This unannounced inspection took place on 6 November 2018. It was prompted by the outcome of a safeguarding investigation which had been carried out by the local authority and the allegation had been substantiated.

At our previous inspection in 16 September 2016 we found the service was good. At this inspection we found a significant deterioration in the quality of care and the overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Keswick House is a residential care home registered to provide accommodation and personal care for up to 14 people with a learning disability. The house is next door to another of the providers services. At the time of the inspection 14 people were living there. We inspected this service within the principles of Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion and promote people with learning disabilities and autism using the service living as ordinary a life as any citizen. We found that the model of care at Keswick House was not supportive of these principles and that people did not have choice and control over their day to day lives.

There was a 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.

The provider had not taken action to ensure that people were safeguarded from abuse. They had failed to respond and learn lessons from an incident that had resulted in psychological abuse of some people who used the service. There were still insufficient safely recruited staff to meet people's assessed needs. The provider could not be sure that staff were trained and safe to fulfil their roles.

The service did not always provide care that promoted people's independence as much as they were able. A lack of staff and resources meant that systems and routines had been put in place which prevented people from living as ordinary a life as possible. People did not always receive care that met their individual assessed needs.

People were able to take assessed risks when accessing the community independently and risks associated with health care conditions were minimised t

This inspection took place on 14 September 2016 and was unannounced.

Keswick House is a care home for people with learning disabilities or autism spectrum disorder. A maximum of 15 people can use the service. At the time of our visit, 14 people lived in the home.

The service 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.

Staff understood the risks related to people's physical health and well-being, and followed people’s individual risk assessments to ensure they minimised any identified risks. The registered manager and staff understood and followed the local authority's safeguarding policies and procedures when necessary. Checks to reduce the risks of employing unsuitable staff were carried out prior to staff starting work at the home. Staff received training to help them meet people’s needs effectively.

The provider understood the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards and the service complied with these requirements. People had good access to health care professionals when required, and their medicines were administered to them as prescribed.

Whilst there had been staff absences over the summer period, there were enough staff to meet people’s needs. People were supported to attend activities that interested them which included going shopping, to the pub and to other recreational facilities. They enjoyed the food provided and helped with meal planning, preparation and cooking.

People who lived at Keswick House liked the staff who supported them. They felt they lived in a 'family' environment with staff who demonstrated kindness, and who they could have fun with.

The registered manager was open and accessible to both people and staff. There were sufficient informal and formal monitoring systems in place to ensure quality of service was maintained. People and relatives felt at east to raise concerns with staff if they needed to.

This inspection was unannounced which meant the provider and the staff did not know we were coming.

At our last inspection on 3 September 2013 we made two compliance actions, one in medication management and one in relation to quality assurance systems. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in these areas.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate outcomes for people using the service had improved.

During our inspection we spoke with eight people who used the service, four members of care staff and the registered manager. People told us they were happy with their care. One person told us, “I want to live here forever. It’s good here”. Another person said, "We get to do what we want here. You name it, we do it”.

People told us they could make choices about their care and that the choices they made were respected by the staff.

We saw that staff understood people’s needs and people received support from staff in a caring and professional manner. Appropriate checks were made by the provider to ensure that staff were suitable to work with the people who used the service.

People told us they were happy with the food provided, and we saw that people could access suitable amounts of food and drink to keep them well.

We saw that people were not protected from the risks associated with medicines, because appropriate systems were not in place to ensure that medicines were stored and administered as prescribed.

We found that the provider did not have effective systems in place to consistently assess and monitor the quality of the service provided. People were at risk of receiving inappropriate care because of this.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people using this service and because concerns had been identified about some aspects of the support people received. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with four people using this service, one relative, a health and social care professional and two members of staff. People using the service told us they liked living in the home. One person said, “I've live here a long time. It's perfect". A relative told us they were happy with the care provided.

During our inspection we saw that people were supported to make decisions and there was some evidence they were involved in the planning of their care. We saw that people were treated with care and respect.

We saw that most people were supported to access the community and that appropriate risk management plans were in place to promote independence.

We saw that staff had the required knowledge and skills to provide the level of care that people using the service required.

During our inspection we identified that adequate systems were not in place to assess and monitor the quality of the service. This meant the provider needed to make improvements to meet this regulation.

Fourteen people live at Keswick House. When we arrived at 8.30 am four people were up having breakfast others arrived for breakfast until mid morning. Some people told us that they go to bed early, some said they liked to rise later unless they were going out somewhere in the morning.

Although the building comprises two semi houses with links for movement between the buildings, most people gather in one of the main kitchen/dining areas. They were keen to tell us what their plans for the day were.

We were told about a new "Friday Feast" at a church centre nearby, they showed us the menu that included breakfast and scampi and chips. Some said they were going later in the morning when it opened clearly looking forward to the experience.

One person told us about a Medieval Feast they were going to the following week at the famous Bear Inn at Hodnet. They had been before, had asked to go again and booked for several people. They told us about the food and the entertainment that included jousting and dancing.

People were keen to tell us about the many social events and activities they enjoyed in the community. Some recounted holidays they had, one person telling us they had been to France, Tunisia and Tenerife several times.