This unannounced inspection was carried out on 25 September 2018.

Durham and Endymion 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.

49 - 53 Durham Street is registered to provide care and accommodation for up to five adults with a learning disability. 48 Endymion Street is a terraced property which is registered to provide care and accommodation for two adults who have a learning disability. They are both part of the Avocet Trust organisation, which is a registered charity.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed. There were sufficient staff to meet people's needs and staff recruitment processes and procedures were robust.

Staff received appropriate induction, supervision and training to provide safe and effective care. The registered manager worked in partnership with healthcare professionals and other organisations to meet people’s needs.

Observations showed staff were compassionate, kind and caring and had developed good relationships with people using the service. Staff knew people well and promoted their dignity and respected their privacy. Care plans detailed and provided staff with guidance on how to meet people's individual needs. People using the service were provided with the care, support and equipment they needed to maintain their independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and procedures in the service supported this practice.

Medicines were managed safely and people’s individual nutritional needs were met. A range of activities were available for people to participate in. People using the service were supported to maintain relationships that were important to them.

The registered provider had a procedure for receiving and responding to complaints about the service. Staff spoken with were fully aware of their responsibilities in supporting people if they needed to complain about the service they received. People using the service had access to an advocate.

The provider and registered manager consistently monitored the quality of the service and made changes to improve and develop the service, considering people’s needs and views. People knew the registered manager and were comfortable and confident in approaching them. Staff told us the registered manager was approachable and supportive.

Further information is in the detailed findings below.

49 - 53 Durham Street is registered to provide care and accommodation for up to five adults with a learning disability. 48 Endymion Street is a terraced property which is registered to provide care and accommodation for two adults who have a learning disability. They are both part of the Avocet Trust organisation, which is a registered charity. The services are is located in the east of the city of Hull.

We undertook this unannounced inspection on the 21 March 2016. At the last inspection on 11 November 2013, the registered provider was compliant with the regulations we assessed. Four people were using the service at 49 -53 Durham Street and 48 Endymion Street was unoccupied.

Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff and those people using the service who were able to speak with us.

The service had 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 registered manager informed us they would be moving to manage another service within the organisation and another manager would be taking over responsibility for the service. They told us that a date for these changes had not yet been confirmed.

We found improvements were required with the quality assurance system in place this needed further improvements as this did not always show what actions had been taken, when areas for improvement were identified through audits and surveys. A revised quality assurance system had recently been introduced which consisted of seeking people’s views and carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them. However we found that the system had not identified the need for one person’s mealtime prescription, (this is a document which identifies people's nutritional needs and the support they need with eating and drinking) required updating.

Positive interactions were observed between staff and the people they cared for. People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

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 found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions. People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

People’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. Meals provided to people were varied and in line with risk management plans produced by speech and language therapists and dieticians. We observed drinks and snacks were served between meals. People who used the service received care in a person

The registered manager for this service was not present for this inspection. The registered manager from one of the provider’s other services supported the inspection visit.

We saw people's preferences and choices were made clear in their care files and there was use of pictorial representations to aid communication and understanding.

Detailed support plans had been developed that staff followed to make sure people's needs were met. We observed the people who used the service were happy with the service provided. They appeared relaxed and satisfied that their needs were being met in the way they wanted. We found the staff were very caring. One person we spoke with described the staff member looking after them as, “Nice.” Another person said, “Staff are good."

People who used the service were provided with a balanced and varied diet. One person told us, “I like pork chops best and I like crisps.”

We found suitable arrangements were in place to manage people’s medication to ensure they received any medication they needed.

Appropriate background checks were carried out to ensure new staff were safe to work with vulnerable people.

We saw the complaints procedure was available to people who used and visited the service. Staff told us how they would support people to raise concerns if they could not do so themselves. People who used the service named staff they would talk to if they were worried or upset.

Because the people who used the service had complex needs we used a number of different methods to help us understand their experiences.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people’s needs and provided reassurance and guidance when needed.

We saw that people were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of anything.

We saw that staff had received adequate training which helped them to care for the people who used the service and to meet their needs.

We did not speak with people who use the services regarding these outcome areas. This was because the information we examined as part of this review was all held at the Head Office and not at the location.

Due to people having a variety of complex needs and communication difficulties, they were not able to tell us directly about their care.