The inspection took place on the 27 April 2017. At the last inspection we said the quality of the service was good but it needed to improve the way in which the Mental Capacity Act 2005 was applied. At this inspection we found the service remained good and the required improvements had been made.

Community Integrated Care are a national charity delivering care and support to people with a diverse range of needs including people with learning disabilities, mental health concerns and health related problems. Glen Cottage is registered to provide accommodation and personal care for one person. The home is located in a residential area close to community facilities. At the time of the inspection there was one person living at Glen Cottage.

The service had a registered manager. 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 and associated Regulations about how the service is run. The registered manager also managed three of the provider’s other registered services in the local area and was providing temporary management support to a nearby supported living service managed by the provider.

Our last inspection had found that mental capacity assessments had not been undertaken when required and that aspects of the care and support being delivered, whilst in the person’s best interests, amounted to a deprivation of the person’s liberty, however, an application to authorise the restrictions had not been submitted. The application had now been submitted to the local authority and was awaiting approval and relevant mental capacity assessments were now in place. This meant that the person was supported to have maximum choice and control of their life and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

Recruitment practices needed to be more robust to ensure that all of the relevant checks were completed. Full employment histories had not been obtained for two staff members. This information has now been obtained.

Improvements could be made to the training programme to ensure that staff had more up to date training which was also specific to the needs of the person using the service. We have made a recommendation about this.

Relevant risk assessments were in place and covered activities and associated health and safety issues both within the home and in the community.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. Staff had clear guidance about what they must do if they suspected abuse was taking place.

There was sufficient staff to meet the person’s needs. The person was supported by a stable staff team who were experienced and knew and understood their needs.

Appropriate arrangements were in place to manage the person’s medicines. There were policies and procedures in place to ensure the safe handling and administration of medicines, which were only administered by staff that had been trained to do this.

The person was supported to have enough to eat and drink and their support plans included information about their dietary needs and risks in relation to nutrition and hydration. Staff involved the person in decisions about what they ate and they were assisted to remain as independent as possible with eating and drinking.

Where necessary a range of healthcare professionals had been involved in planning the person’s support to ensure their health care needs were met.

We observed interactions between staff and the person which were relaxed and calm. Staff showed the person kindness, patience and respect. Staff were aware from the person’s body language whether they were comfortable with the care being provided or wanted space or time on their own.

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We observed care and support being given to the person and spoke with the member of staff supporting them on the day of our inspection. As the person used non verbal communication systems we were unable to speak with them. We saw the person being informed of activities before they began. Staff waited for the person's response before proceeding to give support. We saw in their care records information about how the person gave consent. For important decisions a mental capacity assessment was in place and decisions were made in the person's best interest due to the person's limited capacity to make decisions.

The service regularly updated their assessment of the person's needs and amended their care plans as required. This ensured the person's care plans reflected changes within their needs. The person's care plans identified clear health needs and we saw these were managed with support from visiting health professionals. We observed the person was treated with dignity and respect by staff supporting them.

We found medicines were ordered and administered in line with the provider's policy. Records were maintained of all medicines administered and staff received appropriate training to administer them safely.

The manager explained the recruitment process they followed and shared the records of recruitment used by the provider. We saw staff had undertaken all appropriate checks to ensure they were fit and of good character to support the individual.

The provider monitored the quality of service delivery on a regular basis. This ensured risks were managed and the person received safe care and support.

We spoke with the person who used the service and they appeared to understand some things we said. They gave some responses to our questions which the staff were able to inform us if it was a positive or negative response. When we asked the person if they liked living in the service, they smiled and laughed. We spoke with the person's care staff who told us that they felt privileged to support the person in the person's own home. The staff told us that the person made their needs and wishes known by showing when they were happy or sad by vocalisations, gestures and movement.

We saw how the person responded when their relative phoned and they could hear their voice. This was a positive response and the person appeared happy that they would see the relative soon. The relative told us that they were very pleased with the support the person received and was happy that they were safe in their own home.

We saw that staff responded to cues given by the person and responded in a way to make the person comfortable and happy. The service was person centred and reflected a knowledge and understanding of the person's likes, dislikes and wishes.

The inspection took place over two days on 11 and 12 May 2015. The inspection was unannounced.

Community Integrated Care are a national charity delivering care and support to people with a diverse range of needs including people with learning disabilities, mental health concerns and health related problems. Glen Cottage is registered to provide accommodation and personal care for one person. The home is located in a residential area close to community facilities. At the time of the inspection there was one person living at Glen Cottage.

The service had a registered manager. 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 and associated Regulations about how the service is run.

Mental capacity assessments had not been undertaken to establish whether people using the service were able to make decisions about and agree to their support plan. This is a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The care and support arrangements in place, whilst in the person’s best interests, meant there was a risk of the person’s liberty or freedoms being restricted. However an application for a deprivation of liberty safeguards (DoLS) had not been submitted. This is a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements could be made to the training programme to ensure that staff had more up to date training which was specific to the needs of the person using the service. This would help to ensure that staff were consistently delivering effective care.

Relevant risk assessments were in place and covered activities and associated health and safety issues both within the home and in the community.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. Staff had clear guidance about what they must do if they suspected abuse was taking place.

There was sufficient staff to meet the person’s needs. The person was supported by a stable staff team who were experienced and knew and understood their needs.

Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised. These measures helped to ensure that only suitable staff were employed to support people in their homes.

Appropriate arrangements were in place to manage the person’s medicines. There were policies and procedures in place to ensure the safe handling and administration of medicines, which were only administered by staff that had been trained to do this.

People were supported to have enough to eat and drink and their support plans included information about their dietary needs and risks in relation to nutrition and hydration. Staff involved the person in decisions about what they ate and they were assisted to remain as independent as possible with eating and drinking.

Where necessary a range of healthcare professionals had been involved in planning people’s support to ensure their health care needs were met.

We observed interactions between staff and the person which were relaxed and calm. Staff showed the person kindness, patience and respect. Staff were aware from the person’s body language whether they were comfortable with the care being provided or wanted space or time on their own.

There was an open and transparent culture within the service and the engagement and involvement of the person relatives and staff was encouraged and their feedback was used to drive improvements.

The registered manager had a clear vision for the service which had been formulated into a service improvement plan that focussed on driving improvement. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.