This inspection took place on 07 and 15 March 2017 and was unannounced. This meant the registered provider and care workers did not know we would be inspecting. The inspection was completed by one adult social care inspector.

We previously inspected this location on 15 November 2015. At that time the home was rated overall as requires improvement. We identified a breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17(2) Good governance in Well Led. This was because there was no effective system in place to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity. The service did not evaluate and improve their practice effectively. At this inspection we checked and found the registered provider had implemented a quality assurance and audit programme and had met with the identified breach.

During our previous inspection we advised the registered provider to make improvements on the recording and storage temperature for people’s medicines. At this inspection our checks confirmed the registered provider had systems and processes in place to ensure medicines were managed and administered safely in line with guidance and people’s prescription. This included appropriate procedures that ensured medicines were stored at the correct temperature.

During our previous inspection we advised the registered provider to make improvements on the recording and completion of pre-employment checks for care workers. At this inspection we found all care workers had completed an application form, interview and that two references from recent employers had been obtained along with checks with the Disclosure Barring Service (DBS) before they started their role as care workers with people. These measures helped to ensure only suitable care workers were employed to work with vulnerable people.

During our previous inspection there was a manager in post but they had not registered with the Care Quality Commission (CQC). At this inspection there was a registered manager in post. 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.

33 Main Street is a house in the residential area of Wawne, on the outskirts of the city of Hull. It has two bedrooms, a lounge with a dining area and a kitchen. It provides a service to a maximum of 1 younger adult with learning disabilities or autistic spectrum disorder, physical disability or sensory impairment.

People were supported by care workers who understood the importance of protecting them from harm and abuse. The registered provider had a safeguarding adult’s policy and procedure and care workers had received training in how to identify abuse and report this to the appropriate authorities.

The registered provider had completed assessments of risks for people, the home and the environment. Along with associated support plans these measures helped people to remain safe and helped care workers to provide people with safe care and support, in line with their needs and with minimal restrictions in place.

Systems and processes were in place to record, evaluate and implement actions and outcomes in a timely manner for any accidents or incidents that occurred. This helped to help prevent re-occurrence.

Care workers completed an induction to the home, their job role and to people they supported. Care workers received training to support them with the skills required to meet the needs of people and this was recorded electronically. Systems and processes to support care workers had been reviewed to ensure supervisions and annual appraisals were robustly recorded and these were scheduled for all care workers.

People were supported to remain healthy. People’s

We carried out this inspection on 5 November 2015. The last inspection was carried out 29 April 2014 and the regulations we assessed were all being complied with.

33 Main Street is a small residential care home located in the village of Wawne close to the local shops and amenities. It provides accommodation and support for people who may have a learning disability.

The home is required to have a registered manager but had not had a registered manager in post since May 2015. 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.

The registered provider had employed a new manager and they came into post on 18 May 2015. The manager told us that they had submitted their application for the disclosing and barring service (DBS) process of their application to the Care Quality Commission (CQC). We were able to verify this had been completed.

The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. This helps employers make safer recruiting decisions and also prevents unsuitable people from working with children and vulnerable adults.

The registered provider had a system in place for ordering, administering and disposing of medicines and this helped to ensure that people received their medicines as prescribed. However, some improvements were needed in the way that medicines were stored. We have made a recommendation about this in our report.

There were sufficient numbers of trained, skilled and competent staff on duty. However, the manager was unable to provide evidence of all staffs’ DBS disclosures. We have made a recommendation about this in our report.

We saw that staff completed an induction process and had received training in a variety of topics.

The registered provider had some systems in place to monitor and improve the quality of the service. However, this was not completed regularly and had not picked up issues with medicines and recruitment paperwork.

People that used the service were protected from the risks of harm or abuse because there were safeguarding systems in place. Staff were aware of their responsibilities to make referrals to the local authority safeguarding team.

We found that the premises were safe because they had been regularly maintained using maintenance contracts.

People’s rights were protected because the principles of the Mental Capacity Act 2005 (MCA) were followed to ensure those without capacity to make decisions were represented according to legal frameworks.

We found that people were cared for and supported by kind and caring staff that were knowledgeable about people’s individual care and support needs. People’s privacy and dignity was upheld at all times and their personal details were kept confidential.

We saw that people’s wellbeing was monitored by staff and that efforts were made to assist people to improve their wellbeing.

We saw that people had person-centred care plans in place to instruct staff on how best to support them and meet their needs.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection to 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 our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The person was treated with respect and dignity and we observed caring and compassionate care by the staff. The person had their own care file and these contained person centred information for example ‘how I communicate with you’ and ‘how you communicate with me’. This was in pictorial format and also included Makaton signs relating to feelings, dislikes and likes. This contained information about the way each person should be supported and cared for. Additional information included risk assessments to ensure the person remained safe from harm.

There were activities for the person to be involved in to give them stimulation and a choice about their welfare for example shopping, swimming, visits to the seaside, music, visiting the café and a weekly stay at a relative’s house and a shopping day.

We saw that the service had appropriate controls in place for the safeguarding of the person. Records we looked at included personalised plans to ensure the person who used the service was appropriately safeguarded. Records included for example plans for neglect, institutional abuse, physical abuse, and emotional abuse.

The service and communal areas were pleasant, clean and hygienic. All areas of the property were free from clutter and obstructions which meant that the person was protected from trip hazards and self-harm. The overall building maintenance was kept to a generally high standard.

Is the service effective?

We reviewed records for incidents and accidents and found that they were appropriately recorded and acted on. However, we found four records not to be dated. We spoke to the manager about this and they assured us that they would update these records immediately. Staff we spoke with were clear about the incident process and the procedure for recording when incidents occurred.

Visiting relatives told us, “Staff listen to our views and they ask us a lot of questions and we get a lot of input with XXX’s support. Staff even contact us to ask if they can get XXX a new jumper or cut her hair.”

Is the service caring?

The person’s care was planned and delivered in a way that was intended to ensure their safety and welfare. We saw that the person had risk assessments in place. These were up to date and covered areas such as: behaviour which challenged, being out in the community, mealtimes, personal care, bathing and travelling in the car.

We spoke with visiting relatives of the person that used the service and they told us, “The staff here are absolutely superb. They have offered for us to come to tea with XXX. We have not done this yet, but we will soon” and “XXX’s mobility was quite bad before she came here but now she is even walking on her own. We have seen three things improve over the last few months which are mobility, nutrition and handling her behaviour. We are very confident that the staff know how to handle XXX’s behaviour and we are so pleased XXX is here.”

Is the service responsive?

We observed positive interactions between staff and the person living in the home. We saw that staff offered the person choices in how care was to be delivered and that they took their time to explain care tasks to the person. We saw that the person was encouraged and supported to maintain their independence where they were able to.

Records we looked at confirmed that the head office on behalf of all its services had sent out a quality performance survey to all of the people who used the service, their relatives and other healthcare professionals. We saw that 35 surveys were sent out in November 2013. Records we looked at showed that the provider had monitored the survey returns of; three from healthcare professionals, two from social care, eight from relatives and three from people who used the service.

Is the service well-led?

The service had an effective quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Records we looked at included a monthly check of the persons care plan for the purposes of accuracy for example; diary notes, behaviour monitoring charts, bowel chart, body maps and support plans. Following the evaluation the monthly check was signed by the team leader.

The staff we spoke with knew about their involvement with team meetings and supervisors and the manager observing their care activity. This meant that staff were confident and clear about their roles and their responsibilities. Staff told us, “We have staff meetings every month to discuss any issues about the service but we also have a key worker meeting to discuss more person centred things. The meetings are really useful to resolve any potential issues that may be arising and they always get resolved quickly.”