The inspection was carried out on 4 September 2018, and was unannounced.

Little Oyster Residential Home is a ‘care home’. 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.

Little Oyster Residential Home is a privately owned care home providing accommodation, personal care and support for up to 64 people with diverse and complex needs such as physical disabilities, acquired brain injury, learning disabilities, autism, downs syndrome and limited verbal communication abilities. At the time of our visit, 55 people who lived in the service were between the ages of 18 and 65 years.

At the last Care Quality Commission (CQC) inspection on 18 October 2016, the service was rated as Good. At this inspection, we found the service Requires Improvement.

Little Oyster was designed, built and registered before registering the right support. Therefore, the service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance.

Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this guidance and used other best practice to support people. They have applied the values under Registering the Right Support. 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.

There was a manager at the service. 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 and associated Regulations about how the service is run.

Medicines practice was not always safe. Medicines had not always been recorded and we found gaps on the MAR chart.

The registered manager had a quality audit in place. However, at the time we inspected, the scheduled monthly audit had not been carried out. The registered manager was not aware of some of the concerns we found during this inspection.

Staff received regular training. Although staff had not been provided with appropriate support and supervision as is necessary to enable them to carry out their duties, staff told us they had regular access to the registered manager and they would not hesitate to contact her if required.

People were protected from the risk of abuse at Little Oyster Residential Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People received the support they needed to access healthcare services.

There were enough staff to keep people safe. The registered manager had appropriate arrangements in place to ensure there were always enough staff on shift.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

People were supported to eat and drink enough to meet their needs.

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 service supported this practice.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people who mattered to them. Relatives and visitors were welcomed at the service at

The inspection was carried out on 18 October 2016, and was an unannounced inspection.

Little Oyster Residential Home is a privately owned care home providing accommodation, personal care and support for up to 64 people with diverse and complex needs such as learning disabilities, autism, downs syndrome and limited verbal communication abilities . At the time of our visit, 54 people who lived in the home were between the age of 18 and 65 year.

There was a registered manager at the home. 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.

At our previous inspection on 21 April 2015, we recommended that the provider seeks and follows the National Institute for Health and Care Excellence NICE guidance on managing medicines in care homes because medicines were not disposed off safely and medicines were not recorded in either medication administration records (MAR) sheet or home’s counting sheet when they came in. We also recommended that the provider and registered manager seek advice and guidance from a reputable source, about the user friendly and personalised communication standards. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

During this inspection, we found that medicines were stored, disposed and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the home.

The home had implemented and encouraged communication with people who use the service through the development of care files that included communication passports, which provided clear descriptions of how people communicate. Communication standard for people in the home such as using pictures, objects and signing with the people with communication impairments that live at Little Oyster had been implemented.

Little Oyster had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training at start of their employment.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People had access to nutritious food that met their needs. We observed that people freely made their cold and hot drinks when they wanted them. The provider had fitted a new accessible kitchen that promoted people’s independence in the home.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Our observation on the day showed that people had a variety of activities. Activities were diverse enough to meet people’s needs and the home was responsive to people’s activity needs.

People knew how to make a complaint and these were managed in accordance with the provider’s policy.

Staff were clear about their roles and responsib

The inspection took place on 21 April 2015, it was unannounced.

Little Oyster Residential Home is a privately owned care home providing accommodation, personal care and support for up to 64 people with diverse and complex needs such as learning disabilities, autism, downs syndrome and limited verbal communication abilities . At the time of our visit, 54 people who lived in the home were between the age of 18 and 65 year..

At our last inspection on 22 May 2014, we found that the provider was in breach of regulations relating to consent to care and treatment, safeguarding people from abuse, cleanliness and infection control, management of medicines, supporting workers, assessing and monitoring the quality of service provision and records. We requested the provider submit an action plan on how and when they planned to improve the service. The provider submitted an action plan to show how they planned to improve the service by December 2014. Following our inspection of 22 May 2014, Little Oysters management team was restructured and a new manager was recruited in September 2014.

The new manager was the registered manager at the home and was going through the process of registration with CQC at the time of our inspection. The registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Medicines were not disposed off safely. Medicines were not recorded in either medication administration records (MAR) sheet or home’s counting sheet when they came in. This meant that medicine were not safely audited and disposed of in the home, which could lead to medicine administration error to people who lived in the home. We have made a recommendation about this.

There were no specialist methods of communication for people. Easy to read information had not been developed for people to understand documentation such as the complaints procedure. The management and staff did not have adequate communication systems in place for people with learning disabilities who might have difficulties in communicating. We have made a recommendation about this.

The provider had ensured the quality of care had improved since our previous inspection. The new registered manager had created a strong staff team, committed to providing personalised care, in line with people’s needs and preferences. People living at the home and their visitors were complimentary about the quality of care.

People told us they felt safe. There were systems in place to protect people from abuse. The staff were aware of their roles and responsibilities in relation to protecting people from abuse. Relatives felt people were safe in the home and indicated that if they had any concerns they were confident these would be quickly addressed by the registered manager.

Staff were friendly, kind and compassionate, treating people with respect and dignity. People’s safety was promoted through individualised risk assessments and safe medicines administration. Arrangements were in place to check safe care and treatment procedures were undertaken to improve the quality of care provision.

Staff recruitment processes were robust. There were sufficient staff deployed to provide care and treatment and staff understood their roles and responsibilities to provide care in the way people wished. They were responsive to people’s specific needs and tailored care for each individual. Staff worked well as a team and were supported to develop their skills and acquire further qualifications.

Staff helped people to maintain their health and wellbeing by providing practical support. Staff were trained to deliver effective care, and followed advice from specialists and other professionals. This included training in caring for people with specific health conditions.

People’s health needs were looked after, and medical advice and treatment was sought promptly. Any concerns about people’s health were escalated appropriately to the GP.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Acts protect the human rights of people by ensuring that if there are any restrictions on a person’s freedom and

liberty, they have been appropriately assessed. Staff showed they had an understanding of the MCA 2005 and DoLS legislation.

People were supported to have choices and received food and drink at regular times throughout the day. People spoke positively about the choice and quality of food available.

People told us they were confident that if they had any concerns or complaints, they would be listened to and addressed quickly.

The provider had management systems to assess and monitor the quality of the home provided. This included gathering feedback from people, their relatives and health care professionals. However, these were not always effective in identifying areas that needed improvement that we noted during our inspection.

We visited the home on Thursday 22 May 2014. There were two inspectors and we visited to undertake a responsive inspection following on from information received from a whistle-blower and safeguarding concerns. We looked at records including care plans, staff files, policies and procedures. We spoke to people who lived at the home and also staff. We used all the information we gathered to answer the following five questions.

Is the service safe?

People we spoke with told us they felt safe, they told us that if they were concerned about anything they would speak to the manager or the staff. Safeguarding procedures were available however not all staff were clear on what constituted abuse or when they should be reporting suspicions to the manager. This increases the risk of harm to people and fails to ensure that all abuse whatever type is reported and investigated.

The service did not have robust infection control procedures in place, for example we saw that hand wash soap and hand gels were not available in all toilets, en-suite shower rooms, main bathrooms, laundry room and people's bedroom sinks. This would put people at risk of harm.

People’s health and care needs were assessed with them and there were evidence that they had been involved in writing their care plans. We found that some people were not aware of what was in their care plans. Some of the care plans did not have enough detail or risk assessments/management strategy of how to reduce people’s risks. Care plans were therefore not able to support staff consistently to meet people’s needs safely.

People’s mobility and other needs were taken into account in relation to the buildings adaptations, enabling people to move around freely and safely.

A visitor we spoke with confirmed that they were able to see relative in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people’s needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and sensitivity when supporting people. People commented, "I feel looked after here” another said “Meals are good, if you don’t like what they are offering they offer something else, not found anything I don’t like” and “The staff are very caring and everyone is well looked after here”.

The care plans were not always detailed and may not have shown people’s preferences, interests, aspirations and diverse needs were not fully recorded. However, care staff spoken with appeared to understand people’s individual needs and preferences and interests as well as their care and support needs

We did not find evidence that people had been involved in the preparation of their care plans, and we found plans had not been signed by the people who lived at the home or their representative to show consent. Some people spoken with did remember being part of the process, however others did not and some said they did not know what was in their care plan.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We spoke to a health professional who visits the home regularly and offers support to some of the people who lived there. The specialist nurse commented “I am very happy with the way people are looked after in the home. The staff are very good at referring any issues to us and they follow our instructions.” I think people are well cared for at Little Oyster”.

Staff explained that they have a number of health professionals they can speak with if they have concerns about individuals they included, the person’s GP, continuing care nurse, district nurse, and dentist.

Is the service well-led?

We found that the home did seek the views of people who lived in the home, their families and some health professionals. For example the home sent out a survey to people who lived in the home, families and health professionals who visit the home on a regular basis. They also had and they reviewed care plans with the person, their families and care manager normally twice a year.

Not all staff we spoke with had a good understanding of the whistleblowing policy but some were aware that the service had one. Staff had received training regarding safeguarding, however not all staff spoken with were clear about what constituted abuse.

The service has some quality audit systems in place; however we found shortfalls in their auditing. For example, there were not robust auditing systems covering Infection control, For example, medicine records were checked to ensure staff had signed for medication given. However the amount of medicines in stock did not tally with the number of medicines administered. This meant people were not receiving the medicines prescribed and the auditing system failed to recognise this short fall.

The service now worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to staff awareness of whistleblowing procedures.

We carried out this inspection visit to check that a compliance action the provider was given following our visit on 20 September 2013 had been completed.

We spoke with management staff, two senior staff and two care staff. Two Social Services’ care managers who were visiting the service on the day of the visit spoke positively about the care the service provided.

We looked at the staff induction programme and the staff training records. These included the staff training matrix and a separate record of staff training that had taken place since the last visit to the service on 20 September 2013.

We were told that a new member of the management team had been appointed and had started work at the home at the time of the inspection visit.

We found that since the last inspection visit on 20 September 2013, an induction programme had been implemented, and staff training had been updated.

A scheduled inspection was undertaken on 30 May 2013 and at that time the service was judged to be compliant with Outcomes 1, 4, 5, 7, 12, 14 and 17.

We carried out an inspection visit on 20 September 2013 in response to some concerns raised anonymously by a member of the public. The concerns were in relation to care and welfare of people, insufficient numbers of staff on duty at night time and inadequate staff training. In accordance with information sharing policies we contacted Social Services and discussed the concerns raised.

We visited the service unannounced and commenced the visit at 06.30 as this enabled us to speak with the night staff that were on duty. During the visit we spoke with the providers the general manager, members of staff and people that used the service. People told us that they were happy with the support they received, and that the staff looked after them well.

We found that there were enough qualified, skilled and experienced staff on duty at the time of the visit to meet the needs of the people that used the service.

Care records seen showed that the people were supported with their care in a way that was individual and in accordance with their wishes.

Mandatory training that included fire awareness, infection control and health and safety was not up to date for all staff. There was no thorough induction programme in place.

We found overall that the service was non-compliant with Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

During our inspection we spoke to people who used the service, relatives, a district nurse and staff. We found that care staff were appropriately recruited, trained and supervised so that they could meet people’s individual care needs. Care records seen showed that the people were supported with their care in a way that was individual and in accordance with their wishes.

People told us that they were happy with the support they received, and that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. People said they knew who to speak to should they have any concerns, but said they had no complaints.

We saw comments from relatives that included “Staff are welcoming and friendly, happy to answer any questions and deal with concerns as and when. Communication is good and regular updates given whilst keeping confidentiality. The level of care in my opinion has been of a good standard having residents' best interests as a central point at all times”, and “As always I was very impressed by your enthusiasm and efforts to improve the daily lives of your patients”.

All the people we spoke with said, or indicated, that they were happy living in the home and that their care needs were met. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own. The support that we saw being given to people matched what their care plan said they needed.

People seen sitting outside the entrance to the home commented on the position of the home overlooking the sea. One person said, 'I like to sit outside when the weather is good’.

We spoke to 20 of the people who used this service, some in private, some at lunchtime and some as we made a tour of the home. We also interacted with some people who were not able to express their views verbally but were able to show whether they were happy or not.

All the people we spoke with said, or indicated, that they were happy living in the home and that their care needs were met. Several people commented on the position of the home overlooking the sea. One person said, “I love to get out in the fresh air, I love the sunshine and feeling the wind”. Another person told us about the progress they had made since coming to the home. They said, “I’ve done well since I came here. They have helped me to lose weight and this has made my breathing better”. Another said, “They care for me very well. I have no complaints at all. They make my family welcome and you can’t fault the food”. One person was unable to tell us about the home but indicated that they were happy by giving us the thumbs up sign.