May Morning 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. CQC carried out an unannounced inspection of this service on 12 September 2018.

May Morning provides accommodation and personal care for up to eight people who have a learning disability, autistic spectrum disorder and some physical disabilities. The accommodation is accessible and appropriate to meet the needs of the people living in the service. At the time of our inspection there were seven people living at the service.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The values that underpin the guidance such as offering choice, promotion of independence and inclusion were evident in the support people received from staff so that they can live as ordinary a life as any citizen.

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.

At the last inspection on 31 May 2017 the service was overall rated as requires improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well led to at least good.

At this inspection we checked that the action plan for the previous inspection had been implemented. We found that the previous breaches regarding completion of health and safety checks, an accessible complaints procedure and the effectiveness of quality assurance systems had now been fully met, and we have rated the service as ‘Good’.

There were enough staff to support people’s needs. Risks to people had been assessed and measures implemented to reduce these. Peoples medicines were managed safely and only trained staff administered these. Their competency to do so was assessed at regular intervals. People’s health and wellbeing was monitored by staff who were proactive in referring people appropriately to GP’s or for specialist support from other health professionals. Guidance was in place to inform staff how to support people’s specific health conditions such as epilepsy and recognise signs of deterioration.

People had care plans in place which detailed their needs and wishes. Where known people’s end of life choices and wishes were recorded to inform staff who would implement these if the need arose.

Staff were trained to recognise and respond to suspicions of abuse, they understood their responsibilities to act on their concerns. Staff knew how to escalate their concerns to protect people from harm. Staff understood how to report and act upon accidents and incidents. These were analysed and informed the development of strategies to reduce risk and avoid recurrence where possible.

Staff recruitment files showed that satisfactory processes were in place for the recruitment and selection of all levels of staff. Staff received the training they needed to ensure they had the right knowledge and understanding of people’s needs. Staff said that they felt supported and listened to, communication within the service between all levels of staff was good. New staff said they had felt fully supported by existing staff members and that there was good teamwork. Staff were given opportunities to express their views through staff meetings and one to one meetings. However, the delivery of an annual staff appraisal system needed improvement.

People lived in a clean safe environment that was maintained to a good standard. Equipment for the detection of fires and electrical a

This inspection took place on the 31 May 2017 and was unannounced. May Morning provide accommodation and support for up to eight people who have a learning disability, autistic spectrum disorder and some mental health needs. The service is not accessible to people in wheelchairs. At the time of our inspection the service was full.

At the previous inspection on the 18 & 19 October 2017 we found eight breaches of our regulations, and an overall rating of requires improvement was given at that inspection. As there were recurrent breaches in respect of the recruitment of staff and quality monitoring we issued enforcement notices for the provider to take urgent action in these areas. We issued requirement notices for other breaches because the provider had failed to ensure that medicines were managed safely, that some risks were appropriately assessed or that guidance in respect of some health conditions was in place. Applications for Deprivation of liberty authorisations had not been pursued to ensure restrictions in place were authorised. People were not provided with an accessible version of the complaints procedure. Service inspection ratings were not displayed in the service or on the provider’s website. New staff were not provided with appropriate induction training and supervision to ensure they could fulfil their role competently. The provider sent us an action plan following this inspection to tell us how they would improve. At this inspection we found the provider had made enough progress to meet the two previous warning notices in respect of regulation 17 for a lack of effective quality monitoring and regulation 19 for significant shortfalls within recruitment documentation. Minor shortfalls remain in some areas of staff monitoring and recording and we have issued a new breach for regulation 17, this is to ensure progress in this area continues and is maintained. Progress to address a previous breach of regulation 16 in respect of complaints had not been fully covered by the actions taken within the service and this remains a continued breach of regulation 16.

The service had a new registered manager in post that had been in post for three months at the time of inspection. A registered manager is a person who is 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 registered manager was present throughout the inspection.

The service is a large detached house adjacent to another service May Lodge overseen by the same registered manager. People’s bedrooms were located on the ground and first floors, some bedrooms had en-suite facilities but the majority of people shared communal bathrooms and everyone shared living/dining room and kitchen facilities.

Although the new registered manager had been proactive in addressing many of the outstanding breaches, her influence on the service is still to embed. At the last inspection we highlighted that there was not an accessible complaints procedure for people in the service actions taken to address this had not been adequate to meet the needs of people in the service and this remains a breach.

Although the provider had taken action to address previous breaches and improve operational quality monitoring, improvements made were taking time to impact on the effectiveness of quality monitoring and there were still gaps in some of the safety checks made. We have issued a requirement notice for improvements to the quality monitoring system to be made.

Staffing was sufficient and flexible to meet people’s needs. New and existing staff had appropriate training and experience to support people well. Recruitment processes were in place to protect people and ensure staff employed were suitable for their roles. Staff felt supported a

The inspection was unannounced and took place on 18 & 19 October 2016. May Morning is a care home which provides care and support for up to eight people with learning disabilities or autistic spectrum disorder who may also have some behaviours that other people could find challenging. The service was full at the time of inspection and most people had lived there for a number of years. People have their own bedrooms with access to several communal areas and a garden. The service is located in a detached period house in its own grounds. It is adjacent to another service owned by the same provider. May Morning is not accessible to people who use wheelchairs. The service is set back from the road amongst residential housing and off street parking is available.

At our previous inspection of this service on 17 November 2015 we found the service was not meeting the required standards of quality, safety, protection from abuse and employment of suitable staff. There were breaches of regulations and we asked the provider to tell us what they were going to do to put the shortfalls right; they sent us action plans to tell us what they were doing and when this would be completed. This inspection was to assess whether the improvements they had told us about had been embedded and were now everyday practice.

A registered manager had not been in post since December 2015, although there was an on-going recruitment for this. A registered manager is a person who is 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.

Our inspection and feedback from relatives and care professionals indicated that whilst they felt that the day to day delivery of care people received from staff met their basic care needs, we found there were a number of areas where improvement was still needed, for example in regard to protecting peoples privacy and understanding and documenting better some peoples communication styles to inform staff engagement with them. Relatives said they were always made to feel welcome whenever they visited and that people were supported to maintain contact with the important people in their lives. Relatives said they felt they were kept informed about care and health issues.

The lack of oversight and settled management had meant that a number of important areas had lapsed or not been addressed at all including some of the previous breaches. The provider had not ensured that the previous inspection rating was visibly displayed in the service or on the provider’s service website. The inspection found that much of the operational knowledge for running the service had been invested in the previous registered manager, with the deputy manager having a fairly narrow role; the deputy manager was unaware of many of the tasks the previous manager undertook and as a consequence many of these areas had not been proceeded with for example there was a lack of awareness about previous action plans and what audits were undertaken to monitor service quality. Some information could not be found.

There were signs that incidents of abuse between people had reduced and staff were more alert to what would be considered abusive under safeguarding. Overall medicines were better managed and the previous shortfall had been adequately addressed, however, protocols for administering ‘as required’ medicines to people were generic and this could lead to inconsistency in the way these medicines were administered by different staff. There were enough staff to keep people safe but this was unsettled and supplemented each week by agency staff whilst recruitment was on-going to permanent posts. Recruitment documentation had deteriorated further and failed to demonstrate that all necessary checks were being undertaken before staf

We carried out this unannounced inspection on 17 November 2015. May Morning is a service for up to eight people with learning disabilities or autistic spectrum disorder who may also have some behaviours that other people could find challenging. The service was full at the time of inspection. People had their own bedrooms. The service was not accessible for people who needed to use a wheelchair or found stairs difficult. This service was last inspected on 13 September 2013 when we found the provider was meeting all the requirements of the legislation.

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.

Staff had been trained in how to protect people, but in every day practice there was a culture within the service of not reporting some incidents which they viewed as minor. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed, but their view of incidents could be compromised by their assessment of the significance of some incidents.

Improvements were needed to the recruitment procedures for new staff to ensure these protected people from the appointment of staff who were unsuitable.

Medicines were managed safely by trained staff, but minor improvement was needed to ensure unused out of date medicines kept in the fridge were also disposed of appropriately.

A range of quality audits were in place to help the registered manager and provider monitor the service, but these were not sufficiently in depth or effective and failed to highlight the issues found at inspection, or provide the provider with the assurance that a safe standard of care was being maintained. People’s relatives were routinely asked to comment about the service but were not informed about actions taken in response to their feedback.

Fire detection and alarm systems were maintained. Day staff knew how to protect people in the event of a fire as they had undertaken fire training and participated in fire drills. However, night staff were not routinely participating in fire drills to ensure they understood the actions to take to keep people safe.

Staff showed that they understood people’s individual styles of communication, and how they made their needs known. Staff used communication aids such as pictorial prompt cards with some people to help them with making independent decisions and choices. However, there was an absence of visible accessible information for people to read about everyday routines and events.

People were happy and comfortable in the presence of staff. Relatives told us they were kept informed and had been consulted about their family members care and treatment plans.

Staff monitored people’s health and wellbeing and supported them to access routine and

specialist health when this was needed. People ate a varied diet and were individually consulted about their personal food preferences to inform menu development.

People were given support to pursue their interests and hobbies. Each person had their own daily planner and this took account of their activity and interest preferences.

Risks were assessed, and risk reduction measures were developed and implemented to ensure people were kept safe; these were kept updated. Staff were provided with guidance to inform them about the actions to take in the event of emergency events so they knew who to contact and how to protect people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and had taken the appropriate steps to refer all the people living at the service who met the requirements for a DoLS authorisation. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

There were enough staff to meet people’s needs. Staff were provided with a wide range of essential and specialist training to help them understand and meet people’s needs. They received support through regular staff meetings and had opportunities to discuss their performance through one to one meetings and annual appraisals of their work performance.

People lived in a clean, well maintained environment. Decoration and furnishings were maintained to a high standard. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe.

We have made three recommendations:

The provider should liaise with the Fire service to determine the expected number of fire drills night staff should attend in any one year in accordance with the Regulatory Reform (Fire Safety) Order 2005.

The registered manager should review staffing to enable staff to meet together with her without the presence of people who need support.

The provider reviews current practice around the availability of visible and accessible information to people.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

People told us they were happy living at May Morning. We found that people had detailed care plans to ensure they were given the care and support they needed. Staff knew people well and records showed that they provided the care that people’s care plans said they needed. The service had ensured that the risks related to people’s anxiety and challenging behaviours had been assessed and that staff knew how to avoid the triggers for such behaviours. Staff had received the training and support they needed to care for people safely and effectively.

People knew how to make a compliant if they needed to and had a range of opportunities to talk about their care and share their views. Staff and the manager knew what they needed to do to keep people safe from abuse and how to report any concerns appropriately.

Six people were living at the home at the time of the inspection. Some people were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records and observed some of the support that people were given.

People were treated with respect and dignity. They were supported to make decisions about their day to day lives and things that were important to them. They could choose when to get up and go to bed, what to do and what to each day and staff respected their choices. People told us they liked their rooms and had chosen the colour schemes for them.

Staff understood people’s needs well and their individual preferred methods of communication. People had good relationships with staff and were comfortable spending time with them.

People were supported to be as independent as they could and to learn new skills. People could make their own meals if they chose and helped with their laundry and some household tasks.

There were enough staff on duty to support people safely and the organisation had processes and procedures in place to check on the quality of the service people received and to keep them safe.

People who use services told us or expressed that they felt safe and that they received the care and support they needed to remain well and healthy.

They said that they enjoyed attending clubs and going out into the community. One person said told us how they enjoyed going out for the day and that there was always something to look forward to. They said they helped with the shopping and were able to choose the menu.

People were involved in how the home ran from taking part in re-decorating to preparing their own breakfast and cooking meals.

During our visit we saw that staff treated people that use the service with respect. We saw that staff listened to people and took their views seriously and always answered their questions in a way that they could understand. We observed that the people were happy and relaxed. They were involved in planning their own care and how they preferred to be supported.