We carried out this announced inspection on 8 September 2018. The inspection was announced as this allowed the registered manager to prepare the people they supported at The Nak Centre, to know that an inspector would be visiting their home. With this knowledge they were then prepared and could choose if they wished to be involved in the inspection process. The last inspection took place in March 2016. The service was rated as Good.

The Nak Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The provider is also the registered manager. 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.

The care service has been developed and designed 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 and autism using the service can live as ordinary a life as any citizen.

The Nak Centre is a detached home which provides accommodation for up to six people. At the time of the inspection six people were living at The Nak Centre. People had lived at the service for several years and staff knew the people they supported well. The registered manager took an active role in the running of the service. They were supported by a core staff team who had worked at the service for some time.

People had limited verbal communication skills so we spent time observing their interactions with staff. The atmosphere at the Nak Centre was calm and friendly. Interactions between staff and people were kind, respectful and supportive. Relatives were positive about the care their family members received. Staff described to us how they worked to support people to make day to day choices and build on their independent living skills.

The premises were well maintained, pleasant and spacious. People's bedrooms had been decorated and furnished in line with their personal preferences. Risks associated with the environment had been identified and action taken to minimise them.

Staff said they were proud to work at The Nak Center and told us “This is our extended family.” People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

The service had suitable arrangements for the storage and disposal of medicines. Medicines were administered by staff who had been trained and assessed as competent to manage them safely.

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at the Nak Center. Staff were prompt at recognising if a person’s health needs had changed and sought appropriate medical advice promptly.

Staff had received appropriate training so that they could communicate with people in a meaningful way, for example use of pictures/photographs to support effective communication. The care plan identified the person’s communication needs and this was shared with other agencies when necessary.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

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We carried out an unannounced comprehensive inspection of this service on 17 February 2016 at which time a breach of legal requirements was identified. Care plans were not being regularly reviewed and contained information which was out of date and inaccurate. Some information was contradictory which meant it could be difficult to gain an accurate picture of people's support needs.

We carried out this focused inspection to check the provider was now meeting the legal requirements. The inspection took place on 7 June 2017 and was unannounced. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for the Nak Centre on our website at www.cqc.org.uk.

The Nak Centre provides care and accommodation for up to six people who have a learning disability. At the time of the inspection five people were living at 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care plans were up to date, accurate and gave a comprehensive picture of people's needs and preferences. There was a system in place to help ensure they were regularly reviewed and any changes in people's needs were clearly highlighted. Daily logs were completed regularly and the information was detailed and descriptive. Where necessary, people's health was monitored to help ensure any changes would be quickly recognised. We found the service was now meeting the requirements of the legislation.

People had access to a range of activities which were meaningful and appropriate to their needs. Activities took place both within the service and in the local community. People were supported to be involved in daily tasks such as laundry and other household chores according to their abilities.

We inspected the Nak Centre on 16 February 2016, the inspection was unannounced. The service was last inspected in April 2015, we had no concerns at that time.

The Nak Centre provides care and accommodation for up to six people who have a learning disability. At the time of the inspection five people were living at 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People had lived at the Nak Centre for several years and staff knew the people they supported well. The registered manager took an active role in the running of the service. They were supported by a core staff team who had worked at the service for some time. Staff told us they had worked with other agencies to improve the way they supported people. They were confident this had been a positive development for people who they said had been “empowered” by the changes.

People had limited verbal communication skills so we spent time observing people and their interactions with staff. The atmosphere at the Nak Centre was calm and friendly. Interactions between staff and people were kind and supportive. Staff described to us how they worked to support people to make day to day choices and build on their independent living skills.

The premises were well maintained, pleasant and spacious. People’s bedrooms had been decorated and furnished in line with their personal preferences. Risks associated with the environment had been identified and action taken to minimise them.

Care plans had not been updated for some time and some information was out of date or contradictory. We identified a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of suitably qualified staff to keep people safe. Recruitment practices helped ensure staff were fit and appropriate to work in the care sector. Staff received an induction when they first started work which included training in areas identified as necessary for the service. This included training in safeguarding and staff knew how to recognise and report abuse. They were confident the registered manager would take any concerns they had seriously.

People took part in a range of activities such as riding, attending local day centres and regular trips out to cafes and restaurants. In addition external health care workers often visited the service to facilitate sessions such as drumming, creative art and aromatherapy massages. People were supported to be involved in daily tasks for example, laundry and preparing meals, according to their abilities.

We carried out an unannounced comprehensive inspection of this service on 2 December 2014. A breach of legal requirements was identified. This was because there were no suitable arrangements in place for acting in accordance with the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. This meant the delivery of care may have been unlawful. We carried out a focused inspection on 22 April 2015 to check if the provider had taken steps to ensure people’s liberty was not being restricted unlawfully.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for the Nak Centre on our website at www.cqc.org.uk.

The Nak Centre is a care home that is registered to provide care and accommodation for up to six people with a learning disability. At the time of the inspection five people were living at the service.

The service had a registered manager in place. 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 focused inspection we found the provider had taken steps to ensure the service was acting within the requirements of the MCA and DoLS. Mental capacity assessments were carried out to establish whether people had the capacity to make specific decisions about their care and support. Where people were found to lack capacity best interest meetings were held with relevant professionals to make decisions on the person’s behalf.

Applications for authorisations to deprive people of their liberty in order to keep them safe had been made. The service was awaiting the outcomes of the applications.

We inspected the Nak Centre on 2 December 2014, the inspection was unannounced.

At the last inspection we had concerns regarding record keeping at the home. We identified failings in the recording of people’s finances as well as health monitoring records and care records.

The Nak Centre is a care home that is registered to provide care and accommodation for up to six people with a learning disability. At the time of the inspection five people were living at the home.

The home has a registered manager in place. 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.

On the day of the inspection there was a pleasant and friendly atmosphere at the Nak Centre. People were engaged in a range of activities and all except one spent some of the day elsewhere. Interactions between staff and people were relaxed and warm. Staff were caring and supportive and encouraged people to carry out day to day living tasks. We saw there were sufficient numbers of staff to meet people’s needs.

At previous inspections we had concerns regarding the management of people’s finances. We found the systems in place at this inspection were greatly improved. The records we checked were largely accurate although we did identify two small discrepancies. The registered manager was able to account for these mistakes and corrected them.

Care records were reviewed regularly and daily notes provided an accurate account of how people spent their time. Health monitoring charts were updated appropriately.

Staff had received training in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. The registered manager had not applied for any DoLS authorisations although they were aware of the need to do this. This meant the delivery of care may have been unlawful. You can see what action we have asked the provider to take at the back of this report.

There was no formal system in place to gather the views of people in respect of the care and support they received. The registered manger told us this was done informally but this had not been recorded.

People had access to a wide range of activities both in and outside of the home. Activities were meaningful and reflected people’s interests and preferences. Care plans contained information regarding people’s likes and dislikes as well as background information pertaining to people’s early lives.

Staff felt well supported and told us the registered manager was available at all times. External professionals connected with the service said they believed the home had improved within the last year. One commented; “Staff promote opportunities and independence.” Another said, “There’s been a clear improvement and it sounds like things have been sustained.”

We did not speak to the people who lived at the Nak Centre due to their complex communication needs. We spoke with the registered provider and two members of staff.

This inspection was completed to check compliance with the warning notice issued by the Care Quality Commission on the 9th January 2014. We issued the warning notice due to concerns about the lack of effective quality assurance systems in place at the Nak Centre.

At this inspection we found the Nak Centre had made some improvements to the way in which the quality of the service was monitored and audited.

We found staff had received training to enable them to support people to a good standard. Supervision was occurring although this was not always documented.

We found records were not always maintained to a high enough standard to ensure people who used the service and staff were protected from risk. We will check again within six months to ensure improvements have continued.

This inspection was completed to check compliance with the warning notice the Care Quality Commission issued on 9 September 2013. We issued the warning notice due to concerns about the management of the finances of people who used the service.

At this inspection we still had significant concerns about how the registered provider looked after people’s finances. For example in most cases the totals of money held, did not tally with records kept. We were also concerned about the arrangements in place regarding the management of government social security financial benefits.

We have reported our concerns to Cornwall Council, who, at the time of the inspection, were co-ordinating a systemic safeguarding review regarding the service. As a consequence of our findings, we decided to extend the deadline of the warning notice for it to be complied with by 29th November 2013. After this date, we will check again to ascertain it has been complied with.

This inspection was completed due to concerns found at our scheduled inspection completed on 1 August 2013. At the previous inspection we had significant concerns regarding the management service user finances. We had been unable to inspect all monies belonging to people who used the services, and their financial records. This was because the registered provider told us she did not have the key to access them. This inspection was subsequently completed, with 24 hours’ notice so we could ensure we could access all monies and related records.

The inspection resulted in significant concerns relating to the management of monies belonging to people who used the service. In summary financial records made it difficult to account for monies people should have received. It was difficult or impossible to account for how people’s monies were spent. There were significant discrepancies between the balances in financial records and cash held.

On the day of the inspection five people with a learning disability, some who were autistic, lived at the home. Most people had very limited or did not have any verbal communication skills. We used our ‘Short Observational tool For Inspection’ (SOFI) tool to observe care. Over a period of one hour we recorded every five minutes the interactions between staff and people who used the service, the activities people were engaged in, and noted people’s moods.

During the inspection we were satisfied people were adequately cared for and treated in a respectful manner although we had some concerns whether there were enough activities available for people. The registered provider was currently in the process of rewriting care plans. We were concerned about the management of people’s finances and have discussed these concerns with the local authority.

When we inspected the home it was well maintained, was clean and odour free. Health and safety standards were adequate, although some improvements were required.

Staffing levels were adequate although we were concerned whether they were sufficient to give satisfactory flexibility if people’s needs changed and /or people wanted to go out in the evening. Most staff personnel files contained satisfactory information to confirm appropriate staff recruitment checks had been completed. Training records contained limited information and improvement was required in this area. There was no quality assurance system in place.

This inspection was completed to check compliance with two warning notices issued on 2 April 2013. The warning notices were due to concerns the Care Quality Commission (CQC) had about the registered provider not ensuring satisfactory standards were provided about respecting and involving people who used the service, and not making satisfactory arrangements to ensure the health and welfare of people who used the service.

The home accommodated six people with a learning disability, some who were autistic. Most people did not have verbal communication skills, although we spoke with one person who said they were happy with the care and support they received.

The inspection was carried out over two days in order to observe care in the evening and during the day time. On both occasions we used our ‘Short Observational tool For Inspection’ (SOFI) tool to observe care. The care we observed was generally to a satisfactory standard. We concluded the four people we case tracked had satisfactory activities. Each person had a care plan, but these did not effectively describe people’s care needs.

The home accommodated six people with a learning disability, some of whom had additional care needs. (such as being on the autistic spectrum)

We inspected the home on a Saturday. Most people did not have verbal communication skills. Two people had some verbal communication skills and said they were happy, and that the food and the staff were nice.

We used our ‘Short Observational tool For Inspection’ (SOFI) tool to observe care. During a period of one hour and ten minutes we recorded every five minutes the interactions between staff and people who used the service, the activities people were engaged in, and noted people’s moods. We had significant concerns about how staff worked with people.

We concluded care plans and records did not describe people’s care needs, and records kept by staff caused us significant concern regarding care provided.

We checked the service’s medication system. This operated well and suitable records were kept.

When we inspected the home it was well maintained and furnished. The home had pleasant gardens, in a rural setting. The home was clean and odour free. We had concerns about health and safety standards.

Staffing levels were satisfactory. We had significant concerns regarding the conduct of the staff. We subsequently used safeguarding procedures to report our concerns to the local authority. We were not able to check staff recruitment and training records as these were not available for inspection.

The home accommodated up to six people with a learning disability, some of whom were autistic. On the day of the inspection five people were resident at the home.

Most people living at the home had very limited, or did not have any, verbal communication skills. We spent two hours in the lounge observing care practice whilst we were inspecting records.

From our observation of care practice, and from the feedback we have received from external professionals, we have judged there has been significant improvement in care practice within the home. We observed, and have been told by external professionals, that people who used the service were treated with respect and dignity. External professionals and our observations have concluded that, at the time of our inspection, there was more involvement of people who used the service both within the home and in the community than we previously saw. There was limited improvement in the management of the financial benefits and monies of people who used the service, although we still had significant concerns regarding how the personal monies system operated.

The home was well maintained and furnished. The home was situated in a rural setting and had pleasant gardens. The home was clean and odour free. Health and safety standards needed improvement to comply with the regulations.

Staffing levels were adequate. Staff training and supervision arrangements were not satisfactory.

The quality assurance system was not satisfactory. Despite significant involvement from the multi-disciplinary team, the registered provider had not developed any systems of audit or improvement planning.