We inspected Foresight Residential Limited – 14 Otley Road on 23 April and 2 May 2018. Day one was unannounced and we told the provider we would be visiting on the second day.

At the last inspection in February 2017 we found the provider had breached two regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to evidence that people’s capacity had been assessed and the oversight of the home. The provider submitted an action plan and has met with us on three occasions since the last inspection. A continuing breach of Regulation 17 Good Governance was found at this inspection. You can see what action we have told the provider to take at the end of this report.

The rating remains unchanged at Requires Improvement. This is the second time the service has been rated Requires Improvement. We will meet with the provider outside of the inspection process to understand what action they will take to improve their overall rating to Good.

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Up to 13 people can be accommodated. Ten people lived at the service when we inspected. People between the ages of 18 and 64 live in the service who have a sensory impairment and or a learning disability/ autism. Some people also have mobility needs.

The service is developing in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Two registered managers were new in post since the last inspection who shared responsibility for the service. 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 and staff felt the support from the registered managers, deputy and senior care workers was positive. People and staff were more confident and told us they felt able to speak up about concerns or ideas they may have to improve the service they received. We observed people looking relaxed and fully involved in their own care and support.

The provider had not ensured that systems were properly established which are required to keep people safe and to enable them to receive a quality service. For example, health and safety systems, risk assessment tools, records relating to the Mental Capacity Act, and accident, incident procedures. The registered managers did not have the resources, skills and support to implement all that was delegated from the provider to sufficiently improve the service and demonstrate sustained improvements. The provider has confirmed following the inspection they will take appropriate action to address these concerns.

People and their families told us they felt safe using the service and we saw day to day checks and servicing of the building and equipment had occurred to support this. All staff understood how to protect people from avoidable harm and knew how to raise concerns if they saw signs of abuse.

Appropriate systems were in place for the management of medicines so people received their medicines safely.

People told us there were enough staff on duty to meet people’s needs. We found safe recruitment and selection procedures were in place which the provider needed to ensure were followed consistently.

Staff felt confident they had the skills to deliver safe and effective support. We saw the training they required was not always up to date. The regist

We inspected 14 Otley Road on February 20 and 27 March 2017. Day one of the inspection was unannounced and following this visit we met with the provider to discuss our concerns. We told the registered provider we would be visiting on day two.

Situated over three floors, 14 Otley Road is registered to provide residential, personal and social care for 13 adults with learning disabilities who may have other sensory impairments and physical difficulties. At the time of our visit there were 12 people living at the service.

The home’s previous registered manager had left in early 2017 and the registered provider's two other registered managers from nearby services were jointly applying to the Care Quality Commission to manage the service. 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. We met with one of the joint managers during the course of our inspection visits.

The registered provider did not always have systems and processes in place to assess, monitor and mitigate any risks relating to the health, safety and welfare of people who used the service.

The provider’s fire risk assessment had not been reviewed since 2006. We had some concerns such as the regularity of fire drills outlined did not correspond with the registered provider’s current regime. The management team told us they would ensure the fire risk assessment was appropriately reviewed as soon as possible.

We saw that risk assessments were in place which detailed some measures to keep people safe. However these required further development.

Following day one of our visit we asked the NHS infection prevention control team to visit because we found areas of concern. The provider has since submitted an action plan in response to issues found by the infection control team.

Staff members were not all aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. We saw that assessments to check whether people had capacity to make their own decisions were not in place where required.

We found that records to evidence safe recruitment and selection procedures were in place. The registered provider did not ensure they recorded their decision to proceed with recruitment where one of the members of staff had been disciplined at their previous employment. We saw that the managers had produced an action plan to ensure appropriate records of checks were carried out in future to ensure staff members had been assessed to work safely.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. The service did not have “as and when required” medicine protocols in place for people although this had been addressed by day two of our visit.

The registered provider needed to develop effective systems to monitor and improve the quality of the service provided. There was no robust audit programme in place to ensure the safe and effective management of the service.

Staff members had been trained and had the skills and knowledge to provide support to the people they cared for. We received feedback that staff felt there should be a review of night-time arrangements as staff sleeping over at the service were sometimes awoken by people using the service.

Staff told us the culture of the service needed to change to ensure people were supported and empowered to lead fulfilling lives and to ensure they were at the centre of the service being provided. Staff we spoke with were positive about the changes being made at the service to ensure people led an active community life.

Staff told us that they felt supported. By day two there was a programme of regular staff supervision and appraisal in place, which had

This inspection took place on the 08 January 2015 and was unannounced. At our last inspection on 9 November 2013 we had not found any breaches of legal requirements.

This service is registered to provide accommodation for 13 adults with learning disabilities who may have other sensory impairments and physical difficulties. Accommodation is provided over three floors; the home is set in private gardens and has a small car park. The house is in a residential area close to Harrogate town centre and provides good access to local amenities.

There was a registered manager in place. 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 who used the service were cared for by staff who understood they had a duty to protect people from harm and keep them safe. Staff knew how to report abuse and said they felt able to raise any issues. This helped to keep people safe.

We observed that there were enough staff available to support people. We saw that they had been recruited using robust methods to help to protect people from staff who may not be suitable to work with vulnerable people.

Staff were provided with information about people’s care and support needs and risks to their health and wellbeing which enabled them to assist people appropriately. Training was provided to all staff to help them to develop and maintain their skills. Training was provided to all staff about visual impairment which helped staff understand people’s individual needs.

People lived in well maintained, clean environment, bedrooms were personalised and were decorated as people requested when they moved in. This helped people to feel at home.

People were provided nutritious food which was home cooked. People were asked what they wanted to eat and drink and this was provided. The service catered for people’s cultural or chosen diet. Where dietary advice was required to be gained to help people maintain their nutrition this was gained and was acted upon.

Staff assisted people to attend appointments with health care professional’s some of whom visited the home to provide treatment and support.

People were involved in making decisions about their care and social activities. Staff supported people to make decisions for themselves so that they lived the life they chose. We saw that people’s privacy and dignity was respected by the staff.

A complaints procedure was in place, anyone wishing to make a complaint could do so, this information was provided in a format that met people’s needs. There were systems in place to deal with complaints in a timely manner.

People were asked for their opinions about the service. The registered manager undertook regular audits which helped them to monitor and maintain the quality of the service provided.

During our visit we spent time observing how people were being cared for. We also spoke with people who were able to share their views and talked with the staff on duty. We observed staff supporting people in an appropriate manner, providing reassurance and support to those who needed it. One person told us, "They [the staff] are brilliant. I get on with them all."

People's needs were assessed and their rights were respected by the staff. We saw that people were encouraged to make decisions for themselves or were supported, by the staff, to make decisions about their daily routines. We observed staff treating people in a kind way and with dignity. We saw that people were supported to maintain their independence and observed a warm and friendly rapport between those living and working at the home.

People had care plans and risk assessments in place, which helped staff to understand and meet their needs.

We saw that there were sufficient staff on duty and staff received training to ensure that they had the skills they needed to be able to look after people safely. Staff told us the training was very good. One member of staff told us, "It is a very good organisation to work for; we are kept up to date with our training." Another member of staff told us, “I have the skills and abilities I need to feel confident about my work.”

The complaints procedure was displayed in the home, this meant that people had access to the information they needed should they wish to make a complaint. People also had access to other methods of complaining should they need support to raise issues.

We did not speak to people in detail on this visit, as this inspection was to check whether improvements had been made to the medication administration records for the home. People we did chat to said they were happy and enjoyed living at the home.

We had previously found that while some medication records were up to date and completed properly, the home did not have an adequate system for the recording of medicines, or for the auditing of their stocks. The numbers of some medicines in stock did not tally with how many the home thought they should have. In addition, the home was not able to evidence whether the numbers of medicines in stock were correct, or whether some medication had been lost or misappropriated. This meant that errors, such as missed doses or overdoses, would have been less likely to be discovered.

On this visit we found that the home had improved procedures and introduced new practices for medication recording. They were able to demonstrate that numbers of medicines were being recorded correctly. This meant that people who use the service were protected against the risks associated with the unsafe management of medicines.

We spoke with two people who use the service, who spoke highly of the home, with comments including “I love it here, I wouldn’t change a thing” and “There’s not anything I’m not happy with.”

We looked at the care plans for three people who live at the home. Although in some cases risk assessments required updating and review, in general records kept for each person showed that the home had carried out sufficient assessment of the needs of each person, to enable appropriate care and support to be given.

Staff told us they felt settled and happy in their jobs, and had been well trained and supported by their manager. Comments included “I never feel like I can’t ask a question.” Training and staff records showed that staff had suitable qualifications and skills, and appropriate character checks had been carried out prior to employment.

We had received a concern from a Local Authority that they had not been kept fully informed by the home about a resident. We found that the home had in place appropriate review procedures and had for the most part been working appropriately with other professionals.

We looked at medication administration records and systems. While some records were up to date and completed properly, the home did not have an adequate system for the recording of medicines, and for the auditing of their stocks. We have asked the manager to take action to improve the recording procedures and to carry out a full audit and stock check of the system.

People said they were happy to be living at 14 Otley Road. One person said "It's nice here." They also told us they are involved in the planning of their care and are able to choose what they want to do during the week.

People told us that they were very happy with the care they were receiving. One person said "The staff are looking after us."

People said they felt safe at 14 Otley Road and they were happy with the staff and the care that they provided. One person told us "The staff are nice."

People said they were happy with the service and knew how to raise issues, should they have any. They also said the manager and staff were happy to see and talk to people at any time about anything.