This comprehensive inspection took place on 14 August 2017. At our previous inspection in March 2016, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated overall Requires Improvement. The breaches related to the provider not having sufficient systems in place for the safe management of medicines. People’s care plans did not have specific risk assessments in place and guidance was not available to staff about how to minimise risks in order to keep people safe.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements which had been signed by the registered manager as completed on 13 June 2016.

At this inspection, we found the provider had made the required improvements as outlined in their action plan. The service was now compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Neave Crescent is registered to accommodate ten people with profound and multiple learning and physical disabilities. People are accommodated in two adjacent bungalows which are purpose built. At the time of our inspection, the service was providing care and support to nine people.

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.

During this inspection, we found that people were protected against the risks associated with the unsafe management and use of medicines. Staff received regular competency checks to ensure they had the correct skills for administering medicines.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Systems were in place to minimise risk, to ensure that staff supported people as safely as possible.

The provider had systems to deal with foreseeable emergencies and there were safeguarding adult's policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. Staff were recruited safely and there were appropriate numbers of staff to meet people's needs.

Staff were knowledgeable about people's individual needs and how best to meet these. Staff had access to the support, supervision, training and on going professional development that they required to work effectively in their roles. The training and support they received helped them to provide an effective and responsive service.

Staff had received Mental Capacity Act 2005 (MCA) training and understood the systems in place to protect people who could not make independent decisions. The service followed the legal requirements outlined in the MCA and the Deprivation of Liberty Safeguards (DoLS).

People received a person centred service and had detailed personalised plans of care in place. They were supported by kind, caring staff who treated them with respect. Their cultural and religious needs were respected and celebrated.

People were supported to maintain good health and nutrition.

People and their representatives knew how to raise a concern or make a complaint and effective systems were in place to manage complaints.

People lived in an environment that was suitable for their needs. Specialised equipment was available and used for those who needed this.

The quality of the service was monitored by the service's operations manager and the registered manager. The service had a positive ethos and an open culture.

This inspection took place on the 22 and 23 March 2016 and was unannounced on the first day. At our previous inspection in March 2014, we found that the provider was meeting the regulations we inspected.

Neave Crescent is registered to accommodate ten people with profound and multiple learning and physical disabilities. People are accommodated in two adjacent bungalows which are purpose built. At the time of our inspection the home was providing care and support to ten people.

The provider of the service is an organisation (The Avenues Group). The home had 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 were safe at the service and were cared for by staff who were knowledgeable about safeguarding people. They knew how to report concerns.

However, we had concerns that medicines at the home were not managed safely. Protocols were not in place for the safe administration of medicines to be administered when required (PRN) for the people concerned. There were no records of regular effective systems in place to monitor and check safe medicines practice within the home.

Not all care plans we looked at included specific risk assessments which identified risks associated with people’s care. They did not sufficiently guide staff about how to minimise risks in order to keep people safe.

Staff were supported through regular supervision, and the provider is in the process of ensuring that systems were in place to ensure staff received an annual appraisal of their practice and performance.

There were sufficient qualified and experienced staff to meet people’s needs. Staff received the support and training they needed to provide an effective service that met people’s needs. The staffing levels were flexible to support with planned activities and appointments.

The recruitment process was robust to make sure that the right staff were recruited to keep people safe. Staff confirmed and personnel records showed that appropriate checks were carried out before they began working at the home.

Staff had received Mental Capacity Act (2005) training and understood the systems in place to protect people who could not make independent decisions. The service followed the legal requirements outlined in the MCA and the Deprivation of Liberty Safeguards (DoLS).

People were supported to have a nutritionally balanced diet and had adequate fluids throughout the day to promote their health and wellbeing.

People were supported to see specialist healthcare professionals according to their needs in order to ensure their health and well being were adequately maintained.

People were looked after by staff who understood their needs, were caring, compassionate and promoted their privacy and dignity.

We found that not all care plans were based upon people’s specific individual needs and wishes. They were not regularly reviewed and updated according to people’s changing needs.

A pictorial complaints procedure was available. People’s relatives were made aware of the complaints procedure and they knew who to speak with if they had any concerns.

Systems were in place to evaluate and monitor the quality of the service. However, improvements were needed to ensure there was continued monitoring of the progress made where actions were identified.

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

During this inspection we spoke with five people using the service, and the relatives and friends of three people. We also spoke with three support workers, a senior support worker and the deputy manager. People using the service told us they were happy and enjoyed living at their home. The relatives and friends were all positive about the quality of the care. One relative said, "I think the management have people's interests at heart. The deputy is superb and the staff team is like one big family. People are well looked after by a compassionate bunch." Another relative told us, "they do what they can to make [my relative] happy and [my relative] is clean, tidy and happy. On the whole all the care workers are lovely and they always get the doctor when needed."

People's care and support needs were regularly assessed and monitored. People were supported to take part in meaningful activities at home and in the wider community.

There were safe systems in place to provide people with a clean environment and to minimise the risk of cross infection.

The premises were appropriately maintained and were suitable for the needs of people using the service.

The staffing levels and skills mix of staff meant that people received the support they required to meet their holistic needs.

People using the service and/or their representatives were confident that any complaints would be taken seriously and properly managed.