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

Houghtons can accommodate up to six people living with a learning disability or autistic spectrum disorder. The accommodation is single storey and is accessible for people who may also have a physical disability. At the time of this inspection there were six people living at the service.

At the last inspection in January 2016, the service was rated Good. During this inspection, which took place on 6 September 2018, we identified some areas requiring improvement. Consequently, we have changed the rating from Good to Requires Improvement. This is the first time the service has been rated Requires Improvement.

Why we rated the service Requires Improvement:

We found some anomalies with medicines and how medicine records were being maintained. Although there was no evidence that people were not receiving their medicines as prescribed, there was also no clear audit trail to explain some of the concerns we found, such as gaps in Medicine Administration Records (MAR) and tablets taken from the wrong day in medicine packaging.

Systems were in place to make sure people's consent was sought in line with legislation and guidance, but these needed strengthening. This included the processes for gaining people’s consent to care and support, and for managing people’s finances where they lacked capacity to manage their own money.

The provider had systems in place to monitor the quality of service provision, to drive continuous improvement. Quality audits had identified several areas where improvements were needed, and a new management team was working to make the required changes. As stated above we also identified some areas requiring action, for the service to become fully compliant with legal requirements (regulations). The registered manager took swift action to address our inspection findings and provided evidence soon afterwards that improvements had already begun to take place. There was still more work to be done, but some good progress was being made to improve the service for the people living there.

We did find that the service continued to provide a good service in other areas that we checked. For example, people were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely and they were protected by the prevention and control of infection.

Arrangements were in place to make sure there were enough staff, with the right training and support, to meet people’s needs and help them to stay safe. The provider carried out checks on new staff to make sure they were suitable and safe to work at the service.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People received care and support that promoted a good quality of life and was delivered in line with current legislation and standards.

People were supported to eat and drink enough. Risks to people with complex eating needs were being managed appropriately.

Staff worked with other external teams and services to ensure people received effective care and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

The building provided people with sufficient accessible space, including a garden, to meet their needs. The service operated 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.

Staff provided care and support in a kind and compassionate way. People were enabled to have maximum choice and control

During our inspection on 31 October 2013, we used a number of different methods to help us understand the experiences of people using the service, because some people had complex needs which meant they were not always able to talk with us about their experiences. We spoke with one person using the service at the time of our inspection.

We observed that people experienced effective, safe and appropriate care.

Care plans were well documented to promote continuity of care.

During our inspection we saw evidence that people's nutritional requirements were assessed and managed in line with their needs, and that these were reviewed on a regular basis.

We found that people living in the home received their prescribed medication when they needed it and in a way that suited them.

We found the premises to be maintained to ensure the home remained safe for people using the service, staff and visitors.

Suitable arrangements were in place to address people's comments and complaints and ensure they were listened to.

When we visited Houghtons on 28 January 2013, we used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant they were not able to tell us their experiences. We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. There was a relaxed atmosphere in the home and people were at ease in the company of the staff supporting them. The staff were friendly and polite in their approach and interacted confidently with people.

We noted that people were encouraged to express their views using various methods of communication. People were involved in planning their care and making decisions about their support and how they spent their time. We observed people were engaged in one to one activities of their choice, such as sessions in the sensory room, and shopping in the local community.

The provider had systems in place to ensure people were involved in the quality monitoring processes for this service. People were encouraged to share their views and opinions to help improve the standard of care provision.

Houghtons provides care and support for up to six adults with both physical disabilities and learning disabilities. It is situated in a residential part of Bedford. On the day of our visit, there were six people living in the service.

Our inspection took place on 11 and 12 January 2016. At the last inspection in October 2013, the provider was meeting the regulations we looked at.

There was 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.

The provider had robust systems in place to safeguard people from the risk of harm and to ensure staff were able to report suspected abuse. Risks to people were assessed and assessments detailed the control measures in place to minimise the potential for future risk to occur. There were sufficient numbers of staff on duty to meet people’s needs and we found that robust recruitment processes had been followed to ensure that staff were suitable to work with people. Safe systems were in place for the administration, storage and recording of medicines.

Staff received an induction with on-going training and formal supervision, to help them to deliver safe and appropriate care to people. Staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS)

People were given a choice of nutritious food and drink throughout the day. People were supported to access other healthcare professionals to maintain their health and general well-being

Staff were knowledgeable about how to meet people’s needs and how people preferred to be supported on a daily basis. They understood how to promote and protect people’s rights and maintain their privacy and dignity. People had access to advocacy services when this was required. Relationships with family members were considered important and staff supported people to maintain these.

People received person-centred care, based on their likes, dislikes and individual preferences. People and their relatives were encouraged to contribute to the development of the service.

This feedback was used to help identify areas for development in the future. People were aware of the provider’s complaints system and information about this was available in an easy read format.

Staff were encouraged to contribute to the development of the service and understood the provider’s visions and values. The service had an open, positive and forward thinking culture. There were internal and external quality control systems in place to monitor quality and safety and to drive improvements.