Ebony House is a care home providing accommodation and support with personal care for adults with learning disabilities. The service is registered to provide support to a maximum of nine people. Seven people were using the service at the time of our inspection.

At the last inspection on 12 and 18 October 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.. We issued two warning notices following the inspection.

This was because people were not safe at the service. There were poor arrangements for managing and administering medicines. Staff did not always receive up to date training. Records were not always fully completed and quality checks did not identify some of the issues we found during the inspection.

We inspected Ebony House on 21 June 2017. This was an unannounced inspection. At this inspection we found the service had made the required improvements.

At the last inspection on 12 and 18 October 2016 the service did not have a registered manager. At this inspection the service had appointed 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.

Relatives of people using the service told us they thought it was safe. Staff knew how to report safeguarding concerns. Risk assessments were completed and management plans put in place to enable people to receive safe care and support. There were systems in place to maintain the safety of the premises and equipment. We found there were enough staff working at the service and recruitment checks were in place to ensure new staff were suitable to work at the service. Medicines were administered safely.

Staff received supervision and appraisals and training in line with the provider's policies and procedures. Staff had a clear understanding of application of the Mental Capacity Act 2005. Appropriate applications for Deprivation of Liberty Safeguards authorisations had been made. People using the service had access to healthcare professionals as required to meet their needs. People were offered a choice of nutritious food and drink.

Personalised support plans were in place for people using the service. Staff knew people they were supporting including their preferences to ensure personalised support was delivered. People using the service told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people's privacy and dignity and encouraged independence. People using the service knew how to make a complaint.

Regular meetings took place for staff and people using the service. The provider sought the views of people and their relatives. The provider had quality assurance systems in place to identify areas of improvement. Staff told us they felt part of a team and that the registered manager was supportive and approachable.

We inspected Ebony House on 12 and 18 October 2016. This was an unannounced inspection. At our last inspection of the service on 13 and 25 January 2016 we found the service to be in breach of two Regulations of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Risk assessments did not always include risks associated with people’s medical conditions. The provider did not always notify the Care Quality Commission of Deprivation of Liberty Safeguards applications and decisions and of incidents that occurred in the service. Accurate records were not always kept of how the service monitored, learnt from incidents, handed over information to staff and monitored people’s needs following an incident. Refresher training in first aid for staff was not up to date. We imposed conditions on the provider’s registration.

At this inspection we found the provider had addressed some of these issues. However we found the provider was in breach of three regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 Notification of Other Incidents. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after representations and appeals have been concluded.

The service was registered to provide personal care and support for people with learning disabilities. The service is registered for nine people. At the time of our inspection they were providing care and support to seven people. The service is a large property arranged over two floors. All bedrooms are single occupancy.

At the time of our inspection the service had a team leader in post who was in the process of applying to become the 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 service was not always safe. Medicines were not safely managed or administered. Relatives of people using the service had mixed views about the safety at the service. Staff training was not up to date in line with the providers statutory training requirements. Records were not always fully completed and quality checks did not identify some of the issues we found during the inspection.

We found there were enough staff working at the service and checks were carried out on staff before they commenced working. The premises were found to be clean and secure. Support plans and risk assessment were in place and provided guidance on how to support people.

People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. People were able to participate in a programme of varied activities. There was a choice of food and drinks available.

Relatives of people using the service felt the service met their relative’s needs. The service had a complaints procedure and relatives of people using the service knew how to make a complaint.

Staff told us they felt part of the team working at the service and found the management team approachable.

We inspected Ebony house on 13 and 25 January 2016. This was an unannounced inspection. At our last inspection of the service in March 2015 we found the service was not always effective because people did not always have access to drinks. At this inspection we found the provider had addressed this issue.

The service was registered to provide personal care and support for people with learning disabilities. The service is registered for nine people. At the time of our inspection they were providing care and support to six people. The service is a large property arranged over two floors. All bedrooms are single occupancy.

The service did not have a registered manager in place at the time of our inspection. 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.

Risk assessments did not always include risks associated with people’s medical conditions. The provider did not always notify the Care Quality Commission of the outcome of Deprivation of Liberty Safeguards applications and of incidents that occurred in the service. Accurate records were not always kept of how the service monitored, learnt from incidents, handed over information to staff and monitored people’s needs following an incident. Refresher training in first aid training for staff was not up to date.

People and their relatives told us they felt safe using the service. We found there were enough staff working at the service and checks were carried out on staff before they commenced working. The premises were found to be clean and secure. Support plans and risk assessment were in place and provided guidance on how to support people.

People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner.

Relatives of people using the service had mixed views about how the service met their relative’s needs. People were aware of how to make a complaint.

Staff told us they felt part of the team working at the service and found the management team approachable.

The service was found to be in breach of three Regulations of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what actions we have asked the provider to take at the end of the full version of this report.

We inspected Ebony House on 24 March 2015. This was an unannounced inspection.

Ebony House is a care home providing personal care and support for people with learning disabilities. The service is registered for nine people. The service is a large property arranged over two floors. All bedrooms are single occupancy. At the time of the inspection they were providing personal care and support to six people.

There was a registered manager at the service at the time of our inspection. 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 were supported to make their own decisions where they had capacity. Where people

lacked capacity, proper procedures were followed in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were provided with a choice of food and drinks ensuring their nutritional needs were met.

A safe environment was provided for people who used the service and staff supporting them. The staff were knowledgeable in recognising signs of abuse and knew how to report concerns. We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Medicines were managed safely and incidents were reported and managed in an appropriate way.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained information setting out how each person should be supported to ensure their needs were met. Care and support was tailored to meet people’s individual needs and staff knew people well. Risk assessments addressed the risks to people using the service.

Staff had good relationships with people living at the service. We observed interactions between staff and people living in the service and staff were caring and respectful to people when supporting them.

Staff knew how to respect people’s privacy and dignity. People were supported to attend meetings where they could express their views about the service. We found that people using the service pursued their own individual activities and interests, with the support of staff.

There was a clear management structure at the service. People who lived at the service, relatives and staff felt comfortable about sharing their views and talking to the manager if they had any concerns. The registered manager demonstrated a good understanding of their role and responsibilities, and staff told us the manager was always supportive. There were systems in place to routinely monitor the safety and quality of the service provided.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at peoples files which contained detailed care plans in pictorial format and were person centred.

Relatives we spoke with told us they were happy with the care relatives received. One commented “I am happy with how they look after them. They take them out a lot and know what they like.”

We saw that people were offered drinks and snacks throughout the day during our inspection.

The premises were clean and adequately maintained, with all ordinary and homely facilities such as laundry and a well maintained garden. One person living in the home told us they ate their food outside during the summer.

We looked at the recruitment records of the most recently recruited staff. We found that robust recruitment checks such as references and checks with the Disclosure and Barring Service (DBS) were carried out in each case, prior to staff being employed at the home.

Staff records and other records relevant to the management of the services were accurate and fit for purpose. All records were kept securely and could be located promptly when needed.

At this inspection we found people expressed their views and were involved in making decisions about their care and treatment. The service used pictorial communication tools to communicate effectively with some people.

We were told that everyone that lives at the home goes out every week. One person told us they liked going out. Another person told us they work at the café in the daycentre.

We were told by the manager that all staff had received training in breakaway, de-escalation and diversion techniques. We checked staff training files which confirmed this

We saw that all staff had received an annual appraisal which clearly documented their training needs. Staff we spoke to told us they felt well supported by the manager and the organisation.

We saw the provider had sought feedback from relatives and stakeholders in November 2012. One relative had commented “Just keep doing the same thing. Special thank you to the home.”

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that there had been assessments carried out by a behavioural therapist, occupational therapist and a physiotherapist and that the home was following the advice given by these professionals.

There was speech and language therapist at the home when we visited and they told us this was their second visit in two weeks and that they had carried out an assessment of the food preparation needs of one user. They said they had discussed with staff their findings and would support staff to put a procedure in place and that they would monitor progress.

Some staff had received training in Makaton and we saw evidence that provider would be training all staff at the home.

We spoke with two people who used the service, who both told us that they were satisfied with the care and support provided. They were treated with dignity and respect and their independence was promoted.

People who used the service require high staffing levels due to their level of need. We saw that staff encouraged and supported people to engage with relevant social activities dependent on their level of need and individual goals set out in their support plan.

People we spoke to said they were able to express their views, exercise choice and they felt safe in their living environment.

We spoke with two people who used the service, who both told us that they were satisfied with the care and support provided. They were treated with dignity and respect and their independence was promoted.

People who used the service require high staffing levels due to their level of need. We saw that staff encouraged and supported people to engage with relevant social activities dependent on their level of need and individual goals set out in their support plan.

People we spoke to said they were able to express their views, exercise choice and they felt safe in their living environment.

People told us that they like living at the home, they like the food and the staff, get on well together and like their rooms.

Staff told us that people who use the service attend regular weekly activity in the community. When we carried out our inspection four people who use the service were away at Butlin’s with staff.

Some people were not supported in promoting their independence and community involvement. It had been identified that some people liked to go out of the home and into the community. However, two people had not left the home in several months. Staff also told us that some people who use the service “shout a lot when they are out and are difficult to calm down.” We looked in files and found that most care plans were signed by people who use the service. However some people using the service had complex needs and limited communication skills and there was no evidence to demonstrate how staff ensured they fully understood what they were agreeing to.

There was a complaints and compliments book at the service. However people who use the service told us they have never made a complaint and would not know how to. They said if they had a complaint they would talk to the manager.

One person said they felt safe there and said if he saw any abuse he would tell the staff.

We saw that arrangements were in place for quarterly audits to be carried out by the provider’s senior management team. The audit in July had also highlighted concerns in the areas of community involvement, activity plans and staff supervisions. We did not see any evidence that this had been addressed.