This inspection was unannounced and carried out on the 14 February 2017. Mythe End House (Registered care home) is a residential care home providing individualised support for up to six people with a learning disability or an autistic spectrum disorder. At the time of the inspection five people were using the service.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. Medicines were managed safely.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS). Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. Relatives said the management team were approachable.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they liked to be supported. People were supported with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people's needs. Care plans were person centred to provide consistent, high quality care and support. People who were using the service and their relatives were able to raise concerns and were listened to.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the registered manager.

Due to the complex communication needs of people living at the service we looked at a ‘Gloucestershire Voices’ report from June 2016, which gave people and relatives views on the service. People who live at Mythe End House gave lots of feedback and answered many questions about the care and support they receive.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 October 2014 at which a breach of legal requirements was found. This was because the registered person had not notified the Commission without delay of incidents reported to or investigated by the police.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 3 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Mythe End House (Registered Care Home)’ on our website at www.cqc.org.uk.

Mythe End House is a care home providing accommodation and personal care for up to six adults with a learning disability or an autistic spectrum condition. The people living at the home have a range of support needs. Some people cannot communicate verbally and need help with personal care and moving about. Other people are physically able but need support if they become confused on anxious. Staff support was provided at the home at all times and most people required the support of one or more staff away from the home.

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 and associated Regulations about how the service is run.

At our focused inspection on 3 July 2015 we found the provider had followed the action plan which they had told us would be completed by 2 February 2015 and legal requirements had been met. Notifications of significant events were being shared with us in line with the requirements of the law. The registered manager demonstrated she knew when a notification was required. The provider was auditing the submission of notifications to make sure the registered manager was complying with the law.

This inspection was planned to review two outcomes that were previously non compliant; the administration of medicines and maintenance of the premises. We also used the inspection to follow up information of concern relating to staff support and medicines administration. We spoke with staff, looked at care records, observed how staff interacted with people and spoke with people about general topics.

We found the recording of medicines administration had improved. Ongoing compliance with the provider's medicines policy was being monitored using regular internal audits. We found that creams and liquids were now being dated on opening to prevent them being used past their disposal date.

We discussed a possible medicines error that had been shared with us prior to the visit with the registered manager. The registered manager said she would investigate the event and report back to us.

The building had been redecorated and maintenance completed following our last inspection. People now had a safe and pleasant place to live. We checked that each of the specific concerns we identified had been addressed. Staff were positive about the changes.

We also spoke with staff about a concern raised with us that staff feedback on colleague performance issues was not being listened to. The staff we spoke with did not agree with this and felt well supported. The registered manager said she would investigate this concern further following our inspection.

We spoke with one person living at the home and observed the support provided for three other people. We also spoke with a relative and two professionals involved in the care of people living at the home.

We found that care plans were person centred and appropriately detailed. Staff seemed familiar with the content of the plans. One person told us “new staff come and read about our behaviour and what we like and don’t like”. The person and relative we spoke with seemed happy with the care being provided.

We had concerns about the maintenance of the building. Apart from aesthetic issues, some bathrooms were not clean and there were unaddressed risks, such as exposed wiring. We also had concerns about the recording and quality management of medication administration.

We found that appropriate checks were made on staff prior to them starting employment. We spoke with two community nurses who both felt that staff would benefit from a better understanding of the people's needs. This would allow them to support the people more effectively.

Quality monitoring followed a robust structure. It was working well apart from in relation to maintenance and medication. A relative felt well communicated with and told us “I get the updates I need”.

We undertook a follow-up inspection to ensure that the provider had taken the actions detailed in their action plan following our last inspection on 23rd November 2012. The provider had told us that they had improved the system for recording training and for monitoring quality.

At this inspection we were able to verify that the identified actions had been undertaken. The provider had implemented a robust system to monitor the ongoing training needs of staff. They had also developed an effective system for identifying areas for service improvement. The system allowed us to track the improvements that had been implemented and identify what was ongoing.

We did not speak to any of the people living at the home about the training and quality management systems. We did, however, observe ongoing positive interactions between people and the staff supporting them.

We used a number of methods to help us understand the experiences of people using the service because people had complex needs so they were not able to tell us their experiences. We spoke with four staff, reviewed three people's care records and observed care.

During the inspection, we observed care that was in accordance with the care plans for each person. Staff interacted well with people living at the home. We saw evidence that as people's care needs changed, the planning documentation was updated.

We were able to see from care records and meeting minutes that people were given choices about their diet and activities. The activities were varied and people were encouraged to be as independent as possible.

One person was able to tell us that they felt safe at the home and could talk to staff about any concerns. Staff had received training to help them keep people safe and knew when to report concerns.

We saw evidence of good training availability and staff told us that support from the manager and supervision had improved. The primary training record was not robust enough to safely monitor training needs.

The general environment of the home was good but we did notice some issues that needed to be addressed. Staff told us that some maintenance can be slow. We did not see a quality assessment system in place that could demonstrate adequate assessment and monitoring of required improvements. There was also limited evidence available of feedback on quality.

This inspection took place on 14 and 15 October 2014 and was unannounced.

Mythe End House is a care home providing accommodation and personal care for up to six adults with a learning disability or an autistic spectrum condition. Some people were new to the service whilst others had been there for a number of years. The people living at the home had a range of support needs. Some people could not communicate verbally and needed help with personal care and moving about. Other people were physically able but needed support when they became confused on anxious. Staff support was provided at the home at all times and most people required the support of one or more staff away from the home.

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 and associated Regulations about how the service is run.

We had not received relevant notifications from the service. Services tell us about important events relating to the service they provide using a notification. This was a breach of our regulations. You can see what action we told the provider to take at the back of the full version of this report.

People using the service, relatives, local authority commissioners, an occupational therapist and a speech and language therapist told us they were happy with the care provided. The registered manager led by example to provide a service which was tailored to each person’s individual needs and preferences. As part of this, a balance was achieved between keeping people safe and supporting them to make choices and develop their independence.

Health and social care professionals and relatives told us about improvements to the service over the last 12 months. People’s needs, such as health, nutrition and personal care, were being met. The focus was now on improving people’s activity levels and helping them work towards their personal goals. Staff were not yet recording the progress people were making against goals they were working towards consistently enough. This risked staff not being able to support people to work towards their chosen goals as effectively as possible.

Staff felt well supported and had the training they needed to provide personalised support to each person. Staff were now meeting with their line manager to discuss problems and we could see action was taken when concerns were raised. These meetings had only recently started taking place regularly. When things did not go well, staff reviewed the situation and learned for the future. The recording of actions following an incident was, however, not robust. This could make checking actions had been completed difficult and result in actions not being taken.