had resulted in people having increased opportunities to develop their skills and independence.

Medicines were managed safely and people were supported to have their health and nutritional needs met.

People were protected by safe and robust recruitment practices. When staff first started working in the home they completed a thorough induction process, which gave them the opportunity to get to know people and understand about the running and ethos of the service. Staff undertook regular training, which was specific to the needs of the people they supported. Opportunities were available for staff to discuss their practice and share ideas and experiences.

All staff demonstrated good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm. Staff and management understood the principles of the Mental Capacity Act and were aware of when people who lacked capacity could still be supported to make everyday decisions. The correct procedures had been followed when it had been assessed people lacked the capacity to make decisions. This helped to ensure people’s rights were protected.

Staff responded quickly to any change in people’s needs. People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were documented and understood by the staff team. People’s life histories, disabilities and abilities were taken into account, communicated and recorded so staff provided consistent, personalised care and support.

People were encouraged to lead full and active lives and were supported to go out and use local services and facilities. Staffing arrangements were planned so people could go out and do the things they wanted.

Staff ensured consistency of care when people moved between services. Feedback from other agencies about a recent transition plan for one person was very positive. We were told that the transition planning was excellent and one of the best examples of joint working they had experienced.

Despite recent changes in management staff said they felt well supported and valued as part of a team.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents, complaints and internal monitoring was used to help drive continuous improvement.