Coxwold and Priory consists of three individual houses and a bungalow situated in the west of the City of Hull, it is registered to provide care and accommodation for up to six people with a learning disability, physical disability or autistic spectrum disorder.

The inspection took place on 14 and 15 November 2016 and was announced. At this inspection, we found there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff, relatives and professionals involved.

We found staff were recruited in a safe way. Appropriate checks were in place before new staff started work and they received a comprehensive induction. Staff received training in how to safeguard people from the risk of harm and abuse. They knew what to do if they had concerns and there were policies and procedures in place to guide them when reporting issues of potential abuse.

Safe systems were in place for the administration, storage and recording of people’s medicines.

The registered manager ensured staff had a clear understanding of people’s support needs, whilst recognising their individual qualities and attributes. Staff were positive about the support they received from the registered manager.

Records showed people had assessments of their needs and support plans were produced. These showed people and their relatives had been consulted and involved in this process. We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

People told us they liked the meals provided and were offered support to prepare their own meals when they wished to do this. Staff supported people with their nutritional and health needs. Staff liaised with healthcare professionals, on people’s behalf, if they required support in accessing their GP or other professionals involved in their care.

Risk assessments were completed to guide staff in how to minimise risks and potential harm during activities of daily living. Staff took steps to minimise risks to people’s health and wellbeing without taking away people’s rights to make decisions.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it.

We saw people were supported to make choices about aspects of their lives when they were able to. Staff were clear about how they supported people to do this and in discussions they provided examples.

There was a complaints procedure in place that was available in a suitable format, enabling people who used the service to access this information if needed.

People told us staff treated them with respect and were kind and caring. Staff demonstrated they understood how to promote people’s independence, whilst respecting their privacy and dignity. Staff also supported people to maintain relationships with their families and friends.

We found the environment was accessible and safe for people. Equipment used in the home was regularly serviced.

There was a system of audits and checks in place to identify shortfalls within the service and to rectify them so the quality of care could be maintained and improved. This had proved effective, for example in the development of recording information in a person-centred way.

The service covered different houses and bungalows between Coxwold Grove and Priory Grove; one of the properties in Priory Grove was undergoing extensive refurbishment so was not occupied. We were able to visit three locations. We were unable to gain the views of the majority of people when we visited due to their complex needs. We observed how support was provided, reviewed records, spoke with staff and spoke with a health professional to help us understand their experiences.

If people could not tell staff what they wanted, systems were in place to help them do so or other people were involved. One person told us, “Staff ask me about things, I can choose myself.”

There were clear care plans for staff to follow about how to support people safely and promote their independence.

People were provided with a choice of suitable and nutritious food and drink. One person told us, “I like all the meals. I like going out for meals best.”

The premises were in a good state of repair and were clean and fresh.

People who used the service and the staff we spoke with said there were enough staff on duty to meet people’s needs. One person said, “Staff are lovely, I like the staff. I have a new person occasionally but that’s OK. All my staff are ladies, I like that.”

People had opportunities to comment on the service through meetings and surveys. The person we spoke with told us they felt comfortable talking with staff about any concerns they had.

The service covers different houses and bungalows between Coxwold Grove and Priory Grove and currently part of Priory Grove is undergoing extensive refurbishment so is not occupied. This meant we were only able to visit and speak with one person who used the service as others were out in the community.

They told us they where happy at the home, they liked the staff and they knew they had a care plan. They said “I am happy living here and all the staff are very nice.”

They knew they had a care plan and confirmed to us they were involved in decisions about their care and they would speak with the manager if they had any worries or concerns.

They told us they always got their medication on time. They also told us they take their medication on holiday with them.

An unannounced inspection was carried out at the service on 21 and 22 October 2014.

Coxwold and Priory is situated in the west of the City of Kingston Upon Hull. It is registered to provide care and accommodation for six people with a physical disability, learning disability or autistic spectrum disorder. A registered manager was in place 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 majority of people who lived at the home had complex needs which meant they could not tell us their experiences. We saw that staff gave encouragement to people who lived at the home and supported them to make choices about their daily lives.

Care plans and communication passports had been produced to enable care workers to communicate effectively with people who lived at the home. Care workers had completed ‘objects of reference’ training. ‘Objects of reference’ is a way to communicate with a person who has complex needs by showing them objects to indicate to them what is about to happen.

People who lived at the home were protected from abuse and avoidable harm. Care workers had completed safeguarding of vulnerable adults training and knew what action to take if they suspected abuse had occurred. The care workers we spoke with were confident the registered manager would respond appropriately to any allegation of abuse.

The registered provider had a dedicated medicines room for the safe storage of medication.

Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication. A medication policy in place that outlined how to manage medicines effectively and we saw evidence to confirm that medication audits were completed on a monthly basis.

Care workers had completed training in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). These safeguards provide a legal framework to ensure that people are only deprived of their liberty when there is no other way to care for them or safely provide treatment. People who lived at the home were supported in the least restrictive way.

Care workers that we spoke with told us they felt supported in their role and that the registered manager was approachable. Staff meetings took place regularly and supervisions were completed at least four times a year.

We saw evidence that care plans and risk assessments were kept under review and updated as required. Before people moved into the home, assessments of their individual needs were completed and care plans were produced to help ensure their safety and welfare.

The registered provider had an effective system in place to highlight areas for improvement within the service. Audits were completed on a monthly basis covering a range of topics including medicines, care planning and the environment. We saw evidence that when shortfalls were identified action was taken by the registered manager.