This inspection took place on 31 January 2017 and was unannounced. At the last inspection on 18 May 2016 we asked the provider to take action to make improvements to the way they monitored the quality of the service, and this action has been partially completed.

Langston Care Limited - 37 Hill Top View is registered to provide personal care for up to three people who present with varying levels of learning disabilities. There were three people living at the home when we inspected.

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 needed to improve the way they monitored the quality of the service they were providing. Action was required to ensure audits identified where improvements needed to be made.

People were kept safe from harm because staff understood their responsibility to protect them from abuse and poor care. People’s risks were assessed and staff were provided with management plans to support people in the least restrictive manner. Staff maintained a consistent approach to support people when they became anxious or presented with behaviours that challenged their safety. There were processes in place to ensure staff were suitable to work with people in a caring environment.

Staff had access to training to improve their knowledge of care and enhance their skills. Staff sought people’s consent before providing care and supported people when they needed help with their decision making. People received their medicines as needed and staff had recorded them accurately. People were provided with meals that met their individual needs. The advice of specialist healthcare professionals was sought whenever necessary to maintain people’s health and wellbeing.

People received kind and compassionate care. Staff supported people to maintain their dignity, independence and privacy. Staff gained information about what was important to people so that they could provide care which met their preferences. People were encouraged to try new activities and staff recorded what they did or did not enjoy to ensure what they did met their preferences.

Relatives and visiting healthcare professionals were given the opportunity to share their views of the service. Staff felt supported and were provided with updates through a regular meeting schedule.

We inspected this service on 18 May 2016. The inspection was unannounced and undertaken by one inspector. At our last inspection on 9 July 2014 the provider was meeting the legal requirements we inspected.

37 Hill Top View is registered to provide personal care for up to three people who present with varying levels of learning disabilities. There were three people living in the home when we inspected.

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 did not have an audit programme in place to monitor the quality of care they provided to bring about improvements when necessary.

Staff knew how to recognise abuse and the actions they should take to report their concerns. People risks had been assessed and there were plans in place to ensure risks were managed. Medicines were stored and managed safely and people were supported to take their prescribed treatments.

Staff understood and respected people’s needs and provided kind and supportive care in their home environment. Staff reflected people’s wishes and preferences in the way they delivered care. Staff understood how to support people who did not have the capacity to make their own decisions. People were offered a varied and nutritious diet and received support when they needed specific nutritional assistance.

People were encouraged and supported to engage in activities and outings that gave them an opportunity to socialise. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health and wellbeing whenever necessary. People were supported to maintain the relationships which were important to them.

There were suitable recruitment practices to ensure that the staff employed were suitable to work with people. Staff received training and support to deliver a good quality of care to people and a training programme was in place to address identified training needs.

This visit to 37 Hill Top View was an unannounced inspection. At the time of our visit three people were using the service.

Below is a summary of our finding based on our observations, speaking to people who used the service, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask:-

Is the service safe?

In general we saw that risk assessments were in place where risks had been identified, with plans of action to inform staff how risks could be minimised. However one person did not have a risk assessment in place regarding a particular moving and handling manoeuvre. This meant that the risks regarding this had not been recorded to ensure that any actions required had been put in place to minimise the risks identified.Following our visit the provider sent us evidence to show that this was now in place.

Sufficient numbers of qualified staff were available to meet people’s needs.

Is the service effective?

Although in general the care provided corresponded with information in care records, not all care plans and risk assessments reflected the care that people received. This meant that this person’s records did not accurately reflect the level of support needed.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection. People appeared comfortable with the staff that supported them.

Is the service responsive?

People's health and care needs were addressed promptly and referrals made to relevant health professionals as required.

People’s preferred routines were followed to promote personalised care and support.

Is the service well-led?

The home has been without a registered manager since January 2014. The acting manager advised us that she was in the process of applying for registration.

Staff told us that they received the support needed to undertake their job and told us that the acting manager was approachable and available to them when needed.

We inspected 37 Hill Top View on a planned unannounced inspection which meant the service did not know we were coming. We spoke with people who used the service, their relatives, staff, the provider and new manager during the inspection. There were three people using the service at the time of our inspection.

In this report the name of a registered manager appears. They were not in post and not managing the regulated activities at this service at the time of the inspection. Their name appears because they were still a Registered manager on our register at the time. The provider told us that recruitment to the manager post was underway.

We found that people who used the service were respected and were involved in how their service was run.

We saw that people’s care and welfare needs were being met. A relative told us: “I’ve got a good relationship with the home, I’m happy with the care the girls give”.

We found that the service had systems in place to manage people’s medication safely.

The service followed the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure and representatives of people who used the service knew how to make a complaint.

When we visited 37 Hill Top View we found that there were three people living in the home. Due to the complex needs of the people that lived in the home we were unable to get their verbal opinions about their day to day lives. To help us understand if people were happy, comfortable and relaxed in their environment we observed their care and looked at the interaction between them and care staff.

We read comments made by family members in questionnaires sent out by the manager to gain people’s opinions on the services they received. We saw that people made positive comments about the services. One person commented, “’B’ obviously looks very happy we are extremely grateful to all the staff that care for her”. Another person said “Staff are very pleasant and very caring and attentive at all times”.

We were able to read one person’s diary. The daily entries in the diary were written with the support of the person’s care worker. The information in the diary provided us with details of how people spent their day to day lives.

We found that staff understood people’s individual and personal needs. Staff showed that they knew how people communicated their needs. Staff said they had received training to help them understand how to meet the needs of people in their care. We saw that staff treated people kindly and respectfully.

We read documents that showed that the provider regularly audited the service people received at 37 Hill Top View.