About the service: Huws is a nursing home for people living with a learning disability, physical disability and or autistic spectrum disorder. Huws accommodates 14 people across two separate buildings each of which have separate adapted facilities. At the time of the inspection 14 people were using the service.

People’s experience of using this service:

People were supported to take their medicines as prescribed. Medicines were stored in a safe way. The service was clean and infection control was managed well and in line with the providers policy and procedures. Systems were in place to make sure people were kept safe. There was enough staff employed to support people. Any shortfalls in staff numbers were managed by agency staff. Lessons were learned when things went wrong. These incidents were managed, and changes were made.

Staff completed an induction and training relevant to their post when they first started working with the service. However, we found gaps in the ongoing training matrix, which needed to be addressed. Staff received opportunities to review their work and development, but these were not up to date. People’s needs were assessed, and care was reviewed to ensure people’s needs were met. People were offered a choice of food and drink on a daily basis. If a person did not want what was on the menu alternative meals were offered. Positive outcomes were experienced from care and treatment. The service was adapted and designed to ensure it met people’s needs and requirements. People had access to healthcare professionals and were supported to attend appointments.

People received support from kind compassionate staff who were knowledgeable about the people they cared for. People were able to express their views through meetings and discussions about their needs and preferences. People were treated with dignity and respect by staff that encouraged them to be independent and to do things for themselves.

Care was planned and delivered in a person-centred way. There was instructions and guidance to ensure staff supported people who used specialist equipment in a specific way that met the person’s needs. Communication needs were identified and planned for in line with the accessible information standard. The manager was aware of end of life care, but we were not confident staff had received any training in end of life care.

We recommend that the service seeks advice and guidance from a reputable source about end of life care.

An interim manager was in post at the time of the inspection. The interim manager was an experienced registered manager from another service run by the provider. Staff were complimentary of the manager and felt supported. Monitoring systems were in place and where we identified concerns the manager had already started to take action. The provider understands and acts on duty of candour responsibility, as notifications were submitted to CQC in a timely manner.

Rating at last inspection: Requires Improvement last report published 4 January 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we saw that improvements had been made. However, further improvement is required.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out an unannounced inspection of the service on 29 November 2017. 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.

Huws is a nursing home for people living with a learning disability, physical disability and or autistic spectrum disorder. Huws accommodates 14 people across two separate buildings each of which have separate adapted facilities. At the time of the inspection 13 people were using the service and one person was in hospital.

A registered manager was present during the inspection and had been in post for six months. A registered manager is a person who has registered with the Care Quality Commission (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.

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. Registering the Right Support CQC policy

At our last inspection in November 2015, the service was rated 'Good'. At this inspection we found that the service remained 'Good’ in Effective and Caring and had deteriorated to ‘Requires Improvement’ in Safe, Responsive and Well-led.

Improvements were required in how people were supported with their prescribed medicines. This included safe storage, management and the checks and audits in place. Whilst the service was found to be clean, improvements were required on the prevention and control of infection. An action plan was required to meet the shortfalls identified in an NHS infection control audit completed in November 2017.

Risks associated with people’s needs had been assessed but the plans in place to mitigate risks lacked clear and up to date information for staff. Support plans were not always followed by staff and information was lacking in places for staff to provide responsive and effective care and treatment.

The systems and processes in place to audit the quality and safety of the service required improvements to ensure staff were clear about their role, responsibility and accountably. The registered manager on the whole was aware of the shortfalls identified during this inspection and an action plan was in place.

Staff were aware of their role and responsibility of how to support people from avoidable harm and had received safeguarding training. Improvements had been made in the recruitment of permanent staff and safe staff recruitment checks were carried out before staff commenced employment.

The environment and equipment was found to be appropriate and safe to meet people’s needs. Staff had received training in health and safety. Accidents and incidents were recorded and analysed by the registered manager.

People’s holistic needs had been assessed and planned for and there was good use of assisted technology to support people effectively.

Staff received an appropriate induction, refresher training was due for some staff and this had been planned for. The registered manager was aware the frequency of staff supervisions needed to be improved upon and had plans for this.

The monitoring of menus required improving to ensure they reflected people’s needs, preferences and provided healthy balanced meals. Staff worked with external healthcare professionals to support people with their health needs and outcomes.

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 servic

We inspected the service on 10 November 2015. The inspection was unannounced. Huws provides care and support for up to 14 people with learning and physical disabilities. The service is split into two apartments and one house to provide smaller living spaces. All three living areas had their own lounges and kitchen/diners. The accommodation has been adapted to meet the needs of the people living there. On the day of our inspection 14 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 were supported by staff knew how to recognise abuse and how to respond. Incidents were responded to appropriately internally to ensure people were protected from harm.

Risks were assessed and managed and people were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and where there was a lack of capacity to make certain decisions; people were protected under the Mental Capacity Act 2005.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

Staff valued and empowered people to achieve their goals and aspirations. People lived in a service where the ethos was inclusion and valuing people as individuals and staff went the extra mile to ensure people lived an enriched and fulfilling life. Staff took the time to get to know people and tailored their support to meet individual need. Staff were compassionate and respected people’s privacy and dignity and rights to be involved in developing their daily living skills.

People were involved in planning their care and support. They were supported to have a social life and to go out into the community and go on holidays.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

We found that where people did not have the capability to make a decision the provider ensured that decisions were being taken in that person's best interests.

We observed that staff understood people's preferences through people smiling and laughing or vocalising for their prefered choice. We found that care was given in a way that met individual need.

We found that there were arrangements in place to deal with foreseeable emergencies and that staff we spoke with felt confident in dealing with emergency situations.

We found that the provider had suitable arrangements in place to protect service users against the risk of control or restraint being unlawful or otherwise excessive. We observed staff following the providers arrangements to deliver care that protected people from the risk of unlawful or excessive control or restraint.

We found that staff and people using the service were protected against infections by appropriate standards of cleanliness and hygiene.

We found that staff had received regular training in areas relevant to the needs of people in the service. This meant that staff were appropriately supported in relation to their responsibilities and were able to deliver care and treatment to people using the service safely and to an appropriate standard.

We were unable to speak with people living at Huws and gain their views about the service due to people’s limited and specialised communication. However, from brief observations we saw that people were comfortable and relaxed with staff. We spoke with a person’s relative who was very positive about the service. Their comments included: “they’re wonderful; they do their very best for them….I feel so lucky [X] has a place like this”.

We looked at the care plans and records of four people who used the service. We found people’s needs were assessed and care was planned and delivered in line with their individual plan.

We found medication to be handled appropriately and to be safely stored and administered.

Staff we spoke with demonstrated a good understanding of the needs of people using the service and how their care should be provided. People using the service could be confident that staff had been screened as to their suitability to work with vulnerable adults.

The provider had an effective quality assurance system.

We carried out this review because we had concerns that this service had not been visited since the last inspection which took place on 14 January 2010.

People using the service cannot communicate verbally so we observed staff providing care and support and we spoke with staff about the people using the service. This gave us assurances staff knew the needs of people and knew how to deliver the care and support effectively.

We saw there was a calm, relaxed atmosphere in the home when we visited. Staff and people using the service were interacting positively with each other. We saw that staff were kind and respectful to people using the service. People looked happy and relaxed and they appeared to be enjoying their day with support from staff.

On the day of our visit we were told about individual activities and interest’s people using the service had. Later in the day we saw that staff had facilitated these activities and we saw that people using the service were thoroughly enjoying what they were doing. People were participating in cooking meals, taking part in sensory sessions and some people were supported to go out to a place of interest.

We saw there was a meeting held once a week for people using the service. This was to find out how the activities had gone the week previously and to decide on menus and activities for the following week.

We saw from the care plan of one person using the service, they had been involved in their annual care review and there were signs and photographs used to help the person communicate their views.