Fairfax Road is a detached single storey house that provides accommodation, personal care and support for up to four people who have complex learning disability needs. The home is located in the Beeston area of Leeds. On the day of the inspection three people were living in the home.

The inspection took place on 6 June 2017 and was announced. We gave the provider 24 hours’ notice of our inspection because we wanted to ensure a member of the management team was present to assist us with the inspection.

A registered manager was in post whose time was split between this service and another small service run by the same provider. 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 the last inspection in January 2015 we rated the service ‘good’ overall. At this inspection, the service maintained this rating.

People were protected from abuse whilst living in the home. Risks associated with people’s care and support were assessed and measures put in place to help keep them safe. People’s healthcare needs were assessed and clear and person centred plans of care put in place. People were supported to attend appointments such as annual health checks. People’s needs were assessed and care plans were in place which were regularly reviewed. Staff had a good understanding of people’s plans of care. We concluded care needs were met.

Medicines were managed in a safe and proper way. People received their medicines as prescribed and clear and consistent documentation was maintained. The premises were well maintained and suitable for its purpose. Key safety checks were undertaken on the building and equipment.

There were enough staff deployed to ensure people received the care, support and supervision needed to keep them safe and ensure their welfare. Staff were subject to safe recruitment procedures to check they were suitable to work with vulnerable people. Staff received regular training and support to allow them to effectively undertake their role. Staff felt well supported and told us that morale was good within the service.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity to make decisions, best interest processes were followed. People were involved to the maximum extent in the decision making process.

People were supported to maintain a balanced diet. Action was taken to protect people against the risks of malnutrition. People were supported by kind and caring staff who treated them with dignity and respect. Staff knew people well and how they liked to be supported.

People’s independence was promoted and encouraged. People who used the service were supported to set goals, in order to achieve their full potential. People were fully involved in this process and goals were subject to regular review. A range of activities and social opportunities were available to people. This included the visits of external entertainers and maintaining links with the local community.

We found an open and inclusive atmosphere within the home. People, relatives and staff praised the way the service was run and told us management were approachable. Audits and checks were carried out by members of the management team to help continuously improve the quality of the service provided. People’s feedback was sought and used to make improvements to care, support and the overall quality of the service.

This was an announced inspection carried out on the 6 January 2015. At the last inspection in April 2014 we found the provider met the regulations we looked at.

Fairfax Road provides 24 hour personal care and support for up to four people who have learning disabilities and complex needs. The care provided is long term. The home had 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.

At this inspection we found the provider had systems in place to protect people from the risk of harm. Staff understood how to keep people safe and knew the people they were supporting very well. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff were skilled and experienced to meet people’s needs because they received appropriate training, supervision and appraisal. The service met the requirements of the Deprivation of Liberty safeguards.

Care was personalised and delivered to a very high standard. People received good support to make sure their nutritional and health needs were appropriately met. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs, however, there was sometimes a delay in recognising when care delivery should be reviewed. In the main, support plans contained information which explained how people’s needs should be met.

The service had good management and leadership. The provider had a system to monitor and assess the quality of service provision. Safety checks were carried out around the service and any safety issues were reported and dealt with promptly.

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Medication care plans had clear instruction for administering and supporting people to take their medication. This included medicines prescribed to be taken 'when required'. Medicines were stored safely, securely and were only accessible to staff who were authorised to handle them.

Staff we spoke with had a clear understanding of their roles and responsibilities within the team, and were knowledgeable about the service.

In the main, care and support was planned and delivered in a way that ensured people’s safety and welfare. Care files identified risks and how these were managed. Some people who used the service could be at risk of developing pressure ulcers but this risk had not been formally assessed. This meant the person’s needs or any changes could be overlooked.

Is the service effective?

The provider supported staff to deliver care to an appropriate standard. Training records showed that appropriate training was being delivered. Staff we spoke with told us everyone worked well together and they felt well supported.

Is the service caring?

One person who used the service told us they liked living at the home and were well looked after. Other people were not able to tell us their experiences.

Staff we spoke with said good systems were in place to make sure people’s privacy, dignity and confidentially were maintained, and gave examples of how they did this. One member of staff said, “We always knock, give the ladies time, give people respect. You learn it as soon as you start, it’s a natural inclination.”

We observed staff supporting people who used the service. Staff were friendly, patient, polite and treated people in a respectful way. During lunch staff encouraged people to be independent and make choices but at the same time assisted people when they required support.

Is the service responsive?

People’s needs were assessed and care and support was planned and delivered in line with their care plan. Care records contained good information about how care and support should be delivered. We saw in each person’s documentation what is ‘a good day’ and ‘a good night’ and ‘what is important to me’.

Care records had some information to show how to involve people in making decisions but this was not always detailed. It had been identified that one person’s care records should be agreed by a person acting on their behalf, however, this had not been followed up. Documentation that related to capacity had not been completed. This meant people who used the service or those acting on their behalf may not be appropriately involved in making decisions.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of the service that people received. We looked at a selection of reports which showed the provider had assessed and monitored the quality of service provision.

The service supported people with a wide range of complex needs. We therefore used a number of different methods to help us understand the experiences of people who used the service. This included the use of the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also talked with staff and looked at records in the home.

People experienced care, treatment and support that met their needs and protected their rights. We observed staff treating people kindly and with regard to their dignity and privacy.

One person we spoke with told us they liked living in the home and were looking forward to going on a trip later that week. We looked at the feedback from satisfaction questionnaires which the home sent to people’s relatives. One relative stated, “It’s nice to be able to relax knowing that (person’s name) is well looked after and loved.” Another one commented, “We are very happy with the way (person’s name) is treated and looked after.”

There were effective systems in place to manage and reduce the risk of infection.

The service had effective recruitment and selection processes in place. Appropriate checks were made before people were employed by the service to make sure they had the necessary skills and experience needed for their role.

The home had systems in place to monitor the quality of the service provided.

People we could not communicate with were observed to be comfortable and happy. One person said they liked living in the home, they liked their bedroom and liked going on holiday to Mablethorpe

People we could not communicate with were observed to be happy and comfortable and safe. A visiting Reflexologist said they ‘enjoy coming to the home, people are happy and well cared for’.

People we could not communicate with were observed to be happy and comfortable and positive relationships were observed being fostered between those using the service and those caring for them.

People we could not communicate with were seen to be comfortable and happy. One person said they like the people caring for them and were happy and they particularly liked the homes cats ‘Marmalade and Snowy’

People we could not communicate with were observed to be relaxed and comfortable. One person said they ‘enjoy going out’ and ‘liked the people caring for them’.