We undertook this inspection of Isabella Court on 7 December 2016.

Our previous inspection of Isabella Court took place in October 2015, when the service was given an overall rating of requires improvement. There were no breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations identified at that time, but three recommendations were made to encourage improvements. These related to ensuring people always received caring and responsive care and that the service was consistently well led.

Isabella Court is registered to provide personal care and accommodation for up to nine people. The home focuses on providing care to younger adults who may be living with a learning disability, autism and/or physical disabilities.

At the time of this inspection the home was providing care to nine people.

Isabella Court had 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.

People appeared comfortable in their surroundings and with staff. Relatives told us people were safe at Isabella Court and that their relations were always happy to return to the home after an outing or visit with family.

The registered provider’s recruitment process reduced the risk of unsuitable staff being employed. Staff knew what to do if they had concerns or suspicions of abuse and confirmed they felt able to raise concerns with the management team.

There were enough staff were on duty to support people safely and the manager had flexibility to change staffing to accommodate activities or appointments people needed to attend.

People’s medicines were stored and managed safely. Staff had received training on the safe administration of medicines.

Staff received the training and support relevant to their roles. This included encouragement to complete formal qualifications and regular formal supervision.

Staff worked within the principles of the Mental Capacity Act 2005. The manager knew when and how to seek authorisation under the Deprivation of Liberty Safeguards to deprive people of their liberty lawfully.

People received a varied choice of meals, snacks and drinks throughout the day. Nutritional needs were screened and people’s weight was monitored.

Staff supported people to access other healthcare professionals to maintain and improve their health. This included the involvement of specialist healthcare professionals when needed.

Relatives spoke positively about the care their relations received. Staff were described as kind and caring. Staff knew people well and could describe how they maintained people’s privacy and dignity.

People and their relatives had been involved in planning and reviewing their care and support needs. Records included detailed information about people’s preferences, routines and support needs.

People took part in a variety of activities and outings as part of their weekly routines. The sensory room had been improved since our last inspection and the manager had plans to introduce individual sensory programmes, to support people to get the most out of these facilities.

Staff tried to engage people and encourage activities while people were in the home, but a more structured approach would be beneficial. The manager agreed and had already highlighted this as an area for further improvement.

A complaints procedure was in place and relatives told us that they could discuss any issues or concerns with staff.

Relatives and staff spoke positively about the registered manager. There was a pleasant, warm atmosphere at the home and people told us they were satisfied with the care provided.

Audits and checks took place and there were plans for further improvements to the environment and arrangements for a

We saw that people who used the service were included in the development of the service when possible. Staff worked with them to ensure they had an opportunity to develop their own interests and lifestyle choices. This information was contained in their care plans.

We observed people interacting with staff in a positive way that promoted their dignity.

We saw that staff had received training in the safeguarding of vulnerable adults and they understood their responsibilities in relation to keeping people safe.

The environment was well maintained and we saw an on-going maintenance programme was in place to ensure any issues with the environment were dealt with quickly. We saw records to show that the equipment used was serviced at regular intervals and safe to use.

Staff received training to ensure they had the skills necessary to meet the needs of each person. Staff also received support through supervision and appraisals.

The manager told us about a range of health and safety audits which were carried out by the home. For example, the home carried out regular maintenance checks, portable appliance tests, fire checks and hot water temperature checks. Equipment used within the service was also regularly serviced. This helped to keep people safe.

We observed staff interactions with people using the service and we saw staff use simple language and pictorial prompts. They waited for a response from the individual before beginning any activity with them. Each person had a mental capacity assessment. This was recorded in their file.

Care plans contained an individual daily diary that covered the activities the person had done, who had visited and what they had eaten during the day. Staff told us this information was relayed to the carers of people who used the service so that they could understand how the respite stay had been.

We observed medication being administered and it was done by two members of staff, one person was handling the medicine while the other checked that the dosage and time of administration were in line with the care plan. Staff told us that they were not allowed to handle medicines unless they had completed Safe handling of medication training.

Staff told us that the staffing levels varied depending on the time of day and activities being undertaken by people who used the service.

The manager told us that after each visit she makes contact with the person's carers to see if there were any concerns identified following the person's stay. She said this meant that some concerns were raised immediately and were able to be dealt with before the person came to stay again.

This inspection took place on 20 October 2015 and was unannounced. At the last inspection on 25 September 2013 we found the service was meeting the regulations we inspected.

Isabella Court provides personal care for up to nine people who have a learning disability. On the day of the inspection there were nine people living in the home. The home is located in the market town of Pickering. The home is a large, purpose built dormer bungalow, set within its own grounds. Gardens have seating areas and attractive landscaped flower beds. All bedrooms are situated on the ground floor and rooms are wheelchair accessible. Staff offices are located in a small upper floor area which is accessed by a small flight of stairs.

The home had no 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 were not able to communicate verbally with most of the people who lived at the home. We made observations about care, spoke with relatives and staff and looked at records to make our judgements.

Staff were able to tell us what they would do to ensure people were safe and relatives told us they felt people were safe at the home. The home had sufficient suitable staff to care for people safely and they were safely recruited. Risks were well assessed and the service promoted independence, although people were not always consulted about this sufficiently. We have made a recommendation about this.

Staff had received training to ensure that people received care appropriate for their needs. Training was up to date in mandatory areas, such as infection control, health and safety, food hygiene and medicine handling and also in specialist areas of health care appropriate for the people being cared for.

Staff had received up to date training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood that people should be consulted about their care and that they should assume that a person had capacity to make decisions. They understood what needed to happen to protect the best interests of people who lacked the capacity to make certain decisions.

People’s needs around food and drink were met and appropriate professional advice had been followed.

People were sometimes treated with kindness and compassion, though the service was not consistent in this area. Some staff had a good rapport with people whilst treating them with dignity and respect. However, some people were not treated with as much care and compassion as they could have been which had a negative impact on their experience. For example, one person was not supported with sufficient care at a meal time. However, most staff had a good knowledge and understanding of people’s needs. We have made a recommendation about this.

Care plans provided information about people’s individual needs and preferences and how these should be met.

While we observed that people’s care needs were met, at times they had insufficient to entertain and stimulate them or to make their lives meaningful and fulfilling. The manager was developing a plan to address this. We have made a recommendation about this.

Complaints and concerns were addressed, and the actions were recorded with plans for future learning.

Quality assurance systems were in place to improve the care offered in the home. However, people who were significant to those who lived at the home felt they were not sufficiently consulted about the way the home was managed or communicated with about changes which affected their relatives. We have made a recommendation about this.