This inspection took place on 19 May 2017 and was announced. This was to ensure someone would be available to speak with us and show us records.

Foxglove Care – 18 Hall Leys provides care and accommodation for up to two people who may have a learning disability. On the day of our inspection there were two people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 last inspected the service in March 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Appropriate procedures were in place to record and analyse accidents and incidents. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Risk assessments were in place for people who used the service and staff. These described the potential risk, who was at risk, how the risk was controlled and any additional measures.

Appropriate arrangements were in place for the safe administration and storage of medicines.

Appropriate health and safety checks had been carried out and the home was clean, spacious and suitable for the people who used the service.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals. Some appraisals were overdue but the registered manager had identified this and these were planned.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were supported with their dietary needs and care records contained evidence of visits to and from external health care specialists.

Family members were complimentary about the standard of care at Foxglove Care – 18 Hall Leys.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from the risk of social isolation as activities were planned based on people’s needs, likes and interests.

The provider had an effective complaints procedure in place.

Staff felt supported by the management team and were comfortable raising any concerns.

The provider had an effective quality assurance process in place. People who used the service, family members and staff were regularly consulted about the quality of the service via surveys and meetings.

We saw in records of when a person’s needs changed or their behaviours changed that consultation took place with other healthcare professionals and family members which included peoples consent to care.

The manager told us, “We have a strong relationship with our sister services. They are very closely located nearby and when events take place, we actively encourage our people to be engaged in other services were possible.”

The overall building maintenance was kept to a generally high standard and the grounds outside were sufficiently well kept and security gates were fitted which ensured people were kept safe.

We looked at the staffing rota that confirmed there were always enough staff on duty to support people’s needs. The rota extended to bank staff that were utilised at times when full time staff were not available, for example due to leave or sickness.

The provider took account of compliments and records we looked at included recorded comments such as; during a routine dental visit for a person that used the service, the dental hygienist praised the care staff for the efforts for a person’s personal oral care.

We used a number of different methods to help us understand the experiences of people who used the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with two staff, the manger and a relative.

We observed positive interactions between staff and people living in the home. We saw that staff offered people choices in how care was to be delivered and that they took their time to explain care tasks to people.

A relative told us that; “Even when my son comes home, he his really happy to return to the service” and “There are no worries, I am really happy with the service.”

The manager told us that; “People who used the service are involved in the choice of menus but they can change very quickly on a daily basis, but people are always asked what they would like to eat and are encouraged to assist in the kitchen at mealtimes.”

Our review of care records in the home found that the action plans to keep people safe had been developed and implemented where required. We saw monitoring had been put in place for behaviours that may challenge the service.

We saw management checks of medication records which were completed on a monthly basis and observed that the home had appropriate systems to identify recording concerns.

We spoke with two members of staff who told us they had been on a range of training courses and that their personal development was supported.

Some people who lived in the home had complex needs and we were unable to verbally communicate with them about their views and experiences.

We were unable to talk directly with the people that lived in the home.

18 Hall Leys Park is owned by Foxglove Care Limited. It is registered to provide accommodation for up to two people who may have a learning disability. The service is located in one of the Kingswood housing developments just to the north of Kingston Upon Hull and is close to the local shops and amenities. There is easy access to public transport and sports and social facilities are nearby. At the time of the inspection there were two people living at the service.

The service was last inspected in August 2013 and was meeting all the regulations assessed during the inspection.

The people who used the service had complex needs and were not all able to tell us fully their experiences. We used a Short Observational Framework for Inspection (SOFI) to help us understand the experiences of the people who used the service. SOFI is a way of observing care to help us understand the experiences of people who were unable to speak with us. We observed people being treated with dignity and respect and enjoying the interaction with staff. Staff knew how to communicate with people and involve them in how they were supported and cared for.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

Personalised programmes of care and flexible staffing enabled people to live as independently as possible with appropriate levels of support from a designated staff team. We observed people who used the service being involved in discussions and decisions about their care and treatment during our inspection.

Staff described working together as a team, in order to provide a consistent approach to the care provided to people who used the service, helping people achieve their potential.

People lived in a safe environment. Staff knew how to protect people from abuse and they ensured equipment within the service was regularly checked and maintained. Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s rights to make decisions.

The registered provider had policies and systems in place to manage risks, safeguard vulnerable people from abuse and the safe handling of medicines. Care plans had been developed to provide guidance for staff to support the positive management of behaviours that may challenge the service and others. This was based on least restrictive practice to support people’s safety. This supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, when they lacked capacity, these had been made in the person’s best interests.

People who used the service, who were able to, spoke positively about the care they received and the staff who supported them.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. There was sufficient staff on duty to meet people’s needs. Staff received training and support to enable them to carry out their tasks.

The nutritional and dietary needs of the people who used the service had been assessed and people were supported to plan, shop for ingredients and to prepare their own meals.

Medicines were ordered, stored, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

People who used the service were seen to access a range of community facilities and activities within the service. They were encouraged to pursue hobbies, social interests and to take holidays. People were also supported to maintain relationships with their relatives and friends.

There were sufficient numbers of staff on duty to look after people and provide them with the individual support and care they needed.

Staff were supported and the standard and quality of their work was kept under review. New staff received induction training to ensure they understood their roles and responsibilities. Staff training needs were identified and met.

A quality audit system was in place that consisted of audits, checks and stakeholder surveys. We saw that when any areas for improvement were identified, action was taken to improve the service as required.