About the service: Norwood Drive is a residential care home that can accommodate up to six people. The home was providing support with personal care to five people with a learning disability at the time of our inspection.

People’s experience of using this service:

• Staff treated people with care and respect. There was a small, consistent staff team, which helped staff build positive relationships with people living at the home.

• Staff had a good understanding of people’s needs and preferences. Care plans were person-centred and contained a good level of detail about how people preferred to receive their care.

• Whilst the home was adequate to meet people’s needs, the provider and relatives recognised that the premises needed refurbishment. Although the provider did not own the building, they were responsible under their registration for ensuring the premises met relevant requirements.

• We saw evidence that required servicing, checks and risk assessments relating to the premises and equipment had been completed. However, there was evidence that recommendations from the home’s legionella risk assessment had not been acted upon. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease.

• There were some shortfalls in infection control procedures. We found some areas of the home were visibly unclean.

• Staff were aware how to identify and escalate potential safeguarding concerns. However, we were aware of one instance prior to the inspection when concerns had not initially been adequately investigated.

• There were systems in place to help ensure people’s medicines were manged safely. However, staff had not always followed safe practice when giving people their medicines.

• We observed some activities taking place during the inspection, and some people attended day centres. However, activities did not engage everyone living at the home, and reports from relatives and staff indicated perceived barriers such as the weather, finances and transport could prevent people from accessing the community as often as they would like. We have made a recommendation about activities.

• Staff received a range of training relevant to their roles and the needs of the people they supported.

• The registered manager had recently left the service. The deputy manager was receiving support from the area manager to run the home day to day.

• The provider had systems and processes in place to help them monitor the quality and safety of the service. However, these systems had not always ensured the issues we found had been addressed and the service continues to be rated requires improvement overall. We found this to be a breach of the regulations.

• Relatives told us they felt the provider had not always acted openly and honestly in relation to previous incidents at the service. The provider assured us it was not their intention to withhold information from families, and that this had been due to a misunderstanding about which relatives had been informed of previous events.

• The service applied the principles and values of registering the right support and other best practice guidance, although this was not consistent. This guidance aims to ensure that people using services can live as full a life as possible, and achieve the best possible outcomes that include choice, control, inclusion and independence.

For full details about the findings of this inspection, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected Norwood Drive on 4 and 5 October 2017 when we rated the service as requires improvement overall (report published 12 December 2017). This is the third consecutive time that the service has been rated requires improvement.

Why we inspected: This was a routine scheduled inspection. However, we were unable to inspect the service when we had originally planned in December 2018 due to an incident that raised concerns about the

The inspection took place on 4 and 5 October 2017 and was announced. This meant we gave the provider notice that we would be inspecting.

The service is registered as a care home providing personal care for up to six people with a learning disability. Norwood Drive is a bungalow which has level access into an entrance hall with six bedrooms, two bathrooms and a laundry to the right of the entrance hall and a kitchen, lounge/diner and conservatory to the left. All the bedrooms are single occupancy and decorated to each person's individual preference. There is an enclosed garden surrounding the home and a small car park to the side. The service is located in Altrincham in a quiet residential area.

We last inspected Norwood Drive in June 2016 and the service was rated overall ‘Requires Improvement’. At that inspection we found five breaches of the Health and Social Care Act regulations in relation to medicines management, staffing levels, poor recruitment practices, quality monitoring and the lack of a registered manager.

Since the last inspection the provider had recruited a manager who had registered with the Care Quality Commission since September 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found one breach of the Health and Social Care Act regulations in relation to staff training. We have made a recommendation in relation to how controlled drugs are stored. You can see what action we told the provider to take at the back of the full version of the report.

At our previous inspection we found the service did not manage medicines in a safe way which potentially put people at risk. At this inspection we found there were sufficient improvements in this area to help ensure people received their medicines in a safe way and the service was now meeting the legal requirements. We however found that controlled drugs were not stored in line with current legal requirements. We have recommended that the provider follows current guidance and legislation on the correct storage of controlled drugs.

At our last inspection we found the service did not have robust recruitment checks and adequate staffing levels in place. At this inspection, we found all relevant pre-employment checks had been carried out to help ensure appropriate candidates were employed and we found the staffing levels were adequate to meet people’s assessed needs. This helped to ensure people were protected from harm.

Risk assessments provided clear and specific information to help staff deliver care and support people in a safe way

People and relatives told us Norwood Drive was a safe environment. Staff were aware of safeguarding principles and knew what action to take should they suspect abuse was taking place. They had received relevant training in this area. This meant there were effective systems to help protect people from harm.

There was a process in place to record and monitor accidents and incidents that took place at the service. These were actioned appropriately and the registered manager analysed trends to help mitigate, where possible, future reoccurrence to help to keep people safe.

Maintenance and safety checks were carried out in line with the manufacturers’ guidelines to help ensure equipment and the environment were safe. These checks included moving and handling equipment, fire safety equipment, gas and electrical equipment and water systems. Records confirmed that monthly fire drills were carried out. These checks helped to ensure a safe environment was maintained for the people living there and the staff supporting them.

People and relatives told us staff effectively delivered care and support.

The service carried out capacity assessments to

We inspected this service on the 16 June 2016 and it was an announced inspection. Forty-eight hours’ notice of the inspection was given to ensure the acting manager was available.

Norwood Drive is a small bungalow in Altrincham. It has level access into an entrance hall with six bedrooms, two bathrooms and a laundry to the right of the entrance hall and a kitchen, lounge dinner and conservatory to the left. All the bedrooms are single occupancy and decorated to the person’s individual preference. There is an enclosed garden surrounding the home and a small car park to the side.

The service did not have a registered manager in post. The previous manager left in September 2015 and there has not been one since. We were told at the time of the inspection that a new manager had been appointed and would take up the post in July 2016. 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.

Staff and relatives did not feel the service was well led as there had been no registered manager in post. All staff said they felt supported and felt they could raise any concerns with the acting manager and they would be acted upon.

We found the recruitment process was not robust at Norwood Drive as not all the required checks were in place prior to staff commencing work. People were well cared for despite there not being a sufficient number of permanent staff to support them effectively. The staff were knowledgeable about the needs of the people and had received appropriate training in order for them to meet people’s needs.

Medicines were not always administered, stored and disposed of safely and in line with the required guidelines. There were appropriate guidance and protocols for staff when people needed ‘as required’ medicine.

We viewed the policies and procedures and saw they were not always being followed. Quality assurance checks were not being completed. We saw audits were being completed on medicines and peoples finances; however they had not identified issues with the checking of medicines.

People living at Norwood Drive appeared safe. Relatives felt their loved ones were safe living there. Staff knew how to keep people safe and were aware of how and to whom they could report any safeguarding concerns.

Staff were observed as being kind and caring, and treated people with dignity and respect. There was an open, trusting relationship between the people and staff.

Staff sought consent from people before providing care or support. The ability of people to make decisions was always assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were always taken in the best interests of people when necessary.

Risk assessments were up to date. Care plans were written with the person or their families. People had been supported to be involved in identifying their support needs. People’s likes and preferences were recorded and staff knew the people well.

We saw people were fully supported to attend activities within the home and in the community. People, who were able to, made choices about how they spent their time and where they went each day.

We saw people had been asked for feedback about the service they received. Staff worked well as a team; we saw them communicating with each other in a respectful and calm manner. There was an open and transparent culture which was promoted amongst the staff team.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.