About the service: East Wheal Rose is a residential care home that provides care and accommodation for up to three people who have autistic spectrum disorders. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of specialist care for people with autistic spectrum disorders and learning disabilities. At the time of the inspection two people were living at the service.

What life is like for people using this service:

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

¿ Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. There was a stable staff team who were all knowledgeable about the people living at the service and had built trusting and meaningful relationships with them.

¿ Staff were recruited safely and there were sufficient numbers to ensure people’s care and social needs were met. Staff knew how to keep people safe from harm.

¿ There was time for people to have social interaction and activity with staff. Staff actively encouraged people to maintain links with the local community, their friends and family.

¿ People's care was individualised and focused on promoting their independence as well as their physical and mental well-being. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.

¿ The environment had been adapted to meet people’s individual needs and keep them safe from harm. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

¿ People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. People were involved in meal planning and preparation. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

¿ Where restrictions had been put in place to keep people safe this had been done in line with the

requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were clearly recorded and regularly reviewed to check they were still necessary and proportionate.

¿ There was a clearly defined management structure and regular oversight and input

from senior management. Staff were positive about the management of the service and told us the registered and deputy managers were supportive and approachable. Any concerns or worries were listened and responded to and used as opportunities to make continuous improvements to the service.

Rating at last inspection: Overall Good (Safe rated Requires Improvement). The report was published on 1 November 2016.

Why we inspected: This inspection was a scheduled comprehensive inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect sooner.

The full details can be found on our website at www.cqc.org.uk

We inspected East Wheal Rose on 11 October 2016, the inspection was unannounced. The service was last inspected in April 2016, when we carried out a focused inspection to check improvements had been made to the service following an inspection in September 2015. At our inspection in April we identified a breach of the legal requirements.

East Wheal Rose provides care and accommodation for up to three people who have autistic spectrum disorders. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of specialist care for people with autistic spectrum disorders and learning disabilities. At the time of the inspection two people were living at the service.

The service is required to have 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. Since our last inspection the registered manager had left and there was no registered manager in post at the time of the inspection. The acting manager had been in post since August 2016 and was in the process of making an application for the position.

Staff told us staffing levels had improved since the last inspection. They worked to cover any gaps in the rotas which arose because of sickness or planned leave. The manager told us the staff team were flexible in their approach and committed to helping ensure people were able to take part in activities.

Records showed there were several occasions in the three weeks preceding the inspection when staffing levels that had been commissioned had not been met. Staff told us this had not impacted on people’s opportunities to take part in activities. Daily records confirmed people were going out regularly. We were satisfied that, although commissioned hours were not always met, people were supported by sufficient staff to enable them to take part in meaningful activities. Although the service was now compliant with the requirements of this regulation we have recommended that the provider takes action to ensure people consistently receive the levels of staff support they require and in line with the hours commissioned by Local Authorities.

Staff were not receiving regular face to face supervisions or appraisals to help them think about their professional development or identify training needs. We have made a recommendation about this in the report.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse. Risks were clearly identified and appropriate action taken to minimise risks and protect people from avoidable harm. People sometimes became anxious and distressed and this could lead them to behave in a way which put themselves and others at risk. In these circumstances there were clear guidelines for staff to follow which protected people. Staff told us they were confident supporting people at all times.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). Where people were deprived of their liberty in order to keep them safe the correct processes had been followed. Staff demonstrated a good understanding of the underlying principles of the Mental Capacity Act (MCA).

Staff used a range of techniques and tools to communicate effectively with people. They were skilled and knowledgeable in this aspect of care and were able to describe to us when it would be appropriate to use certain approaches. Information was available for people in pictorial formats to aid understanding. The acting manager had plans to develop this further.

Care plans were well organised and up to date. They had been developed with t

We inspected East Wheal Rose on 18 April 2016, the inspection was unannounced. The service was last inspected in September 2015. At that inspection we identified breaches of the legal requirements. We issued three requirements and told the provider to take action to address the breaches of the regulations. The provider did not send the Care Quality Commission an action plan following the publication of the report. We carried out this inspection to check if the service was now meeting the requirements of the regulations and because we were concerned they had not submitted an action plan.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for East Wheal Rose on our website at www.cqc.org.uk

East Wheal Rose provides care and accommodation for up to two people who have autistic spectrum disorders. At the time of the inspection two people were living at the service.

The service is required to have 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 a registered manager in post at the time of the inspection. However, a few days before the inspection visit, CQC had received a notification to change the registered manager at the service. The registered manager was no longer working at the service and arrangements for their replacement had not been finalised. The service was being managed on a day to day basis by the deputy manager with the support of the divisional manager.

Commissioned staffing levels were not consistently adhered to. During the three weeks preceding the inspection staffing levels had not been met on seven occasions during the day and five occasions during the night.

People were supported to take part in activities outside of the service. Staff told us they made sure people were supported to go out most days. There was one vacancy for a support worker. During the inspection the divisional manger was informed this vacancy had been filled.

There was a stable and consistent staff team in place. Staff told us they worked well together and were a "close knit" team. New staff were required to complete an induction and period of shadowing more experienced staff before starting to work independently.

Since our last inspection, improvements to the premises had been made. These helped ensure facilities were appropriate for people's needs. The property was an old house and regular maintenance audits were carried out to quickly identify any defects. A programme of improvements for the coming year was in place. Any defects or breakages requiring immediate attention were dealt with in a timely fashion.

Staff told us they felt well supported by the deputy manager and divisional manager. The divisional manager had clear oversight, and a good understanding of the day to day running of the service. The deputy manager had been in post since November 2015 and was carrying out regular supervisions and audits. Staff told us Spectrum communicated well with them and kept them informed of any changes which might affect them.

We identified a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The actions we have asked the provider to take are detailed at the back of the full version of the report.

We inspected East Wheal Rose on 30 September 2015, the inspection was unannounced. The service was last inspected in January 2014, we had no concerns at that time.

East Wheal Rose provides care and accommodation for up to two people who have autistic spectrum disorders. At the time of the inspection two people were living at the service. 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 service was sometimes under staffed. Staff told us they did not think staffing levels had impacted people’s safety or resulted in any increased risk to people or staff. They did tell us there was an impact on the opportunities for people to take part in activities in the community or be supported with tasks at the service.

The people living at East Wheal Rose did not use words to communicate and had complex support needs. This meant it took time to get to know them and understand how best to support them. Staff told us that less experienced employees sometimes lacked confidence to support people without the help of more experienced staff. The shortage of staff numbers meant this could be difficult to manage.

Experienced staff were confident when working with people and knew their needs and communication styles well. A relative told us staff were consistent in the way in which they supported their family member. There were a range of communication tools available for people which enabled them to make day to day choices.

Due to people’s health needs there were restrictions in place throughout the service. The requirements of the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS) had been adhered to. This meant people’s legal rights were protected when their liberty was restricted. Staff worked to help ensure people were supported to access the community and take part in activities they enjoyed when staffing levels permitted this. Strategies to support people to have as much autonomy as possible were developed.

The provider had identified where changes to the environment were necessary to meet people’s needs. However, action had not been taken to meet those identified needs in a timely manner. For example a bathroom was in need of refurbishment; although this had been highlighted by the provider in 2014 the work had not been completed.

Staff had access to an effective and thorough programme of training. This included training in areas specific to the needs of the people they supported. New employees undertook a comprehensive induction which incorporated theoretical, classroom based training and shadowing more experienced staff.

Care plans were individualised and contained detailed and up to date information regarding people’s support needs. Staff told us the information was relevant and easy to access. People’s routines were clearly laid out and there was information about what was important for and to people.

Staff told us they were a close team who got on well together. They said they had worked hard to cover staff shortages and help ensure people were supported effectively. However they reported a lack of confidence in the management of the service at all levels. Staff did not feel their grievances were always listened to and told us they did not have confidence in a recent consultation process. Where concerns had been raised they felt these had not been adequately listened to.

Regular audits were carried out to help ensure the service was safe. Incidents and accidents were recorded appropriately and analysed monthly in order to highlight any trends. People’s views regarding the running of the service were actively sought out.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

We did not speak directly with the two people who lived at East Wheal Rose due to their complex communication needs. We spoke with the divisional manager, the registered manager and two members of staff. Following the inspection we contacted professionals who had worked alongside staff at East Wheal Rose to ask their opinion of the service.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We examined people's care files and found the records were up to date and reviewed as the person's needs/wishes changed.

People were protected from the risks of inadequate nutrition and dehydration.

People were safeguarded from the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent it from happening.

Premises were adequate although one bathroom required updating.

We did not speak directly with the one person who lived in the home as they had complex communication needs. Instead we saw how the person interacted with staff. We spoke with a relative after our visit who said "they are very, very good" and “I have no qualms about the care”.

We looked around the home and found that it was clean and hygienic. We examined the person's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that the person was involved in making day to day decisions and participated in tasks at home, such as cleaning and preparing meals. The records showed that the person went out frequently. The person saw healthcare professionals on a regular basis or when they needed them.

Staff were friendly and respected the person's right to privacy, dignity, and independence. Staff said they had received sufficient training to enable them to carry out their roles competently.

There were effective systems for safeguarding people from abuse. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights. We found that the staff used physical intervention techniques with the person but there were no recorded agreements from health or social care professionals. However we were told by the registered manager that meetings were being set up to ensure that such management techniques were properly agreed.

People living in the home are unable to communicate verbally. In order to communicate, people use a limited number of Makaton signs and gestures. From our observations people seemed happy living in the home, and there were positive interactions between staff and people using the service. However we were only able to observe interactions for a very limited period, as our presence negatively affected the atmosphere in the home.