What life is like for people using this service:

We found improvements were needed in two main areas. New staff were not recruited using robust processes to make sure they were suitable to work with the people living in the service who needed care. We made a recommendation to the provider as they could not provide the evidence that staff had completed all the necessary training to be able to carry out their role safely and effectively. The provider was aware of their responsibilities and confirmed they would make sure they improved these areas.

People received care and support based on their needs and preferences. Staff were aware of people's life history, their likes, dislikes and interests and they used this information to develop positive relationships to deliver person centred care.

People enjoyed a range of activities that met their individual choices and interests. They felt a part of their local community and were supported to use local resources to their advantage. Staff

understood the importance of this for people and provided the support people required while promoting and maintaining independence. This enabled people to achieve positive outcomes and promoted a good quality of life.

People were involved in the running of the service and were consulted on key issues that may affect them. They told us they felt safe and were clear who they would speak to if this changed. Promoting independence was a key theme of the support planned and provided.

Staff were supported in their role providing care and support to people through regular one to one supervision meetings, performance appraisals and team meetings.

The provider was using a quality assurance system that they felt met their needs to check the safety and quality of the service. However, this had not picked up the recruitment and training issues we noted. This was in part due to the move to using an electronic based system of recording and storing documents and information.

More information is in detailed findings below.

Rating at last inspection:

Good (Report published 20 September 2016)

About the service: Mrs Della Averley – 14 Phoenix Road is a residential care home that accommodates up to four people living with a learning disability. At the time of our inspection there were two people living at the service. The care service is in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen - ‘Registering the Right Support' CQC policy.

Why we inspected: This was a planned inspection based on the previous rating. We found the service needed to make improvements to recruitment procedures and staff training which means the rating is now Requires Improvement.

Follow up: Following this report being published we will discuss with the provider how they will make changes to ensure the rating of the service improves to at least Good. We will revisit the service in the future to check if improvements have been made.

The inspection took place over two days, on 14 and 15 June 2016. The inspection was unannounced.

14 Phoenix Road is a three bedroomed terraced property in a quiet area, with a small well kept garden area and garden furniture to sit on. This small service provides personal care, accommodation and support for up to three adults who have varied learning needs.

It is a privately owned service and the provider of the service was the registered person. 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 20 January and 4 February 2015, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches were in relation to the recording of information in people’s records about their care and treatment including the management of the regulated activity and a lack of effective systems to monitor the quality and safety of the service. The registered provider sent us an action plan telling us how they were going to make changes to improve the service.

At this inspection we found that the registered provider had taken action to address the breaches from the previous inspection and had made many improvements to the service provided.

People told us they felt safe at Phoenix Road and would feel able to speak to staff if they were concerned. Risks the individual may encounter were identified and plans put in place to minimise these without compromising people’s rights to maintain their independence. Staff had a good understanding of their responsibilities in keeping people safe.

The property was a bit tired looking but clean and comfortable. The environment had been assessed for risks and measures put in place to manage them to keep people and staff safe. All the relevant maintenance and servicing of the property and equipment was undertaken regularly and records kept.

The registered provider followed robust processes when recruiting new staff to make sure they were suitable to work with people. Staff induction was thorough with time given so new staff could get to know people well. Staff had all the necessary training to be able to carry out their role. The registered provider had invested in additional training tools to provide extra training. There were enough staff to support people with their assessed needs.

People were supported well to maintain their physical health and mental wellbeing. Staff had built good relationships with health care professionals, supporting people to have confidence. People had a choice of foods and although menus were planned, these were based around individual’s likes and dislikes.

The home had a caring and supportive atmosphere where staff clearly knew people well. People were comfortable with staff, chatting openly and asking questions. People were treated as individuals and had the opportunity to have plenty of one to one time with staff throughout the day. People were supported to make their own choices and decisions on a day to day basis. Mental capacity assessments had been carried out and records kept, making sure people’s rights were respected and acted upon.

Care plans described the care people required in the way they wanted. People told staff if they wanted to do things differently and this was respected. Care plans were reviewed regularly to make sure they continued to be relevant and up to date.

People had lots of activities and chose what they wanted to do. People went out most days to take part in individual pursuits. Socialising as a group outside of the home was also a regular occurrence. People had the opportunity to go on holiday every year and were fully involved in the decision making about where to go.

As well as being able to give their views on a daily basis, the provider asked people what they thought of the service through a questionnaire. People’s relatives were also asked their

This inspection was carried out by two adult social care inspectors following information of concern which had been received. During the inspection, the inspectors considered five key questions; is the service safe, effective, caring, responsive and well-led?

The inspectors spoke with the service provider, three members of staff, two people who used the service and a volunteer. The inspectors reviewed daily care records, care plans and risk assessments and other records in relation to the management of the home. The inspectors also made observations around the home. Following the inspection, the service provider sent additional records to the inspectors as they had been unavailable at the time of our inspection. The inspectors also spoke with other professionals who were also responsible for the welfare of the people who used the service.

Below is a summary of what we found. The summary describes what people using the service, staff and health and social care professionals told us, what we observed and the records we looked at.

Is the service safe?

There were not enough staff on duty to meet the needs of the people living at the home. There were only two permanent members of staff employed by the home and agency staff were used to cover shifts that permanent staff were unable to work.

Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the service provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well.

Staff had not received training since they had worked at the home. This included basic health and safety training as well as specialised training to meet the needs of the people living at the home.

Is the service caring?

People who used the service had been assessed to see what their level of independence was for carrying out daily tasks such as laying the table and making their bed. We observed them throughout the day and saw that they helped out around the home.

People we spoke with were able to express their preferences to us about activities that they liked to take part in. We found that although they had regular activities planned, they were not always able to attend them due to staffing shortages.

We made observations of staff interaction throughout our inspection and found that one member of staff did not initiate much interaction with people and spent most of their time carrying out cleaning duties.

Is the service responsive?

We found that people did not always receive the care and support that they needed as the service provider had not always adequately engaged with other providers who were involved in providing care and support to people who used the service.

Is the service well-led?

There were not appropriate management processes in place to adequately assess and monitor the quality of the service that people received. Staff and service user meetings had not taken place for four months and staff did not receive regular supervision in order to express their views and make improvements to how the service was run.

The three people that lived at the home had lived there for many years. The provider of the service was not present at the visit, and the inspection process was assisted by two members of staff.

People had limited understanding and therefore were not able to tell us fully about their experiences. It was noted that people interacted with staff who they were familiar with and people appeared happy and contented.

The staff supporting the people who used the service knew what support they needed and we saw that the support being given to people matched what their care plan said they needed. There were risk assessments that met individual needs and provided good guidance to staff to minimise potential risks.

Medications were handled appropriately and people who used the service had their medicines in a safe way.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Records were kept securely and could always be located promptly when needed.

The people that use the service at 14 Phoenix Road have learning difficulties and therefore not everyone was able to tell us about their experiences.

The staff supporting people that use services 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.

We carried out this inspection over two days on 20 January and 4 February 2015, it was unannounced.

14 Phoenix Road is a three bedroomed terraced property, with a small garden area. This small service provides personal care, accommodation and support for up to three adults who have varied learning needs.

It is a privately owned service and the registered provider is in day to day control of the service. A registered person has 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 in September 2014, we asked the registered provider to take action to make improvements in a number of areas. These included making improvements for people to be able to go to their chosen activities; staff recruitment procedures; staff training; staff support and supervision; making sure people were safe from abuse; cooperating with other professionals; and accurate record keeping on how the quality of the service was monitored. The registered provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. Changes had been made, but further improvement is required.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not protected against risks of inappropriate or unsafe care and treatment; as quality assurance systems were not effective in recognising shortfalls in the service. Policies and procedures were not up to date. The registered person had not ensured that records were available and up to date in relation to the management of the regulated activity. You can see what action we told the registered provider to take at the back of the full version of this report.

The registered provider showed no evidence that the fire detection and alarm systems were regularly maintained. Therefore people may not be living in a safe environment. We have made a recommendation to seek advice from a suitably qualified person in relation to the maintenance of the fire detection and alarm system.

Medicines were managed and administered safely. People received their medicines on time. We have made a recommendation related to the recording of one person’s medicines.

The registered provider did not use an effective system to make sure that there were always enough staff to safely meet people’s needs. We have made a recommendation relating to providing enough staff.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered provider and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

One person living at the service had been appropriately assessed regarding their mental capacity to make certain decisions. A ‘best interest’ meeting had taken place involving people’s next of kin, and health and social care professionals for making specific decisions about their care and welfare. It had been assessed that the person was able to manage their own finances.

Staff had been trained in how to protect people from harm and abuse. Discussions with staff confirmed that they knew the action to take in the event of any suspicion of abuse. Staff were confident they could raise any concerns with the registered provider or outside agencies if this was needed.

People and their relatives told us that they were involved in care planning, and that staff supported them in making arrangements to meet their health needs. Care plans were amended to show any changes, and care plans were routinely reviewed. Staff spoke with people in a caring way and supported people to do what they wanted to do. People were supported in having a well-balanced diet and menus offered variety and choice.

Staff knew about people’s individual lifestyles, and supported them in retaining their independence. People were given individual support to carry out their hobbies and interests, such as bowling and swimming. However, individual support to attend activities was dependent upon there being sufficient staff on duty. People said that the staff were kind and caring and treated them with dignity and respect. Assessments identified people’s specific needs, and showed how risks could be minimised.

Staff files contained the required recruitment information. New staff followed an online induction programme. They worked alongside other staff until they felt confident to work on their own, and were assessed as able to do so. There were systems in place for on-going staff training; and for staff supervision and support.

There were systems in place to obtain people’s views. These included formal and informal meetings and daily contact with the registered provider and staff.

People were listened to and relatives said they were happy with the way the service was run.

We recommend that the registered provider seeks advice in relation to the maintenance of the fire detection and alarm system from a suitably qualified person.

We recommend that the registered provider follows the guidance from the Royal Pharmaceutical Society for the “Administration of Medicines in Care Homes” or equivalent best practice guidance.

We recommend that the registered provider seeks and follows guidance relating to the effective operation of a system to provide adequate staff to meet people’s needs at all times.