Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Improvement action plan issued following the previous inspection

Where we asked the provider to complete an improvement action plan following the last inspection, include the text below, adapting where necessary:

'Following the last inspection, what they would do and by when to improve the key question(s) to at least good.' Then describe at a high level what you found, adding detail in the detailed findings section for the relevant key question(s).

Focused inspection

'We undertook an announced / unannounced focused inspection of on . This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection had been made. The team inspected the service against of the five questions we ask about services: is the service well led, , (more as needed)? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection'

Comprehensive or focused inspection

Where breach topic has moved to a different key question in Next Phase

When we completed our previous inspection on DD/MM/YYYY we found concerns relating to . At this time this/these topic area(s) was/were included under the key question of . We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this/these topic area(s) are included under the key question of . Therefore, for this inspection, we have inspected this key question and also the previous key question of to make sure all areas are inspected to validate the ratings.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

Service Types and descriptions

Care at Home services

Domiciliary care agency

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to [older adults], [younger disabled adults], [children].

Provider of care to people living in specialist housing

Location proving care to people housed under supported living arrangements

This service provides care and support to people living in [a] [insert number of] 'supported living' setting[s], so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Location proving care to people living in extra care housing

This service provides care [and support] to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is [bought] [or] [rented], and is the occupant’s own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at peop

This inspection took place on the 18 January 2017 and was unannounced. At our last inspection in November 2015 we found that the provider was meeting the regulations of the Health and Social Care Act 2008. However some improvements were needed and we found most of these improvements had been made at this inspection but further improvements were required.

Eve House is registered to provide accommodation with personal care to five people with a learning disability, and autistic spectrum disorder. At the time of our inspection five people were using the service.

There was a manager in post and she was present during 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 and associated Regulations about how the service is run.

Relatives told us they felt confident that the service provided to people was safe and protected them from harm. People were supported by sufficient numbers of staff that been provided with training and were knowledgeable about how to protect people from harm. People received their medicines when they needed them.

Staff had received training which enabled them to meet people’s needs. Staff applied the principles of the Mental Capacity Act when supporting people. However they needed further knowledge about the Deprivation of Liberty Safeguards and working in the least restrictive way to ensure people’s human rights were respected.

Relatives described staff as caring and kind and we saw people were supported with dignity. Staff were responsive to people’s healthcare needs and alerted health care professionals if they had any concerns. Staff supported people to eat and drink in accordance with their preferences and dietary requirements.

Relatives knew how to raise any concerns and they had confidence that any issues would be addressed. The staff and the registered manager were aware of the signs to look out for which may indicate people were unhappy.

Although the registered manager had made improvements since our last inspection we found further improvements were required. We found that the registered manager had not informed us about a safeguarding incident and ensured staff were aware of the conditions on people’s deprivation of liberty authorisations. The provider had not consistently visited the service to monitor the standards in place and there has been a delay in providing updated training in a timely manner.

Relatives told us they were satisfied with the service provided to people, and described the manager as approachable, kind and caring. Systems were in place to gain feedback from relatives, staff and professionals so that improvements could be made.

We carried out this inspection to check on the care and welfare of people. There were five people living at the home on the day of the inspection but they were unable to verbally express their views so we observed how they were supported. We spoke with three members of staff, the home manager and two relatives by phone after the inspection.

Relatives told us that they were involved in the care planning process and consented to the care people received. One relative said, “Yes I did sign to consent to the care my son got”.

We observed staff interacting with people to ensure their needs were met. One relative said, “The care is second to none”.

Records showed that there was sufficient numbers of staff to care for people and they were suitable qualified and trained.

The provider had a system in place to enable complaints and comments to be investigated and trends monitored.

We saw accurate records related to people's care needs and staffing were maintained.

We visited the home on 5 July 2012. The service provides personal care and accommodation to five people living in the Russell Hall area of the West Midlands.

We spoke to two health and social care professionals who have visited the home. The people living at the home were unable to talk to us so we carried out a Short Observational Framework Inspection (SOFI). A SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed during our visit we found that care workers treated the people with dignity and respect. Care workers were kind and caring in their approach and supported the people in a respectful manner.

Records confirmed that regular meetings were held between staff and external professionals to review the care of people living at the home.

Health and social care professionals spoken to told us they had no concerns about the care being provided at Eve House. One health and social care professional told us; “Very good at working with someone with complex health needs and very good at spotting changes in their needs and getting the appropriate advice”

Care workers spoken with were able to describe the care they give to people and what they would do if they had concerns about anyone’s health and welfare needs.

Care workers need training in safeguarding, so they have a full awareness of what is required of them to protect and promote someone’s rights.

This inspection took place on 30 November and 2 December 2015, and was unannounced. At our last inspection in May 2013 the service was meeting the regulations of the Health and Social Care Act 2008.

Eve House is registered to provide accommodation for persons who require personal care for up to five people. At the time of our inspection four people were living there. People who use the service had a range of needs which include learning disabilities, physical disabilities and autistic spectrum disorder.

There was a registered manager in post and she was present during 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 and associated Regulations about how the service is run.

Although relatives told us they thought their family member was safe, there was times when there were not enough staff to meet people’s needs. This impacted on the support that people received.

The recruitment procedures need to be improved to ensure people are consistently safeguarded as we found that one staff member commenced employment before all of their recruitment checks were received.

Staff were knowledgeable about how to protect people from harm. People received their medicines when they needed them.

We found that staff had not all completed refresher training to ensure their knowledge and skills were up to date.

The staff worked with a range of health and social care professionals to ensure people’s health needs were met, for example psychiatrist and nurse specialists.

People’s consent was sought before staff provided support.

We found that where people lacked capacity and their human rights were being restricted the provider followed the Mental Capacity Act 2005 (MCA) legislation and ensured that the appropriate approval process was in place. However, staff skills and knowledge was limited due to not having received appropriate training in the MCA and the Deprivation of Liberty Safeguards.

Staff knew people well and interacted with them in a kind and compassionate manner. People’s privacy and dignity was respected by the staff supporting them.

People did not always have an opportunity to engage in meaningful activities due to the availability of staff.

Not all of the people living in the home had a personalised plan of care detailing their needs and preferences to guide staff on how they wanted to be supported.

Feedback was being sought from relatives and stakeholders as part of the provider’s quality assurance system.

Quality assurance systems were not always effective and did not identify the shortfalls we found during this inspection.