This inspection took place on 2 October 2017 and was unannounced. The previous inspection was carried out in August 2016 when concerns were identified about recruitment processes, staff supervision, managing people's goals and aspirations and ineffective quality monitoring systems. At this inspection we found improvements had been made.

Cranmore is registered to provide accommodation and personal care for up to six people who have a learning disability and other complex needs. Cranmore is a detached house situated on the outskirts of New Romney. The service had a communal lounge and dining area available with comfortable seating and a TV for people, each person had their own bedroom, decorated and furnished to suit their needs and preference. There was a secure enclosed garden to the rear of the premises. Building works were nearing completion at the time of our inspection to an extension adjoining the main house.

The service had a registered manager, who was present throughout 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 and associated Regulations about how the service is run.

A robust system to recruit new staff was in place; this helped to make sure that people were supported by staff that were fit to do so. Throughout the day and night there were sufficient numbers of staff on duty to meet people’s assessed needs. When staff first started to work at the service they were supported to complete an induction programme. Staff continued to be supported with on going training, support and supervision. Staff meetings took place. These all gave opportunity for staff to share ideas and discuss any issues.

Medicines were managed safely and people received their medicines when they should. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and referrals were made when required. People were supported in a safe environment and risks had been identified, and were managed in a way that enabled and encouraged people to live as independent a life as possible.

Records were in good order and contained current information that was clearly laid out; making them easy to use.

Staff understood how to protect people from the risk of abuse. They had received safeguarding training and were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Systems were in place to check if people were at risk of being deprived of their liberty. Systems were in operation to obtain consent from people and to comply with the MCA. People were supported to make decisions and choices about all aspects of their lives.

Staff encouraged people to be involved and feel included in their environment. People were offered activities and participated in social activities when they chose to do so. Staff knew people and their support needs well. The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support th

This inspection took place on 4 and 5 August 2016 and was unannounced.

Cranmore is registered to provide personal care and accommodation for up to six people who have learning disabilities and range of health and support needs. These included; autism, Prader Willi Syndrome, diabetes and some complex and challenging behavioural needs.

At the time of inspection six people lived at the service. People told us they liked the service, they were happy and staff were kind. They thought the home provided a safe, relaxed and comfortable living environment.

Cranmore is a detached house situated on the outskirts of New Romney. The service had a communal lounge and dining area available with comfortable seating and a TV for people, each person had their own bedroom. There was a secure enclosed garden to the rear of the premises. Building works were being carried out at the time of our inspection to build an office complex in the garden and an extension adjoining the main house. This meant people were unable to use a separate dining area in the service because it was being used as a temporary office.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Cranmore was last inspected in June 2014. At that inspection it was rated as ‘Requires improvement’. A number of breaches of Regulation were found during that inspection and the provider sent us an action plan to tell us what actions had taken place to make improvements. The action plan stated that the breaches had been addressed by mid-September 2015.

At this inspection we found improvements had been made, but some areas required further input to make them better. However, we also found some new breaches of Regulation.

Recruitment processes were not sufficiently robust to demonstrate that identified potential concerns were considered and if needed mitigated.

Staff supervision had lapsed and did not meet the service’s policy; this meant opportunity had been missed to address some elements of staff practice.

People’s aspirations were not effectively developed or maintained; goal setting and reviews were not adequately evaluated or recorded.

Some records were incomplete and auditing and quality monitoring frameworks remained ineffective to identify and address these and other concerns found during the inspection.

Medicines were safely administered and stored. Checks ensured sufficient medicines were ordered, the right amount was given and that people received the right medicines when they were supposed to.

Staffing had increased, was flexible and kept under continuous review; there were sufficient staff to safely support people’s needs.

Items requiring replacement, maintenance or repair received prompt attention and a maintenance schedule planned the completion of remaining work.

Risks were evaluated, measures were put in place to keep known risks to a minimum and staff knew how to keep people safe. People told us they felt safe in the service and when they were out with staff. Staff had access to the local authority safeguarding protocols, and knew which incidents should be referred for investigation.

Authorisations and decisions, made under the Mental Capacity Act 2005 to deprive people of their liberty, were notified to the Care Quality Commission when they needed to be.

All staff had an understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards, they understood in what circumstances a person may need to be referred and when there was a need for best interest meetings to take place. Advocacy services were made available to people.

People had personalised records detailing their care and support, including well developed support plans for their emotional and behavioural needs. People were

We spoke with the four people who were living at the home at the time of the inspection. People told us that they liked living at the home and were happy with the care and support they received. They told us, “I love it here “and “It’s really nice”.

People told us they made choices about their lives such as about what to do, what to eat and when to get up and go to bed. People were aware of their care plans, had contributed to what was in them and had signed the information.

People said they liked the staff and that staff gave them support and encouragement to gain independence skills and to experience new activities. One person told us “I like my keyworker she is really nice”.

People told us they liked their rooms; they kept them clean and tidy themselves to the level of their ability, and had chosen their own colour schemes. They said the home was comfortable. One person told us “I like my room, sometimes I go there in the evening and listen to music or play games” and “it is always clean and tidy”.

People were aware of who they could speak with if they were concerned about anything. They told us they would speak with the manager or staff and that they had opportunities to voice any concerns at their keyworker and house meetings.

We met and spoke with three people who used the service and three staff during this inspection. At our previous inspection on 30 October 2013 all the people spoken with were satisfied with their care and support.

During this inspection we spoke to people who used the service. People continued to be happy with the care and support provided. One person did speak to us about a small concern they had. They said this had not been an issue on the day of the inspection, but over the previous week. With their consent we spoke to staff who told us they were aware of the concern. Staff said the issue had arisen because the upstairs hoover had broken. This had been discussed at a recent staff meeting and until a new one was purchased it had been agreed staff would carry the hoover upstairs for people to use. The individual was satisfied with this outcome.

Staff had received an appraisal to ensure they had the opportunity to discuss any learning and development necessary in order to meet people’s needs. Staff felt well supported.

We spoke with all four people who lived at the home at the time of our inspection. People talked enthusiastically about the activities they did within the home and also out and about in the community. People said they could generally make their own decisions about what to do and when.

People told us they were satisfied with the care and support they received. One said, “I like living here”. People were aware of their care plan although did not always know the detail. People said that they had the opportunity to discuss their care and support with staff.

People told us that they felt safe receiving a service and spoke positively about the staff. One said, “I like all the staff, they help me when I need help”.

People told us they had the opportunity to discuss any concerns, give their opinions and be involved in decision making at their residents’ meetings. They said that when they raised concerns these were “sorted out”.

We undertook an unannounced inspection of this service on 3 and 4 June 2015. We returned to the service for part of the day on 9 June 2015 when the manager was available.

The service is registered to provide accommodation and personal care for up to six people who have learning disabilities, including autism, Prader Willi Syndrome and some complex and challenging behavioural needs.

Accommodation is provided in a detached house in a quiet residential area of New Romney, close to public transport and local amenities and shops. Accommodation is arranged over two floors and each person had their own bedroom. The home benefitted from a large enclosed back garden, where people were supported to look after chickens and ducks and grew fruit and vegetables.

This service had a registered manager in post. A registered manager is a person who is 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 inspection the home was full and we were able to speak with each person. People told us that they liked living in the home, they were happy, they liked the staff and the staff were kind. They thought the home provided a relaxed and comfortable living environment, which didn’t feel crowded.

To help us understand the experiences of people who could not readily communicate with us or preferred not to, we observed their responses to the daily events going on around them, their interaction with each other and with staff.

Our inspection found that whilst the home offered people a homely environment and their basic care needs were being supported; there were shortfalls in a number of areas that required improvement.

Staff planning did not always ensure that there were enough staff who had received relevant training to support people at all times. This included night staffing arrangements.

Although the service had access to the local authority safeguarding protocols, incidents that warranted referrals to the authority were not made.

Some practices for the administration of medicines did not promote proper and safe management because procedures intended to safeguard against mistakes were not always followed.

The home was not always responsive to people’s needs. This was because people’s goals and wishes were not effectively progressed to encourage development of learning and exploring new activities and challenges.

Authorisations and decisions, made under the Mental Capacity Act 2005 to deprive people of their liberty, were not notified to the Care Quality Commission when they needed to be.

A quality monitoring system was in place, but was not effective enough to enable the service to highlight the issues raised within this inspection.

There were other elements of the inspection which were positive. People told us that they felt safe in the service and when they were out with staff.

The registered manager had an understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards, they understood in what circumstances a person may need to be referred and when there was a need for best interest meetings to take place. Advocacy services were made available to people.

People had personalised records detailing their care and support, including well developed support plans for their emotional and behavioural needs. People were supported to access routine and specialist health care appointments. People told us staff showed concern when they were unwell and took appropriate action.

People felt comfortable in complaining, but did not have any concerns. People, relatives and visiting professionals had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been positive.

People felt the service was well-led. The registered manager adopted an open door policy and sometimes worked alongside staff. They took action to address any concerns or issues straightaway to help ensure the service ran smoothly.

The provider had a set of values, which included treating everyone as an individual, working together as an inclusive team and respecting each other. Staff were aware of these and they were followed through into practice.

We found a number of breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.