The inspection took place on 3 and 5 October 2018. The inspection was unannounced on the first day and announced on the second day.

In July 2018 the new providers took over Hill Farm and another small service in the area called Sunnyfields. This is the first time the service has been rated since the change in ownership in July 2018. At the previous inspection in April 2018, under the previous provider, the service was rated ‘inadequate’. We found at this inspection that improvements had and were being made however, further improvements were needed.

Hill Farm is a ‘care home’. People in care homes receive accommodation and nursing and 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. The service provides support for up to nine people with physical and learning disabilities. There were six people living at the service at the time of our inspection including people with sensory impairments, autism and behaviours which can challenge.

The registered manager had worked at the service for many years, was present at our visit and working with the new providers to improve the service. They were registered to manage this service and another small service in the local area which is registered with the same provider. 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 inconsistency in the assessment and management of risks which meant that guidance and practices were not always in place to minimise any risks identified to people. The registered manager had not completed all appropriate risk assessments to minimise any risks identified to people. There were no effective systems in place to monitor accidents and incidents.

Staff did not have the training or knowledge needed for their roles including how to support people with blindness, with an epileptic seizure, to apply first aid and to move people safely. The providers had worked hard to update staff training in the short time they have managed the service. However further improvement was needed especially in providing additional specialist training for staff, so that staff were trained to meet people’s needs.

Quality assurance systems had been implemented, but did not highlight all areas of improvement needed.

We found inconsistencies in staff practice in treating people with dignity and respect and providing people with choices.

There were systems in place for the management, storage, disposal and administration of medicines. However, two records were not accurately completed and for one person their medicine has not been given on one occasion. We have made a recommendation about the management of medicines.

It was difficult to judge if people took part in a range of meaningful activities as records had been completed inconsistently and no record being made for some days. We have made a recommendation about the recording of activities.

There was a shortfall in the recruitment procedure. Recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles. However, the registered manager had not obtained a full employment history for the three newest members of staff. We have made a recommendation about following robust recruitment procedures.

There were enough staff deployed on shift to keep people safe.

Staff knew people well, had built positive relationships, understood their likes and dislikes and preferred methods of communication.

Staff said they felt more supported since the providers had taken over the service and that formal supervision was now taking plac