We undertook an unannounced inspection of HF Trust – Milton Heights on 18 July 2018. The lead inspector also visited on 25th and 31st July 2018 to complete the inspection. HF Trust – Milton Heights is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 24 people living in accommodation across six separate houses, each of which had separate facilities. The houses were situated on the HF Trust Milton Heights site which also comprises of day support facilities and supported living accommodation.

The service had two registered managers. One registered manager was responsible for house 4 and the other registered manager for houses 6, 6a, 7, 8 and 10. 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. There was an acting manager in the absence of the registered manager for houses 6, 6a, 7, 8 and 10.

When we completed our previous inspection on 6th and 15th June 2017 we found the houses were in need of refurbishment and redecoration to ensure they were appropriate and suitable for the current needs of the individuals living there. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well Led to at least good. At this inspection we found that not all actions had been completed to ensure the necessary improvements were made. The service was still not fully meeting the fundamental standards that premises and equipment should be clean and properly maintained. The condition of the premises and some equipment in areas such as bathrooms and flooring created a challenge for staff to achieve a good level of hygiene and cleanliness.

The provider’s Information Return had stated that the provider’s estates department were in negotiations to provide new accommodation. However, there were no clear timelines for when this accommodation would be sourced to ensure people were living in well maintained and suitable premises. Regulations state that providers must monitor progress against plans to improve the quality and safety of services, and take appropriate action without delay where progress is not achieved as expected. Insufficient action had been taken to address the shortfalls identified at the last inspection.

Although staff working at the service were suitably qualified and skilled, people and staff told us that more permanent staff would provide more stability. However, staffing numbers and shifts were managed to suit people's needs so that people received their care when they needed and wanted it. Staff had access to information, support and training they needed to provide people with satisfactory care. The provider’s training was designed to meet the needs of people using the service. As a result, staff had the knowledge they required to care for people effectively.

People told us they were safe. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures in place to follow in case of an allegation of abuse. The service had appropriate recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Risks to people's well-being had been identified and were managed safely. Appropriate individual risk assessments were in place to keep people safe. Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to store medicines safely. People rece

This inspection took place on the 6 June 2017 and was an unannounced inspection. We also visited on 15 June 2017 to complete the inspection.

HF Trust Milton Heights is registered to provide accommodation and personal care for up to 33 people with learning disabilities. At the time of the inspection 25 people were being supported across six houses on the same site.

There were two registered managers in post. One registered manager was responsible for one of the premises and the other registered manager had responsibility for the five other premises. 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.

People’s environment needed improvement. We found the houses were in need of refurbishment and redecorating to ensure they were appropriate and suitable for the current needs of the individuals living there.

In one of the houses, medicines were not always stored at the advised temperatures. We made a recommendation that advice is sought in respect of this. People had received their medicines as prescribed.

The service had systems in place to assess the quality of the support provided in the home. However, where improvements were needed these had not been acted upon by the provider in a timely manner to ensure that people were protected against the risks of unsafe or inappropriate environment. Other risks had been identified and recorded and action had been taken to reduce the risks.

Feedback from two professionals we contacted spoke of communication not always being as effective as it could be.

All staff spoke positively about the support they received from the registered managers. Staff told us they were approachable and supportive. The service worked with other professionals to ensure people in the service received the appropriate support associated with their health and wellbeing.

People told us they felt safe. Staff had received regular training to make sure they maintained their knowledge in relation to recognising and reporting safety concerns. Staff were aware of people’s needs and followed guidance to keep them safe.

People were supported by staff that had the knowledge and skills to effectively care for them. Staff had received the training and support they required to ensure people received good care. The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) which governs decision-making on behalf of adults who may not be able to make particular decisions themselves. People’s capacity to make decisions was regularly assessed.

People had a choice about the food and drink they wanted. People were supported to plan meals, shop and cook if they were able. People we spoke with told us they enjoyed the food and had choices about what they ate.

People spoke highly of the care they received. Staff understood the needs of people and provided care with kindness and compassion. Staff spent time with people and treated them with dignity and respect.

People’s care was planned ensuring that people were treated as individuals. People had been involved in developing their support plans and reviewing these. People were encouraged to be involved in activities and to take part in activities, such as hobbies and social events to ensure they did not become bored or socially isolated.

People in the service knew the registered managers and spoke to them openly and with confidence.

HF Trust – Milton Heights is a service for up to 33 people, based in five houses within its own grounds. It provides accommodation, care and support for people with a learning disability. At the time of our inspection there were 27 people living at the service.

The service was managed by a registered manager.  A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We found people were involved in decisions about their care and support, which they discussed regularly with their key workers. They were encouraged to be as independent as they wished to be and were supported to take part in a wide range of activities.

Care and support were provided by a consistent team of care staff who were clear about their roles and responsibilities and knew people well. Staff received appropriate training and had the skills necessary to carry out their roles. They were clear about how to identify, prevent and report abuse and worked in cooperation with the local safeguarding authority.

People told us they were happy living at the service and they felt safe. They told us they would know who to go to if they were “worried” or “frightened” about anything and said they were confident staff would always help them.

When we asked staff about people’s needs, they were able to provide up to date information about all aspects of people’s care and support. Staff made appropriate referrals to other professional and community services. A healthcare professional from the Community Learning Disability Team told us staff were “always very helpful, provided all the necessary information and sought advice when required”.

During conversations with people, we found staff spoke respectfully and in a friendly way; they adapted their vocabulary appropriately and took time to listen. People attended ‘house meetings’ to express their views about the service and took part in a ‘parliament’ which promoted people’s interests.

Throughout our inspection, staff spoke positively about the service and told us it was well-managed and well-led. We found senior staff promoted a positive culture that was centred on the people who used the service.

Where people were unable to make decisions themselves, we saw decisions were made in their best interests and in accordance with the relevant legislation. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

We spoke with the local safeguarding authority, who told us they were concerned about a number of incidents where people using the service had hit other people using the service. We found several of these incidents had occurred in one house and the service had taken appropriate action to prevent further incidents.

Providers are required to report such incidents, which are a form of abuse, to CQC. However, we identified five incidents which had not been reported to CQC.

Medicines were managed safely for most people. However, we identified concerns with the management of some medicines in one of the houses and with storage arrangements for medicines that needed to be kept at cooler temperatures in all the houses.

You can see the action we have asked the provider to take can be found at the back of this report.

We spoke with six people and nine members of staff. We also observed people who used the service. People appeared happy with the support they received from the service. One person said they felt they were involved in their care and had support to be involved within the community. All of the people we spoke with were happy with the service. One person said "staff are very nice and listen to me". Observations we made during our inspection showed us that staff had positive interactions with people. Choice was offered and people's decisions were respected.

Staff demonstrated a clear understanding of involving people in day-to-day decisions about their care. Interactions with people were respectful. Staff were aware of peoples' needs and how they needed to assist them. Staff had knowledge of safeguarding, and knew the different forms of abuse, and indicators and symptoms to be aware of. Staff also told us they were confident in reporting concerns and felt that there was an open culture fostered by the provider.

All staff we spoke with talked positively about working for the provider and felt they benefitted from appropriate training, communication and support. Records we looked at confirmed that staff were supported to do their job.

The provider had conducted a quality survey and feedback from relatives was positive regarding the service provided. The Registered Manager had a system of logging any constructive feedback as complaints. These were responded to in line with the provider’s documented complaints policy.

You can see our judgements on the front page of this report.

We spoke with two people and five members of staff as well as observing people who used the service. People appeared happy with the support they received from the service. One person we spoke with felt they were involved in their care and had support to be involved within the community.

Both of the people we spoke with were happy with the service. One person said "staff are good". Observations made during the inspection showed us that staff had positive interactions with people. Choice was offered and people’s decisions were respected.

Staff we spoke with demonstrated a clear understanding of involving people in day-to-day decisions about their care. Interactions with people were respectful. Staff were aware of peoples’ needs and how they needed to assist them.

Staff we spoke with had knowledge of safeguarding. All five staff we spoke with knew the forms of abuse, and indicators and symptoms to be aware of. Staff we spoke with told us they were confident in reporting concerns and felt that there was an open environment fostered by the provider.

All staff we spoke with talked positively about working for the provider and felt they benefitted from appropriate training, communication and support.

The provider had conducted a quality survey and was in the process of inputting feedback on their computer system. Feedback from relatives was positive regarding the service provided.

People told us that they liked living in the homes and said the staff treated them very well. One expressed the views of many when they said, ‘‘it is a very nice home’’.

We inspected HF Trust Milton Heights on the 13 and 23 February 2015. HF Trust - Milton Heights is a service that offers residential care to up to 36 people with learning and associated disabilities. People live in five houses on the site.

The previous inspection of this service was carried out in April 2014 when we found breaches of two regulations in relation to medicines and Notifications. The registered person had not protected all service users against the risks associated with the unsafe use and management of medicines and the registered person had not notified CQC of all incidents of abuse in relation to service users. The inspection in February 2015 was an unannounced inspection to see whether action had been taken. At this inspection the service had taken appropriate action to meet the standards in the area.

There was a registered manager in post at the service. 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.

People who used the service were safe. The service had a clear understanding of the risk associated with people’s needs as well as activities people chose to do. The service had sufficient numbers of suitably qualified staff, who had a good understanding of safeguarding and their responsibilities to report suspected abuse. Medicines were administered safely with safe arrangements for storage and recording of medicines.

People were not always supported by staff who had a good understanding of the Mental Capacity Act 2005 and their responsibilities under this Act with regard to supporting people  to make choices.

Staff were supported through ongoing meetings and individual one to one supervisions to reflect on their practice and develop their skills. Staff received the provider's mandatory training as well as training specific to people’s needs.

Staff were caring and showed a genuine warmth and commitment to the people they supported. People felt they mattered to staff and were involved in every aspect of their lives. People were encouraged to be involved and their feedback was used to improve the service.

People’s needs were assessed and staff understood these needs and responded appropriately when these needs changed. People’s interests and preferences were documented and they were encouraged to pursue activities and areas of interest.

The registered manager had a clear vision for the service that was shared by the staff team. Leadership of the service at all levels was open and transparent and supported a positive culture committed to supporting people with learning disabilities.