The inspection visit took place on 18 May 2017 and was unannounced. We returned to speak with the provider on 01 June 2017, as they were out of the country at the time of our inspection.

The last comprehensive inspection of this service was carried out 06 February 2015, at which time we found the provider was meeting legal requirements.

During this inspection, we found the provider had continued to meet legal requirements and, as such showed consistent good practice.

Mr David Calwell – 6 Lord Street is a small home registered to provide care and accommodation for up to three persons who live with learning disabilities. The home is situated in a residential area of St Annes close to the sea front and within walking distance of a number of facilities and amenities. At the time of our inspection, three people were living at the home.

The provider understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they knew how to work within the law to support people who may lack capacity to make their own decisions. However, they had not recorded assessments of people’s capacity to make decisions. Additionally, decisions, which had been taken in people’s best interests, had not been recorded. We have made a recommendation about this.

We found the provider had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We looked at the recruitment of two staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed an induction and training programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Individual risk assessments had been completed for people who lived at the home. This helped to ensure risks had been identified and measures put in place to reduce risks to people’s safety and wellbeing.

The environment was maintained, clean and hygienic when we visited. We saw staff followed infection control guidelines.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were stored appropriately.

People’s nutritional needs were met by staff who knew their individual needs, likes and dislikes. People told us they were satisfied with the meals staff prepared for them.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

We found people had access to healthcare professionals and their healthcare needs had been met.

We observed staff supporting people with their care during the inspection visit. We saw they were kind, caring, patient and attentive.

The provider used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. The provider also spent time with each person who used the service every week. We found people were satisfied with the service they received.

We inspected 6 Lord Street on 06 February 2015. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. Lord Street is a home for up to three people with learning disabilities. The service is situated in a residential area in Lytham close by a trading site. Transport networks are nearby. The house is of a domestic nature with no specific aids and adaptations as people living there are independent.

People using the service are protected from abuse because the provider has taken steps to minimise the risk of abuse. Decisions relating to people’s care are taken in consultation with people using the service, their next of kin and other healthcare professionals. This ensures their rights are protected.

Staffing levels are determined according to people’s individual needs, and there is enough staff available at the service. We saw that extra staff are provided where people’s needs change and when they require extra support.

Staff receive training that is relevant when supporting the needs of people with learning disabilities. Staff are supported through good links with local community healthcare professionals. This ensures people receive effective care and support relating to their healthcare and social care needs.

There is a relaxed atmosphere at the home. People told us they enjoy living there and their relatives told us that staff are supportive and approachable. People are able to take part in activities that they enjoy and receive support from the staff if required.

Where people using the service lack capacity to understand or make certain decisions relating to their care and treatment, if appropriate, best interest meetings are held which involve family members, independent mental capacity advocates, and social workers.

We looked at the systems relating to medicines management and saw that the records relating to medicines are accurate and up to date. People are supported to receive the correct medicines at the right time. Staff working at the home receive appropriate training in medication administration.

This inspection was undertaken to review improvements the provider had made following the previous inspection undertaken on 9th July 2013. During that inspection the provider had been assessed as being non-compliant in the following two areas. Meeting nutritional needs. This was because the service was not always providing a balanced nutritional diet to people who lived there. Also, safety and suitability of premises. This was because water temperatures were not being regulated to ensure the safety of people who lived there. By not complying with regulations 14 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 meant the provider was in breach of those regulations.

The provider responded by sending the Care quality commission (CQC) an action plan of how they would address the findings from the previous inspection.

We spoke with the provider and a staff member. They told us the nutritional needs of people living at the service had been reviewed and changes made. They also told us they had taken steps to ensure water temperatures were being regulated so they were safe.

In order to demonstrate improvements the provider showed us records where nutrition had been reviewed and revised menus implemented. We were shown risk assessments to ensure people were protected from harm in respect of water temperatures.

We spoke with two people living at 6 Lord Street who told us how they enjoyed going out with key workers on a regular basis. One person living at the service worked in a voluntary position locally. They also told us they were kept busy doing things they liked to do. Comments included, “I’m going to work now, I like going to work”. Another person told us, “I like helping D….., he is taking me out today”.

People described the sort of things they had been involved in. It included, holidays, days out, activities in this home and an associated service. We could see evidence staff provided support and assistance to help people achieve their goals.

One person spoke with us about how their health was managed and the support they received from a range of healthcare professionals.

People had a choice of meals prepared in the home. They also told us they liked to go out for meals or get ‘takeaways’. Staff told us residents choice in meals were important. However, a recent recoding of a person weekly menu demonstrated meals were not always balanced.

People liked the environment they lived in they told us it was comfortable. One person showed us their own personal room. It included personal items which they had chosen to be part of their room.

Water temperatures were not being regulated safely which had the potential to put people at risk.

We visited this service on 28th June 2012. During the course of the inspection we spoke with both registered providers who were working that day and two people using the service. There were no additional staff members on duty.

The service could accommodate up to three people with learning disabilities. However at the time of the inspection two people were living at 6 Lord Street.

One of the people using the service spoke of how they liked living there. They told us, “Its great living here, look at my room, I like it.” They talked about how they liked being cared for by members of the staff team and gave examples of what they like to do and how the staff help them to do things. Examples of which were going out to events, such as football matches, shopping and eating out.

Some people using the service had limited communication. However, this did not stop the registered providers on duty from understanding them. We saw they listened to both service users and were able to communicate with them. This was because they had the knowledge and understanding of their needs. One of the providers told us, “Because we work in the house on a regular basis, we know everyone who uses the service and they know us.” We could see people who lived there responded to both providers in a relaxed way. We observed positive communication between them. An example of which included the recognition of how a service users body language was interpreted as them wanting to go out. This confirmed both providers could understand the needs of people using the service and were able to respond to them.

People using the service had limited communication, however, by making general observations we found people were satisfied with the care and support they receive. Staff were happy with the way they are supported, and they felt they worked well together as a team. “We work closely together”.