This inspection took place on 20 December 2016 and was unannounced. Erindale (1a) is a purpose built care home which provides care and support for up to five adults with profound and multiple learning disabilities. There were five people using the service at the time of our inspection. There was 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.

At our previous inspection on 19 January 2016 we found a breach of regulations because medicines were not always stored within a safe temperature range and records relating to the disposal of medicines had not always been accurately maintained. Following the inspection, the provider wrote to us and told us the action they would take to address these concerns.

At this inspection we found that the provider had taken appropriate action and that people’s medicines were stored, recorded and managed safely. Risks to people had been assessed and guidance was in place for staff on how to manage identified risks safely. People were protected from the risk of abuse because staff were aware of the signs to look for and action to take if they suspected abuse had occurred.

There were sufficient staff deployed at the service to safely meet people’s needs and staff were supported in their roles through regular training and supervision. The provider’s recruitment procedures helped ensure that the service employed staff who were suitable for the roles they were applying for.

Staff were aware of the importance of seeking consent from the people they supported and acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) where people lacked capacity to make decisions for themselves. People were supported to maintain a balanced diet and staff followed guidance from healthcare professionals where appropriate to ensure people’s meals were prepared safely. People were also supported to access to a range of healthcare services when required.

Staff treated people with kindness and consideration. They respected people’s privacy and treated them with dignity. People and their relatives, where appropriate, were involved in day to day decisions about their care and treatment. Relatives told us they were aware of how to raise a complaint and had confidence any concerns they raised would be addressed, although they had not needed to do so.

People had support plans in place which were reviewed regularly and reflected their individual needs and preferences. They were supported to take part in a range of activities and to maintain the relationships that were important to them. Relatives spoke highly of the management of the service and told us the provider had sought their feedback in order to help drive improvements. The provider undertook a range of audits and checks to monitor and improve the quality and safety of the service.

This inspection took place on 19 January 2016 and was unannounced. At our last inspection on 29 January 2014 the provider met all the requirements of the regulations we inspected.

Erindale (1a) is a purpose built care home which provides care and support for up to five adults with profound and multiple learning disabilities. There were five people using the service at the time of our inspection. There was 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.

At this inspection we found a breach in regulations because medicines were not always stored within a safe temperature range and records relating to the disposal of medicines had not always been accurately maintained. You can see the action we have asked the provider to take at the back of the full version of this report.

Risks to people's health and safety had been assessed and were safely managed although improvement was required because risk assessments had not always been reviewed regularly to ensure they were reflective of people's current needs. There were enough staff on duty to meet people's needs when required and the provider had conducted appropriate recruitment checks before staff started work at the service.

People received their medicines as prescribed and their Medication Administration Records (MARs) were up to date and accurate. People were protected from the risk of abuse because staff were aware of the potential signs to look for and could describe the action they would take if they suspected abuse had occurred. Staff underwent an induction when starting work for the service and received regular training and supervision to support them in their roles.

Staff treated people with kindness and compassion and sought consent from people when offering support. The provider worked in line with the requirements of the Mental Capacity Act 2005 (MCA) where people did not have capacity to make specific decisions about their care and treatment. However some improvement was required to clarify which health and social care professionals had been involved in making decisions in people's best interests where they lacked capacity. Legal authorisation had been sought to deprive people of their liberty where is was in their best interests, in line with the Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain a balanced diet and had access to a range of healthcare professionals when required. Staff worked to ensure people's privacy was maintained and treated them with dignity and respect. People and their relatives were involved in decisions about their care and support, and people's support plans were person centred to ensure their individual needs were met.

The provider undertook a range of audits to improve the quality and safety of the service and action was taken in response to any identified issues. However improvement was required because the scope of the audits was not sufficient to identify some of the issues we found during this inspection. Staff and relatives told us that they felt the service was well led and that the registered manager was available to them when required and would take action to address any issues they had.

The provider had a complaints policy and procedure in place and relatives told us they knew how to raise concerns, although they had not formally needed to do so. Regular staff and residents meetings were held and the provider conducted an annual survey to seek feedback about the running of the service. We have made a recommendation that the provider considers additional methods for gathering feedback to ensure that people and their relatives are able to be fully involved in

People using the service had complex needs which meant they were not able to tell us their experiences. We observed staff treating people in a respectful, friendly and caring manner.

We carried out our inspection on 29 January 2014 in response to concerning information we had received about allegations of physical and emotional abuse, poor moving and handling practice, and institutionalised practice in providing personal care in the morning that did not treat people using the service as individuals and respect their dignity.

We found the provider was responding appropriately to the allegations of abuse, and had taken immediate action to make people safe in the meantime. We observed people being moved and handled safely and appropriately. We saw that personal care provided in the morning was centred on individuals' needs, and respected their privacy and dignity. The provider was taking steps to change the way in which care generally was provided so that it became more responsive to each of the persons living at the home.

We found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We were told best interest staff meetings were held when decisions were required and we saw evidence of these meetings. A relative told us they 'were always involved in decisions about care and treatment'. Another told us, 'our decisions are always respected by staff.'

We spoke to and found staff had a good understanding of people’s care needs. A multi-disciplinary team were responsible for assessing people’s risks and care needs and drawing up suitable care plans. Staff told us that where possible relatives of people who used the service were consulted and involved in planning the care. Relatives confirmed this and told us, 'we are involved in all aspects of care.' We observed staff deliver care in a safe, caring and effective manner.

We observed the medicine administration process and found that medicines were given in a safe and timely manner according to the provider's policy.

We found mandatory, job specific and specialist training had been completed by staff, which included safeguarding vulnerable adults, mental capacity act training, medicines awareness and fire awareness. Staff told us they were happy with the training provided.

We found records were fit for purpose and contained appropriate information in relation to care and treatment of people who used the service.

On the day of our inspection we observed staff treating people with respect and dignity and noticed that people were given choices in areas such as food and clothing. We also saw that people’s views were sought with regard to what activities they would like to do.

Care plans were personalised and staff had used aids to ensure that people with communication issues were able to put their views across. Care plans told us that the people here received an effective service and had good links to all appropriate professionals.

We observed that people who used this service felt safe at this home. Staff were knowledgeable in safeguarding and knew how to escalate any alert.

Staff numbers had been appropriately assessed and there was always enough staff on duty to ensure that the people who used the service were kept safe.

Policies and procedures were comprehensive in nature and were regularly reviewed.

Health and safety checks were similarly comprehensive and the provider ensured that people who live at this home received an effective, safe service.