This inspection took place on 20 April 2017 and was announced. A previous inspection undertaken in November 2015 found two breaches of legal requirements. These related to Good governance and the failure to notify the CQC of certain events or incidents. The provider subsequently sent us an action plan detailing what action they would take to meet the breaches in regulations. At this inspection we found the provider had taken appropriate action and there were no breaches of legal requirements.

Flexible Support Options Limited (Thorntree Way) consists of two purpose built bungalows situated in a residential area of Blyth, Northumberland. It is registered to provide accommodation for up to ten people with autism or a learning disability, some of whom may also have physical disabilities. At the time of the inspection there were ten people using the service.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since July 2016. A previously employed registered manager was still listed for the service and had not formally deregistered with the CQC. Consequently their name appears on this report. A registered manager is a person who has registered with the CQC 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 were supported by the registered manager throughout the inspection.

Staff were aware of safeguarding issues, had undertaken training in the area and told us they would report any concerns around potential abuse. The provider was following appropriate safeguarding processes and reported concerns to the local safeguarding adults team and notified the CQC. Appropriate safety checks had been carried out on the environment and equipment used at the service. Risk assessments were in place regarding the environment of the service and the delivery of care. Accidents and incidents were recorded and monitored.

The service was clean and tidy. We found some bathrooms and laundry areas were in need of updating and refreshing. We have made a recommendation about this.

There were sufficient staff to support people appropriately and accompany them to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Medicines were stored and handled correctly and safely.

Staff had access to regular training and updating of skills. Records indicated most staff had completed a range of training and systems were in place to monitor it remained up to date. Staff told us, and records confirmed there were regular supervision sessions for all staff members and annual appraisals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. A number of people had been subject to formal restrictions through the granting of DoLS. Best interests decisions had been made where people did not have capacity to make their own decisions.

People had access to health care services to help maintain their wellbeing. There were regular visits to general practitioners and other health and social care professionals.

People were supported to access adequate levels of food and drink. Specialist dietary advice had been sought, were necessary, and guidance followed.

Some areas of the home, especially the kitchen facilities were in need of refurbishment. We ha

The inspection took place on 12 and 19 November 2015 and was announced. We announced the inspection to make sure staff would be available at the service. In addition, people were often out in the local community and we wanted to make sure that people would be present and able to speak with us.

Flexible Support Options (Thorntree Way) provides care for up to nine people who have learning disabilities. There were nine people living at the service at the time of the inspection. The service comprises of two bungalows. Four people [all female] lived at 13 Thorntree Way. Five people [all male] lived at 15 Thorntree Way.

We noted that the provider had not registered their full address of 13 and 15 Thorntree Way with the Care Quality Commission [CQC]. We have written out to the provider to request that this issue is addressed.

We last inspected the service in August 2014 and found that they were meeting all the regulations we inspected.

There was 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.

Staff and relatives told us that another manager was in ‘day to day’ charge. This was confirmed by the acting manager although she did say that the registered manager was always available by phone should any advice be required. She had commenced work at the service in September 2014 and started managing in January 2015. She said that she was going to apply to become registered manager. We have written to the provider using our regulatory powers to ascertain the registered manager situation.

There were safeguarding policies and procedures in place. Staff told us that they had not witnessed anything which had concerned them. We found, however, there had been some low level safeguarding incidents which involved altercations between people and an allegation of abuse. The acting manager informed us that the local authority had not been informed of the allegation of abuse. We passed this information onto the local authority safeguarding adult’s team. We had not been notified of any safeguarding incidents at the service.

We saw that the premises were clean. We noted that the electrical installations test was overdue. The acting manager organised for this test to be carried out before we visited the service again on 19 November 2015. The electrician had deemed the installations to be satisfactory. Medicines were generally managed safely. One relative told us that the layout and equipment available at the home, did not fully meet their family member’s needs with relation to bathing.

People, staff and relatives told us there were enough staff to meet people’s needs. This was confirmed by our own observations. There was a training programme in place. Staff were trained and supported in safe working practices and to meet the specific needs of people who lived at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Although we found that staff were following the principles of the MCA, the acting manager was aware that further work was required to ensure that mental capacity assessments and best interests were completed for specific decisions.

People told us that they were happy with the meals provided at the home. We saw that the kitchen was well stocked with fresh fruit, meat and vegetables. A weekly menu planner was in place

At the time of the inspection there were nine people accommodated at the service. Due to their health conditions and complex needs they were unable to share their views about the service they received. During our visit we observed their experiences and spoke with the acting manager and the staff on duty.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five 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?

The provider had effective systems in place to identify, assess and manage risks to help protect the health, safety and welfare of people using the service and others.

There were risk assessments in place to help protect people's health and safety. For example, associated risks when going out in the community, eating and drinking and the use of bedrails.

Routine safety checks and repairs were carried out by staff and external contractors carried out regular inspections and servicing. For example, fire safety equipment, hoists, electrical installations and gas appliances.

Appropriate checks were undertaken before staff began work and effective recruitment and selection processes were in place to help ensure staff were suitable to work with vulnerable people.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and staff had received training in the Mental Capacity Act 2005 (MCA) and DoLS. We saw documentation that relevant people had been involved in decisions made in the best interests of people who lacked capacity.

Is the service effective?

People's health and care needs were assessed which included communication, expressing sexuality, medications, personal care, mobility, controlling body temperature and bed time routines. Support plans were in place which gave staff information about people's needs, equipment that may be required and how their care and support should be delivered.

We spoke with staff and they were able to describe people's individual care needs and what support they needed.

Is the service caring?

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people, and supported them to eat their lunch, access community facilities and pursue their hobbies.

We spoke with two relatives whose comments included, "I can't fault the quality of care provided. The staff are pleasant and the manager does a fabulous job" and "I think Y is well cared for but I would like to see more activities provided."

We spoke with a health care professional who visited the home and they told us they felt the staff were very caring and people were well cared for.

Is the service responsive?

A complaints procedure was in place and two relatives confirmed they were aware of how to make a complaint. We saw there was information available on the notice board in the home about making a complaint.

A health care professional told us that the staff were very good at involving other care specialists if they had any concerns or issues and required advice.

Is the service well led?

The registered manager had recently left the organisation and we were told that the position had been advertised and interviews were due to take place. A senior care worker was acting as the manager until a replacement manager was found.

The service had a quality assurance system in place that included the use of surveys issued to relatives of people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

Relatives told us that three monthly family forum meetings had been set up and they had been invited to attend to discuss day to day issues in the home.

Regular staff meetings were held which meant they were able to feedback their views and concerns to the management of the home. Staff told us they felt supported in their role and felt their views were listened to and taken into account.

We saw records to show audits were carried out by the manager to help ensure standards were maintained and any improvements could be introduced. These included audits related to care records, medications, infection control, accidents, safeguarding, health and safety, training and supervision.