This inspection took place on 25 October 2018 and was unannounced. At our last unannounced comprehensive inspection of the service on 18 July 2017 breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12, Safe Care and Treatment, Regulation 18 Staffing and Regulation 17 governance of the service. We undertook an unannounced focused inspection of Grazebrook Homes - 39 Adshead Road on 20 November 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider had been made and we found that they were.

Grazebrook Homes – 39 Adshead Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Grazebrook Homes – 39 Adshead Road accommodates nine people in one adapted building. People that live at this service have support needs that include learning disability and autism.

The care service has been developed and designed 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.

There was 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 2008 and associated Regulations about how the service is run.

The provider did not have in place a dependency tool to assess staffing levels during the day. People felt safe and were supported by staff who were aware of the risks to them. Accidents and incidents were not consistently analysed for any lessons to be learnt. People were supported by staff who had been through a number of checks to ensure their suitability for their role. Systems were in place to ensure people received their medicines as prescribed by their doctor.

Systems in place to record people’s fluid intake were inconsistently completed and ineffective. Staff had not been provided with the guidance required to monitor a person’s diabetes. Staff felt well trained and supported by management. People were supported to access a number of healthcare services in order to support them to maintain good health. 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 by staff who treated them with dignity and respect and were kind and caring. Staff supported people to maintain their independence where possible, respected people’s choices as to how they wished to spend their day. People were supported to see their family and visitors were welcomed by staff.

People and their families were involved in the development and the review of their care. People’s feedback of the service was obtained through reviews and surveys. There were systems in place for people and their relatives to raise any concerns they may have.

Audits in place had not identified a number of areas of concern that were highlighted during the inspection and the provider had failed to follow up on some areas of action that had been agreed at the previous inspection.

We carried out an unannounced comprehensive inspection of this service on 18 July 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 Safe Care and treatment, Regulation 18 staffing, and Regulation 17 Governance of the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link Grazebrook Homes – 39 Adshead Road on our website at www.cqc.org.uk.

Prior to our inspection we received some information of concern. The concerns raised were also reviewed as part of this focused inspection.

Grazebrook Homes - 39 Adshead Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grazebrook Homes - 39 Adshead Road accommodates nine people in one adapted building. People that live at this service have support needs that include learning disability, and autism.

There was a registered manager in post. 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 found the provider had taken action and the legal requirements had been met. We found improvements were still on-going in some areas. We saw where needed improvements had been made in relation to the concerns we had shared with the provider.

The provider had taken action and had improved the fire and health and safety procedures in the home to ensure people were safe. Work was on-going to fit radiator covers to areas of the home the provider had assessed as needing them. Staffing levels at night had been reviewed and increased to ensure people received the support they needed. A tool was not currently in place to indicate the staffing levels required to support people during the day. The provider gave us assurances a tool would be implemented and staff roles reviewed.

Staff understood how to support people and manage any risks that had been assessed. Staff understood their responsibilities to keep people safe from harm and to report any concerns about people’s welfare. Recruitment procedures ensured people were supported by suitable staff. People received their medicines when they needed them and staff were being assessed by the registered manager to ensure they administered medicines safely.

Staff felt supported and had the training they needed to fulfil their role. People and staff had opportunities to share their opinions and ideas on how the service could be improved. Although systems to monitor the service had been reviewed and updated the provider intended to make further improvements and purchase a comprehensive home and infection control audit to drive improvements in the home. Records were being reviewed and new systems implemented to ensure they reflected the support provided to people.

Our inspection took place on 18 July 2017 and was unannounced.

At our last inspection in January 2015 the service was rated as good in all five questions we ask: ‘Is the service safe? Is the service caring?: Is the service effective?: Is the service responsive? And, Is the service well-led?

The provider is registered to provide accommodation and personal care to a maximum of nine people. On the day nine people lived at the home. People had needs in relation to their learning disability/ associated conditions and or/physical disability.

The manager was registered with us as is required by law and they were present on the day. 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.

Although this inspection was carried out as part of our routine inspection programme we had received some information raising concerns about the service. This included staffing levels particularly at night, the way hazardous substances were managed and activities. We looked at these issues during this inspection.

The provider had not ensured that fire safety and other aspects of health and safety were adhered to. There were not enough staff provided at night time to keep people safe and to meet their needs. Although there were procedures in place to safeguard people from harm and abuse staff had not always followed them. Recruitment processes prevented the employment of unsuitable staff. Medicine systems confirmed that people had been given their medicines as they had been prescribed.

Staff had received a range of training and were supported by the management team. Staff knew that people’s care should be provided in line with their best interests and no person should be unlawfully restricted. People were encouraged to make decisions about their care. Their families were also involved in decision making. People’s food and drink preferences and special dietary needs were catered for. There was input from a range of external healthcare professionals to address people’s healthcare and social care needs.

The provider had not promoted a caring service as people’s safety was not always promoted and there were insufficient staff on night duty to meet their needs and to keep them safe. People were supported by staff who were friendly, helpful and caring. People were treated with dignity and respect and their independence was promoted. People could see their family whenever they wanted to and their visitors were welcomed by staff.

People and/or their families were involved in reviews of care and circumstances. Provider feedback forms and meetings were held to gain the views of people and their relatives. Systems were in place for people and their relatives to raise their concerns or complaints if they had a need to.

Quality monitoring and audits had not identified that a number of areas of service provision were not meeting the requirements of the law. People were at risk of potential injury and no action had been taken to address this. The provider had failed to notify us of some issues that they are required to by law. They were visible within the service and knew the people who lived there well.

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

This was an unannounced inspection that took place on 19 January 2015.

We last inspected this service on 22 October 2013. There were no breaches of legal requirements at that inspection.

39 Adshead Road is a care home registered for nine people. The home provides accommodation and care for people who have a learning disability or complex needs (autism spectrum disorder). At the time of our inspection, eight people were living there.

There was a registered manager in post. 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 saw that there were systems and processes in place to protect people from the risk of harm. Relatives of people who lived at the home told us that they felt the service kept their relative safe.

Care plans were detailed and contained personalised information. Staff spoke warmly of the people living at the home. They were able to provide us with detailed information regarding the care and preferences of the people they supported and demonstrated the skills and knowledge required to meet the needs of the people living there.

We observed that people living at the home were encouraged and supported to be as independent as possible. People living at the home spoke positively about the staff who supported them and we observed caring relationships between them.

Staff and relatives told us that they felt there were sufficient numbers of skilled staff on duty to keep people safe. The registered manager had put in place recruitment processes in order to reduce the risk of unsuitable staff being employed by the home. However we noted that on one occasion, despite being told these systems had been followed, there was no written evidence available to support a particular decision making process.

Where staff had concerns about a person’s healthcare needs, they had involved the appropriate professionals to support them to make sure they received the medical care they needed. Where decisions had to be made in people’s best interests, meetings had been arranged with the appropriate stakeholders. Although the appropriate paperwork was completed, on one occasion we noted that there were no formal minutes of the meeting held on the person’s care file.

Relatives of people told us they found the registered manager and staff approachable and that they had confidence that if they needed to raise any concerns or complaints that they would be dealt with. Staff understood their role and felt supported by the registered manager and the training they received.

People living at the home were supported to take part in a variety of different activities and efforts were made to maintain friendships outside of the home and ensure people retained contact with families.

There were management systems in place to measure the quality of the home. Staff felt listened to and were given opportunities to contribute to the running of the home through staff meetings and supervisions.

On the day of our visit there were seven people living at the home. People who used the service had just left for the day to attend a club where they can engage in varied activities. We spoke with people when they returned home.

People’s needs had been assessed and care plans developed. We looked at two care records and we spoke with three people about the care and support they received. One person said “It’s a nice home”. Another person said “It’s alright here, the staff treat you well”.

Every person had individual personalised care plans which people or family members had consented to. This meant that people’s care was planned and delivered in a way they wanted.

We looked at infection control procedures and audits as well as making observations within the home. The manager / owner recognised the importance of infection control and told us that they would be making some changes in this area. This ensured that people were protected from the risk of infection.

Robust recruitment procedures were in place. Legal checks had been made and training plans were in place. This ensured that staff had the knowledge, skills and experience to meet people’s needs.

Quality management procedures were in place to assess and monitor the quality of the service provided. Quality audits were undertaken and action taken to learn from issues identified. This ensured that people received a quality service.

We carried out this inspection to check on the care and welfare of people. There were six people living at the home on the day of the inspection. We spoke with three people, one relative, two staff members, the deputy manager and registered manager who was also the owner.

We found that people’s independence was promoted and they were treated with respect. One person said, “They help me do things, but I do most things myself.”

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We found that people had regular health checks to ensure they received appropriate care and support from other healthcare professionals.

We found that arrangements were in place to ensure that people were safeguarded from harm.

We found that staff were supported appropriately to carry out their role. One person said, “Yes, staff are nice.”

Systems were in place to record complaints and comments although none had been received. One person said, “No complaints.”

39 Adshead Road provides good quality care to people with learning disabilities in a warm and homely environment. We saw that staff had a good rapport with people living in the home , who looked relaxed and content. The staff encourage people to help with the running of the home to promote their independence. People are supported to go into the community to participate in activities they enjoy such as ten pin bowling and the cinema. . People we spoke to said they were happy living in the home. There are quality monitoring systems in place to ensure the home is run with the best interests of people living there.