Courtwick Park provides accommodation and support for a maximum of 10 adults with a learning disability or autistic spectrum needs. At the time of this inspection there were seven people living at the home. People had varied communication needs and abilities. Some people were able to express themselves verbally using one or two words; others used body language to communicate their needs. People required differing levels of support from staff based on their individual needs. Everyone required support and help to access the wider community outside of the home in which they lived.

This was an unannounced inspection which took place on 5 and 8 September 2017. The registered manager was given notice of the second date as we needed to spend time with her to discuss aspects of the inspection and to gather further information.

During the inspection the registered manager was present. 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 previously inspected the home in August 2015 when it was rated ‘Good’ overall and in all domains apart from the ‘Effective’ domain which rated ‘Requires Improvement.’ One breach of regulation was made due to a lack of Mental Capacity Assessments (MCA) and decision specific DoLS applications. At this inspection we found that steps had been taken by the registered manager and that the breach of regulation was met.

Quality assurance audits and checks were completed that helped ensure quality standards were maintained and legislation complied with. Quality assurance processes included obtaining and acting on the views of people in order that their views could be used to drive improvements at the home.

Staff were available for people when they needed support in the home and when they wanted to participate in activities outside of the home. Robust recruitment procedures were followed to ensure staff were safe to work with people.

People appeared happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

Medicines were managed safely and staff training in this area included observations of their practice to ensure medicines were given appropriately and with consideration for the person concerned.

Checks on the environment and equipment had been completed to ensure it was safe for people to use.

People were supported to take control of their lives in a safe way. Risks were identified and managed that supported this. Systems were in place for responding to incidents and accidents that happened within the home in order that actions were taken to reduce, where possible reoccurrence.

Staff were skilled and experienced to care and support people to have a good quality of life. Training was provided during induction and then on an on-going basis. Staff received support that enabled them to carry out their roles and responsibilities.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People were involved in the review of their care packages. People were supported to access healthcare services and to maintain good health. People had enough to eat and drink throughout the day.

Positive, caring relationships had been developed with people. Staff knew what people could do for themselves and areas where support was needed. Staff appeared dedicated and committed.

People received personalised care that was responsive to their needs. Activities were offered and people were supported to increase their daily living skills based on their individual abilities. People were also supported to maintain contact with people who were important to them.

Staff understood the importance of

The inspection was carried out on 11 August 2015 and was unannounced.

At the previous inspection in January 2014, we found concerns across several areas of the regulation.

This included breaches of regulation related to cleanliness and infection control, supporting staff and notification of incidents. Compliance actions were set in relation to these areas. The provider sent us an action plan of how the compliance actions would be met.

At this inspection, we found that sufficient steps had been taken and that the requirements of those regulations were now being met.

Courtwick Park provides accommodation and personal care for up to twelve adults with a learning disability, autism and/or other complex needs.

There were seven people living at Courtwick Park at the time of our visit.

The accommodation was over three floors and consisted of seven bedrooms that were in use. There was a spare bedroom that could be used for emergency placements.

People had access to a communal lounge, dining room and the choice of three activity rooms.

There was an enclosed garden to the rear of the home that had a trampoline, skittles, inflatable swimming pool, swing, covered area and vegetable area.

The home was run by a manager who was present on the day of our visit. The manager had been in post from March 2015 and was in the process of becoming registered 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS).

DoLS protects the rights of people ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

However, prior to the manager commencing in post, DoLS applications had been sent for everyone living at the service. This was a blanket approach and there was a lack of information about people in the completed forms. In addition the DoLS applications went sent before first establishing people’s mental capacity to consent to care and treatment.

Therefore the provider had not acted in accordance with DoLS to protect people’s rights.

We identified this as an area for improvement.

The home had taken steps to make sure that people were safeguarded from abuse and protected from risk of harm. Staff had received training in how to safeguard adults and knew what action to take in the event of any suspicion of abuse.

Medicines were managed and stored appropriately. Staff received regular training and their competency in giving medicines was assessed, to ensure people received their medicines as prescribed.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised.

The manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People’s needs had been assessed to make sure that there were enough staff on duty during the day and night to meet people’s individual needs.

People’s health needs were assessed and monitored. Health records were written in an accessible way. People were supported to have a balanced diet. Staff understood people’s likes, dislikes and cultural preferences.

New staff received a comprehensive induction, which included specific training about supporting people with a learning disability and behaviours that may challenge.

Staff were trained in areas necessary to their roles and also completed additional specialist training such as how to communicate effectively and support people to make sure that they had the right knowledge and skills to meet people’s needs effectively.

Each person who lived in the home had a different way of communicating their needs. Staff understood how to communicate in a personalised manner with each person who lived in the home. Staff spoke with people in a respectful manner, treated them with kindness and encouraged their independence.

People’s care, treatment and support needs were clearly identified in their care plans and included people’s choices and preferences. Staff knew people well and understood their likes and dislikes. Clear guidance was in place to identify the triggers and action to take when people displayed behaviour that may challenge themselves or other people.

People were offered an appropriate range of activities which included in-house activities and trips in the community. People were supported to keep in contact and visit friends, family members and people who were important to them.

Staff understood the aims of the home, were motivated and had confidence in the management of the home. They said that there was good communication in the staff team.

Systems were in place to review the quality of the service and included feedback from people who lived in the home, their relatives and staff. Improvement plans were developed where any shortfalls were identified to make sure that improvements were made and sustained.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

During our visit we spoke with two relatives of people who used the service and five members of staff. We were unable to speak with people due to their complex needs however we spent time observing how staff interacted with and supported them.

One relative that we spoke with told us that staff gained consent from them before they provided any new care or treatment to their family member.

We saw from records that a full assessment of people’s needs was undertaken before they moved to the service. We saw that the care plans were ‘person centred’ and took into account people individual needs. One of the relatives that we spoke with told us “Staff are very caring and interested.”

Staff that we spoke with had an understanding of infection control. We saw examples of staff wearing gloves and using aprons. However we found there were some areas of the property that were not clean or well maintained.

All of the staff that we spoke with told us that they felt supported at the service. We saw that staff were kept up to date with the services mandatory training. However we saw that one to one supervisions were not up to date and that appraisals had not taken place.

There were effective systems in place to monitor complaints. Relatives told us that if they wanted to make a complaint they would know how to. We that the service recorded all complaints and resolved them where they could to the relatives and persons satisfaction.

People who used the service had complex needs and limited communication. They were not able to tell us about the care they received from the staff team so we observed staff interactions with them. We saw the staff, who were on duty at the time of the site visit, were caring and kind in their manner towards the people who used the service. We observed the staff assist three people who used the service and saw they were cared for safely.

We read three people's care plans so that we could find out how people were supported with their care needs. We saw there was sufficient information to ensure staff were aware of each person’s needs. We saw risk assessments were in place to protect people. There was a behavioural plan about how the staff should support each person who used the service.

We looked at the staff rota and saw there was sufficient staff on duty to meet peoples' assessed needs.

The provider had quality assurance systems and processes in place to monitor and identify any shortfalls in their service. Internal audits were carried out by designated members of staff. These included health and safety audits, fire alarm checks and medication audits.