Deerhurst offers accommodation and personal care for up to three people living with a learning disability, autism or mental health needs.

The inspection was announced and was carried out on 30 & 31 May 2017 by one inspector.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and staff told us they felt the home was safe. Staff had received safeguarding training and explained the action they would take to report any concerns.

Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks. Plans were in place to manage emergencies. Regular safety checks were carried out on the environment and equipment.

Systems were in place for the storage and administration of medicines, including controlled drugs. People received their medicines from staff who were appropriately trained and regularly assessed.

There were safe recruitment procedures in place and sufficient staff were deployed to meet people’s needs. People were supported by staff who had received appropriate induction, training and supervision.

People were supported to maintain their health and well-being and were referred to healthcare services when they needed them. People were offered enough to eat and drink and their specific dietary needs were met.

People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood the Deprivation of Liberty Safeguards and had submitted requests for authorisation when required.

Staff were kind and caring, treated people with dignity and respect and ensured their privacy was maintained. People were encouraged to maintain relationships with family and friends and visitors were welcome at any time.

Initial assessments were undertaken before people moved into the home to ensure their needs could be met. People had person centred support plans and their relatives or other representatives were involved in decisions about their care planning. People had access to a wide choice of activities, both at home and in the community.

Easy read complaints procedures were available and complaints were appropriately addressed. People and relatives were encouraged to give their views about the service.

Staff felt supported by the registered manager who provided clear leadership and guidance. Staff felt listened to and involved in the development of the service.

Quality assurance systems and audits were in place to help drive improvements. Incidents and accidents were recorded and actions taken and any learning shared with other homes within the company.

The inspection took place on the 8 November 2016. The inspection was unannounced.

Deerhurst is a small residential care home which provides care and support for up to three people with a learning disability and autism. The home is located in a quiet cul-de-sac within a local housing estate. People’s rooms were located on the first floor which were accessed by stairs. One of the rooms had an ensuite bathroom, the two remaining rooms shared a shower. In addition the home had a lounge and conservatory, a kitchen and separate dining room, a laundry and a staff office. The home had a large garden to the rear of the property and parking to the front. At the time of the inspection there were three people living at the home.

The service had a registered manager. 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. The registered manager was also the registered manager of another of the provider’s nearby service and split their time equally between the two services.

People told us they felt safe living at Deerhurst and our observations indicated they felt relaxed and comfortable in the presence of their care workers and responded positively when staff approached them or offered them support.

We found, however, that some improvements were needed. People were not always protected from risks associated with the environment. The provider’s governance arrangements needed to be more robust to ensure that all of the risks to people were monitored and appropriate action taken when a risk identified.

People’s medicines were managed safely and there were appropriate systems in place for obtaining, storing, administering and disposing of medicines.

Staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect.

Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised.

Where people were unable to make decisions about their care, staff were guided by the principles of the Mental Capacity Act (MCA) 2005.

Improvements had been made which helped to ensure that people received a nutritious diet.

Where necessary staff had worked effectively with a range of other healthcare professionals to help ensure that people’s health care needs were met.

People appeared relaxed and comfortable in the presence of the staff that were supporting them. Staff had a good knowledge and understanding of people which demonstrated they knew them well.

Meetings were held with people on a weekly basis and were an opportunity for them to make choices about how their care was provided.

People were encouraged to maintain relationships with their family and to make new friends through visiting the providers other homes nearby.

Staff demonstrated a good understanding of the meaning of dignity and how this encompassed all of the care provided to each person.

Improvements had been made to ensure that people were receiving care that was responsive to their wishes and preferences and allowed them to take part in activities of their choice.

People’s support plans were personalised and their preferences and choices were detailed throughout their care records.

People and staff were encouraged to give feedback about the service and this was used to drive improvements. Complaints policies and procedures were in place and were available in easy read formats.

The registered manager demonstrated a good understanding of all aspects of the home a

At the time of this inspection there were three people living at Deerhurst. We spoke with the manager, operations manager, care workers and two people who lived in the home.

People were involved in making decisions about the care and support they received. One person told us, "I like going out in the car in the afternoons".

People experienced care and support that met their needs and protected their rights. Risks to people, staff and others were assessed and managed to ensure the safety of all parties.

People were supported to have adequate nutrition and hydration. One person we spoke with told us, "I really liked the lunch today".

There were enough qualified, experienced staff to meet the needs of the people living in the home.

The provider had systems in place to regularly check and monitor the quality of the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At this inspection we spoke with the manager, the operations manager, two members of staff and one person who lived in the home.

People’s diversity, values and human rights were respected.

We found that care plans were detailed, person centred, accurately reflected people’s needs and had been drawn up with their involvement where possible.

People were supported by staff that were supported to deliver care and treatment safely and to an appropriate standard.

One person we spoke with told us “I really like living here”.

We observed that care workers and people living in the home were relaxed with each other, patient and sensitive. We saw care workers knew the people who lived in the home well and could anticipate their needs as required.

Due to the communication and complex needs of people living at the home we were unable to hold in depth discussions with them. However we did talk to them briefly, and spend time observing the care being provided. We also observed the way staff spoke and engaged with people who live at the home.

People who live at this home are treated with dignity and their privacy is generally upheld. However we have suggested that this could be improved.

People are supported to make choices about their individual lifestyles and their care and support needs.

People are provided with a healthy diet and are supported to make choices about what they eat.

The home is clean and tidy and good standards of hygiene are maintained throughout the home.

Staff are well trained and understand the need to keep people safe, whilst making sure that people are still able to live the life they choose.

People living at the home have access to a full range of healthcare support.

Deerhurst is a small residential home for up to three people with a learning disability and autism. The home is set in a quiet cul-de-sac location on a residential estate. It has a large open plan living area with a conservatory leading out into an enclosed garden surrounding the house which provides facilities for growing vegetables, playing games and a barbeque.

The home had recently appointed a new manager who was in the process of applying for their registration 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. The operations manager had managed the home during the absence of a manager. The new manager was under close supervision of the operations manager during their induction period.

Staff understood how to recognise the signs of abuse and how to report their concerns if they had any, including to external agencies such as CQC. There was a safeguarding policy in place and included relevant contact details and telephone numbers for reporting concerns.

Staff felt respected and listened to by the manager who involved them in the development of future plans. Training and support was in place to ensure staff were competent to carry out their role.

There was a positive and caring atmosphere in the home. Staff interacted with people with respect and promoted their independence.

Care plans were detailed and included a range of documents covering every aspect of a person’s care and support. The care plans were used in conjunction with person centred plans which included pictorial versions with photographs of activities. This helped to ensure that people’s wishes and skills were recorded along with their support needs. However, staffing was minimal and did not enable staff to provide responsive person centred support every day of the week. There were few opportunities for people to access activities outside of the home, especially at weekends and in the evenings when there was only one member of staff on duty.

There was evidence in care plans that the home had responded to behavioural and health needs and this had led to positive outcomes for people. However, people's weight management was not always monitored effectively and menus did not always reflect a balanced diet.

Risks to people had been appropriately identified and addressed in relation to people’s specific needs. Staff were aware of people’s individual risk assessments and knew how to mitigate the risks.

Medicines were stored safely and administered by staff who had been trained to do so. Staff gave people the time they needed and respected people’s dignity when giving their medicines.

People were asked for their consent before care or support was provided and where people did not have the capacity to consent, the provider acted in accordance with the Mental Capacity Act 2005. People’s mental capacity was assessed when specific decisions needed to be made, and were made in their best interest involving relevant people. The operations manager was aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications for people using the service.

Systems were in place to assess and monitor the quality of the service although these were not always effective. Medicines audits had not identified some errors with the recording of medicines. Regular checks were carried out in relation to the environment and equipment, and procedures were in place to report any defects. Learning took place from incidents and accidents which were recorded, investigated and action taken to minimise the risk of re-occurrence.

We identified two breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. We have made two recommendations to the provider. You can see what action we have told the provider to take at the back of the full version of the report.