The inspection of Foxglove Care Limited took place on 24 and 29 August 2017 and was unannounced. At the last inspection in July 2015 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Good’.

At this inspection the service remained ‘Good’.

Foxglove Care Limited at 96-98 Church Street, Sutton is a typical farm house style building in a residential area to the north of Kingston-Upon-Hull and is owned by Foxglove Care Limited. It is registered to provide accommodation for up to three people who may have a learning disability or autistic spectrum disorder. It has three bedrooms, a lounge, a dining area and a kitchen. The service is located close to local shops and amenities and there is easy access to public transport. At the time of this inspection there were three people using the service.

The provider is required to have a registered manager in post. On the day of the inspection there was a registered manager. However, they had been absent for a period of time and so the service was being managed by an acting manager, but this was soon to be resolved. A registered manager is a person who has registered with the Care Quality Commission (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.

People were protected from the risk of harm because there were systems in place, staff were trained in and understood their responsibilities for managing safeguarding concerns. Risks were reduced so that people avoided harm.

The premises were safely maintained. Staffing numbers were sufficient to meet people’s needs. Safe recruitment systems ensured staff were suitable to support people. The management of medicines was safe.

Staff were qualified and competent. They were regularly supervised and their personal performance was checked at an annual appraisal. Communication was effective.

People’s mental capacity was appropriately assessed and their rights were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported with nutrition and hydration to maintain their health and wellbeing. The premises were suitably designed and furnished for providing care and support to people with a learning disability.

People were compassionately cared for by kind staff that knew about people’s needs and preferences. Relatives were fully involved in their family member's care and people were asked for their consent before staff undertook support tasks. People’s wellbeing, privacy, dignity and independence were respected.

Person-centred care plans reflected people’s needs and were regularly reviewed. Pastimes and activities were encouraged and people developed their living skills with support from staff. People had very good family connections and support networks. An effective complaint system was used and complaints were investigated without bias. People and their friends and relatives were encouraged to maintain relationships of their choosing.

The service was well-led and people had the benefit of a friendly culture and a positive management style. Systems were in place for checking the quality of the service. People made their views known through their own methods of communication. People’s privacy and confidentiality were maintained as records were held securely in the premises.

Further information is in the detailed findings below.

We looked at records that showed people had attended monthly meetings to discuss their care using communication methods that they understood. This ensured that informed consent had taken place and was recorded in people's support plans.

We were told that there was a choice of meals for people to choose from at each meal time. The manager told us, “People can choose their own food to eat and when they would like to eat it. However, we do have to consider people that are on a healthy balanced diet such as a high fibre diet.”

We saw records of when a person’s medication was adjusted to support their well-being and records showed that staff had consulted with a GP and were advised accordingly. Staff had recorded supporting information from the GP in the format of a diary entry which ensured people were supported to take the correct amounts as prescribed.

During our visit we observed a staff induction session taking place. There were seven new starters and the manager explained that all new staff would be expected to complete a full five day programme. This ensured that all new staff received a consistent approach to induction that followed the common inductions standards skills for care.

We looked at an example of a recent complaint that had been expressed by a family member. The service had responded as appropriate and were awaiting a final response which ensured the complaint was dealt with in a timely manner.

People who lived in the home had complex needs and we were unable to verbally communicate with them about their views and experiences. However, we observed the interactions between them and the staff working there and saw that these were respectful and appropriate. Staff recognised specific support needs required and risk assessed the needs of people who use the service and record these in the person's care and activity plan.

People's likes and dislikes were recorded and respected, with people being supported to make decisions in their lives. Records reflected that people had good access to a range of health care professionals. People were supported by staff who had been recruited through a formal process that included a review by a relative of the person who used the service to ensure that they were suitable for the role.

The staff had a detailed training plan that indicated the essential training required to fulfil their role in an efficient and effective manner. Members of staff we talked with commented; "We pretty much are doing what we are employed to do." and, "I have never worked for an organisation that is more organised than this one."

This unannounced inspection took place on 10 and 14 July 2015. At the last inspection on 12 September 2013, the registered provider was compliant with all the regulations we assessed.

Foxglove Care Limited, 96-98, Church Street, Sutton is a period property in a residential area and is owned by Foxglove Care Limited. It is registered to provide accommodation and care for up to three people who have autism or learning disability. At the time of the inspection there were two people living in the home.

The registered provider is required to have a registered manager in post at Foxglove Care Limited. We found the previous registered manager left their post suddenly in June 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 people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care to help us understand the experiences of people who could not talk with us.

People were protected from abuse and avoidable harm. Staff had completed relevant training and understood their responsibilities to report episodes of poor care or neglectful practices. When accidents or incidents took place they were investigated appropriately, lessons learned were shared with staff, care plans and risk assessments were updated to prevent future re-occurrence.

Staff were recruited safely following the registered provider’s recruitment policy. Staff were deployed in sufficient numbers to meet the assessed needs of the people who used the service. Staff completed relevant training and received on-going support which enabled them to meet to provide effective care in line with people’s preferences.

People’s nutritional needs were met. Staff monitored people’s food and fluid intake and took action when there were any concerns. People were encouraged to be involved with meal choices and assisted staff to prepare meals when possible.

People who used the service were supported to make decisions and choices in their daily lives. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked the capacity to make informed decision themselves. Care files, support plans, patient passports, stakeholder surveys, complaints procedures and the registered providers welcome pack were produced in an easy read format which helped to make them more accessible to the people who used the service.

A quality monitoring system was in place which consisted of audits, daily checks, director assessments and stakeholder surveys. We saw that when shortfalls were identified; action was taken to improve the service as required.