The inspection took place on 15 March 2018. The inspection was unannounced. This meant the provider and staff did not know we would be coming.

Eastbourne Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Eastbourne Avenue provides care and support for up to seven people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were seven people living in the home.

The service had a registered manager in place. 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.

We previously inspected Eastbourne Avenue in November 2015, at which time the service was meeting all regulatory standards and was rated ‘Good’. At this inspection we found the service had deteriorated to Requires Improvement.

At this inspection we found that there was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This related to the Registered Manager failing to notify the Care Quality Commission of incidents regarding receipt of a Deprivation of Liberty Safeguard authorisations. We are dealing with this outside the inspection process.

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

People felt safe living at the service. Staff had completed training in safeguarding people and the registered manager actively raised any safeguarding concerns with the local authority.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

There were enough staff to meet people’s needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

People continued to receive their medicines in a timely way and in line with prescribed instructions. Staff had their competencies checked regularly and medicines audits were completed by the registered manager.

Staff received up to date training, regular supervisions and an annual appraisal to support them in their roles.

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.

People were supported to see a range of health professionals and information about healthcare interventions were included in care records.

People told us the service was caring. Staff treated people with dignity and respect when speaking with them and providing them with support.

People had access to advocacy services if they wished to receive support. Some people had active advocacy services involved in decision making relating to specific aspects of their care.

People had a range of care plans in place that were detailed, personalised, reviewed regularly and included people’s personal preferences.

There was a wide range of activities available for people to enjoy in the home. People were also supported, to regularly access activities in the local community including going to local colleges, music cafes and bowling.

There were audit systems in place to monitor the quality and safety of the service. The views of people and relatives were sought by the registered manager via annual questionnaires. Comments from the last questionnaires received in December 2017 were positive.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. One relative told us, “The staff know him and he feels safe there. He’s well looked after and I think the way they treat people is excellent.”

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us “It’s canny here, the staff are really nice and my key worker X; he’s a canny man”. A relative told us, “The staff are lovely; they’re all nice and very caring.”

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us they met with their key workers once a month to discuss what was important to them. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people’s wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Relatives were able to complete an annual customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. We saw that staff were given the opportunity to complete an annual employee satisfaction survey. This helped to ensure that people received a good quality service at all times.

We used a number of methods to help us understand the experiences of people who used the service. These included carrying out an observation, speaking with people who could share their experiences, reviewing comments and surveys and speaking with staff. We observed the care given to the people who used the service present at the home on the day of our visit.

People who used the service and their relatives had commented upon the care that had been provided. They said ‘they ‘like the home and the friendly staff’, ‘like all food and activities’, ‘the home is excellent’ and staff ‘listen, talk things over, support and hold meetings’.

During this inspection we also checked on the safety and suitability of the accommodation and environment. We saw the communal areas were clean and tidy and bedrooms were spacious, well decorated and personalised by individual service users.

People spoken to had access to their care plan and we were told that any changes in their care had been discussed with them and their family members.

During our observation we saw people were treated with consideration and respect. We reviewed three care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about people's care needs and what they should do to support them. There were enough staff to meet people’s needs.

We spoke with two people living at Eastbourne Avenue and saw how they were treated by staff and how they responded to conversations with staff. They told us that they ‘really like it here’, ‘the place is like home’ and that the accommodation is ‘very good’.

We saw the results of the questionnaires completed by people who used the service. They commented that they knew they had a key worker in place and that they all felt that they were listened to, and that their issues were dealt with appropriately and speedily. People who used the service said they felt ‘good about the home’, there was a ‘choice of activities’, the staff were ‘friendly’ and they enjoy ’planning the weekly menu and planning their holidays’.

People who used the service had also said that they ’knew who to talk to’ if they had a complaint and they felt ‘involved and encouraged’ in decision making within the home.

Family members had commented that the ‘atmosphere is homely, care provided and the activities are very good; the way the home is run and organized is excellent, staff are friendly, helpful and the support given is excellent. Very informative and kept up to date with all aspects of care’.

We saw how staff talked with people who used the service in conversation and responded to any questions or issues they had. People said they were very happy with the service provided by staff and they said they were courteous and polite.

We carried out an inspection of Eastbourne Avenue on 27 November and 7 December 2015. We spoke with relatives over the phone on 10 December. The first day of the inspection was unannounced. We last inspected Eastbourne Avenue on 2 April 2014 and found the service was meeting the relevant regulations in force at that time.

Eastbourne Avenue is a seven bed care home that provides care and support to people with learning disabilities. Nursing care is not provided. At the time of the inspection there were seven people accommodated there.

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.

People told us they felt safe and were well cared for. Staff knew about safeguarding vulnerable adults. Incidents and alerts were dealt with appropriately, which helped to keep people safe.

We observed staff provided care safely. At the time of our inspection, the levels of staff on duty were sufficient to safely meet people’s needs. New staff were subject to thorough recruitment checks. These checks included input from people using the service.

Medicines were managed safely for people and records completed correctly. People received their medicines at the times they needed them and in a consistently safe way.

As Eastbourne Avenue is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Staff obtained people’s consent before providing care. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests.

Staff had completed relevant safety related training for their role and they were well supported by the registered manager. Training included care and safety related topics and further training was planned.

Staff were aware of people’s nutritional needs and made sure they were supported with eating, drinking and maintaining a healthy diet where necessary. People’s health needs were identified and external professionals involved where necessary. This ensured people’s general medical needs were met promptly.

Activities were arranged in house and people accessed community based activities as well as council provided day care. We observed staff interacting positively with people. Relatives told us about the caring approach of staff. We saw staff treated people with respect and explained clearly how people’s privacy and dignity were maintained. Staff understood the needs of people and we saw care plans were person centred.

People using the service, relatives and staff spoke well of the registered manager and care provider and felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care.