We held a comprehensive unannounced inspection on 6 September 2018.

At our last inspection, the service was rated ‘Requires Improvement’ overall and in three of the key areas. There were two breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. The provider had failed to ensure that people’s needs were assessed and people’s care designed to meet their needs and preferences. The provider had also failed to establish and operate systems to assess, monitor and improve the quality and safety of the service; and failed to maintain accurate and complete records.

At this inspection, we found some improvements to people’s needs assessments and a continued breach in the failure to monitor and improve the quality and safety of the service; and maintain accurate records. We identified four further breaches of the Regulations. Therefore, this is the second consecutive time the service has been rated as Requires Improvement.

HF Trust – Phillippines Close is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 16 people in two separate buildings, each of which have separate facilities and is set on a site which is shared with a day service, offices and supported living accommodation owned by the same provider. On the day of our inspection, there were seven people living in one house and eight people in the other. People had a range of learning disabilities and some people also had physical disabilities, autism or dementia.

Although the service had been built and registered before Registering the Right Support (RRS) had been published, the provider had been developing the service in line with the values that underpin this 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 manager on site who is in the process of registering with CQC. A registered manager is a person who has registered with 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.

Safeguarding policies were in line with Local Authority safeguarding procedures, staff had received training and were able to tell us what they would do in the event of a safeguarding concern. However, concerns had not always been reported to the Local Authority and CQC; and acted on by the provider.

People were protected from the risk of infection and were cared for in a clean environment. Risks to people were assessed although some were overdue for review and there was no risk assessment for one person who can present with behaviour that challenges.

The provider did not consistently ensure the safe use of people’s prescribed medicines. Not all bottles had been dated on opening and people did not have protocols in place for all their PRN medicines to ensure people received medicines when they needed them. Medicines were not always stored safely at the correct temperatures in line with the providers policy.

The provider did not always learn from incidents as not all incidents had been reported. Where incidents of behaviour that challenges had been reported, they were not always acted on and therefore lessons were not always learnt when things went wrong.

Safe recruitment practices were carried out by the provider. However, staff had not received regular supervision. The provider struggled to recruit to cover the identified staffing hours required.

The provider had trained and supported staff to understand the requirements of the Mental Capacit

The inspection was carried out on 26 June 2017 and was unannounced.

Philippines Close is registered to provide accommodation and personal care for up to 16 people. There were 16 people living at the service when we visited. People had a range of learning disabilities.

The service is split across two houses on a site which is shared with a day service, offices and supported living accommodation owned by the provider. There were seven people living in one house and nine people in the other. Each house had its own dedicated staff team, though staff occasionally supported in the other house to cover staff shortages.

There is a registered manager in post who was supported on site by an operations manager. They were also part of the provider’s partnership forum. 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.

Risks to people and the environment had been assessed and there were risk assessments in place. However, assessments related to people’s health did not always contain all the information needed for staff to minimise identified risks. When risks in the environment were identified for example, fire doors not closing when the fire alarm is tested, there was no evidence that action had been taken and the outcome. The registered manager took action after the inspection to address these issues. People’s medicines were managed safely; however one person did not have protocols in place for ‘as and when’ required (PRN) medicines and some creams had not been dated when they were opened. Some medicines, including the creams we observed need to be used within a limited time once opened or they may not work properly, so creams should be dated when opened. We made a recommendation about this.

People’s care plans were not updated on a regular basis and some not been updated since 2013 and contained information which was now inaccurate. People’s did not always have their needs assessed before moving into the service and care plans were not completed until sometime after they moved into the service. Some people could present behaviours which can challenge; care plans related to this did not give staff all the information they needed to help the person to manage their distress and feel calm. People did not have plans to support them to reach their goals or develop new skills. People’s care plans were in the process of being updated and moved to an online system.

Audits were completed by allocated staff members, the registered manager and operations manager to monitor the quality of the service. However, these audits had not identified the issues we found during this inspection and did not always record actions taken to address shortfalls. People and relatives were asked for their feedback via surveys and house meetings. There was an easy read complaints policy and complaints were dealt with appropriately.

People were supported by staff who knew them well and treated them with dignity and respect. Staff were recruited safely and had the training and skills required to meet people’s needs. Staff told us they felt supported and had access to regular supervisions with their line manager. People were encouraged to be independent and had access to a wide range of activities both at the on-site day centre and in the local community.

Staff understood their responsibilities in relation to safeguarding people from abuse and worked with people to manage their relationships with the people they lived with. The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. The Care Quality Commission is required by law to monitor the operatio