This inspection took place on the 11 and 13 September 2018 and was unannounced.

During our previous inspection on 7 and 8 July 2017, we identified the provider had breached regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We found that that not all people had evidence of decisions being made in people’s best interest if they lacked capacity. We also found that the provider’s quality assurance process had not picked up on a potential health and safety issue which put people at risk.

We asked the provider to take action to address these issues and at this inspection, we checked whether the provider had made improvements. At this inspection we found the provider had made and sustained the required improvements.

Donec Mews 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.

Donec Mews accommodates 16 people across three separate houses. The care service has been developed and designed 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 2008 and associated Regulations about how the service is run.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered by regular agency staff who knew the people they were supporting well. The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting.

Risks to people were assessed and action was taken to minimise any avoidable harm. Staff were trained to support people who experienced behaviour that may challenge others, in line with recognised best practice. Medicines were managed safely and administered as prescribed and staff had regular competency checks.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally, where required. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

Staff understood the importance of food safety and prepared and handled food in accordance with required standards. High standards of cleanliness and hygiene were maintained within the home.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet individual's’ complex needs. People were supported to have a balanced diet that promoted healthy eating.

The registered manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People or their families were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The registered manager had created an inclusive, family atmosphere at the home. People were relaxed and comfortable in the

This inspection took place on the 6 and 7 July 2017 and was unannounced. Donec Mews is registered to provide accommodation and support for up to 16 people with learning disabilities or autistic spectrum disorder. People supported may also be living with a physical or a sensory impairment. At the time of the inspection there were 16 people living there. Accommodation was arranged into three separate houses with a communal garden.

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 2008 and associated Regulations about how the service is run.

At our last inspection of this service on 15 and 16 June 2015 we found one breach of legal requirements in relation to safeguarding people from abuse and improper treatment. Following the inspection the provider wrote and told us they planned to meet the requirements of this regulation by 30 October 2015. At this inspection we found the provider had met the requirement of this regulation and submitted Deprivation of Liberty Safeguard applications (DoLS) for people who lacked the mental capacity to consent to their care and treatment and had met the requirement of this regulation.

However, at our previous inspection we had asked the provider to ensure people’s rights were upheld by carrying out mental capacity assessments to determine if the person could consent to some decisions made about their care and treatment. These decisions included restrictive practices in place to protect people and promote their safety such as; the deprivation of their liberty, the use of lap belts and bed rails. Whilst we saw some progress had been made, the registered manager had still not completed these assessments in relation to some decisions for some people.This meant people were not always supported to have maximum choice and control of their lives and the policies and systems do not support this practice

We found that actions identified to improve the quality and safety of the home were not always responded to appropriately and without delay. Systems were in place to support the registered manager to monitor the quality and safety of the service. These included a quarterly quality monitoring audit conducted by the provider. However, the system was not sufficiently robust to ensure that where areas for improvements were identified these were always acted on. We found actions relating to fire safety procedures had not been completed in line with the provider’s fire safety policy. Not all the actions had been completed from our previous inspection in relation to mental capacity assessments for decisions which had the potential to restrict people’s movements. Whilst the registered manager has taken action as a result of this inspection to address these issues more time is required to ensure that improvements are fully completed and sustained.

Staff completed an induction and had access to a range of training to ensure they remained competent to meet the needs of the people they supported. A support and development policy was in place which outlined the supervision and appraisal arrangements for staff. However, not all staff had received supervisions and appraisals at the time intervals stated as necessary by the provider. People were not always cared for by staff who had been appraised and supervised in their role to support them in providing a high standard of care to people.

Records relating to the amount of food and drink people consumed to monitor their nutrition and hydration needs were not always completed to ensure their needs were monitored effectively.

Risks to people from choking were assessed and guidance was followed in relation to eating and drinking safely. People were able to choose the meals they ate assisted by pictures of foo

On the day of our visit there were thirteen people residing in the service. We were met by the registered manager who explained that for many years all the people had lived in a single, large house, but about three years ago they had been moved next door into three smaller, purpose-built houses.

We looked at consent to care and treatment and found that people were always being asked for their permission to have care and treatment provide to them, and had the right to refuse care and treatment. We also found that staff had a proper understanding of mental capacity issues.

We looked at the care and welfare of people who used the service and found they and their relatives were happy with the level of care they were receiving. We also found that a proper system of care planning and management was in place.

We looked at how the provider ensured that people were protected from abuse and found that staff were properly trained in safeguarding, and would be able to identify and report any instances of abuse.

We found that there were appropriate staffing levels in the service and that care staff were experienced and qualified to fulfil their roles.

We looked at how the provider ensured a high quality of service, and found that they regularly sought feedback from people who used the service and from staff. We also found they conducted regularly reviews and audits on all aspects of the service.

The inspection took place on 15 and 16 June 2015 and was unannounced. Donec Mews is registered to provide accommodation and support to sixteen people with learning disabilities. At the time of the inspection there were 15 people living there. The service is divided into three houses with a communal garden.

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 2008 and associated Regulations about how the service is run.

The provision of some people’s care required the use of equipment, which could restrict their movement. Some people were potentially deprived of their liberty. The provider had not ensured legal requirements had been met in these situations. People’s capacity to consent to these restrictions had not been taken into account.

Staff had sought people’s consent in relation to the provision of their care on a day to day basis. Staff had received training in the Mental Capacity Act 2005 and best interest’s decisions had been made on each person’s behalf. People were supported by staff who constantly sought to support them to make day to day decisions.

People were safeguarded from the risk of abuse. Staff had responded appropriately to safeguarding incidents to protect people. The provider had made changes to people’s care as a result of incidents to safeguard them.

Risks to people had been assessed. Plans were in place to manage the identified risks whilst not removing people’s right to independence. Staff had access to relevant information in the event of an emergency. People’s medicines were managed safely by competent staff who had undergone relevant training.

People were cared for by sufficient staff who had undergone the required legal pre-employment checks to ensure their suitability. People were supported by staff who received an induction based on the social care industry requirements. The induction also took into account the specific needs of the people cared for by the service. For example, some people experienced epilepsy or autism and training was provided in these areas as part of the induction. This ensured staff received relevant training. People were supported by staff whose work was monitored through regular supervision and annual appraisals.

People were involved in making meal choices and purchasing food. They were able to exercise choice whilst staff supported them to make healthy choices. People were provided with relevant equipment to enable them to eat more independently. Staff interacted with people at mealtimes which were sociable occasions. People were supported by staff to ensure all of their health care needs were met. Staff followed good practice and ensured people had an annual review of their health.

Staff were encouraged from the start of their induction to build positive relationships with people and to spend time getting to know them. Staff were sensitive to people’s communications and worked to support them if they showed any signs of distress. Staff recognised people’s individuality and ensured this was respected.

Staff understood people’s needs and how they communicated. People received appropriate support to enable them to be involved in decisions about their care. People’s rights to choose how and where to spend their time were respected. Staff were sensitive to people’s moods and recognised when they needed to change activity.

Staff treated people with dignity and respect at all times. They respected that they were working within the person’s home. People were encouraged to be as independent as they could be. People decided who they wanted contact with and staff supported them to see people who were important to them.

People’s needs were assessed before they moved into the service and consideration was given to how compatible they would be with others already living there. People’s needs and preferences in relation to their care were documented. Staff supported people to attend a range of activities.

The provider sought people’s views on the service in a variety of ways. Through the complaints process, people’s keyworker meetings, house meetings and the quality assurance questionnaire. People were supported by staff to express their views.

The registered manager and staff had created a positive culture within the service, where people were encouraged to participate in making decisions about the service, for example recruitment. People were represented on the service user forum which had affected change in people’s experience of the service. Staff practiced the provider’s values. People and their support needs were central to the way care was delivered by staff.

The service was well-led by the management team. People’s relatives and staff expressed their satisfaction with the management of the service. The registered manager was passionate and led the team well. They ensured they worked shifts alongside staff to provide people’s support directly.

Processes were in place to monitor the quality of the service people received. Where areas for improvement had been identified appropriate actions had been taken by the provider. People’s records were stored securely.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations

2014. You can see what action we told the provider to take at the back of the full version of the report.