This inspection was carried out on 17 November 2017 and was unannounced.

The home provides care and support for up to twelve people with learning disabilities and/or autism. People who used the home had moderate to low care needs, with some now needing consideration as elderly people having lived at the home for over thirty years. At the time of our inspection there were twelve people living at the home. The home consisted of two houses next door to each other with accommodation split over two floors. There was one bedroom on the ground along with communal living space and the rest of the bedrooms were on the first floor.

A registered manager was employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the previous inspection on 30 September 2016, we made one recommendation concerning finances and found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the last inspection, we found people were at risk of scalding as the water temperature had been too hot. Records showed that the temperature had been taken regularly, however when they had gone above what is considered safe for people who are vulnerable, no action had been taken to protect people.

At this inspection, we found the registered manager had robust audits of water temperatures around the home and immediate action had been taken when necessary to keep people safe.

At the last inspection we found that there were not robust quality control measures in place. The manager had not reviewed audits being undertaken by staff and therefore opportunities had been missed to improve the service provided to people and keep them safe.

At this inspection we saw that the manager was monitoring monthly checks being completed by staff. That the quality of records such as daily records and medication records were reviewed and action taken when appropriate.

At the last inspection, it was recommended that people’s finances be audited by an external auditor, the manager confirmed this had been arranged on a yearly basis.

People were assessed as individuals so that staff understood how people’s care was planned to maintain their safety, health and wellbeing. Risks were assessed within the home, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified.

The registered manager had plans in place for emergency evacuation should this become necessary. These were individual plans for each person and were kept in people’s care files and in a grab bag should the need arise. It ensured that all staff in the home would understand how to continue people’s care, should the home be evacuated in an emergency.

Incidents and accidents were recorded and checked by the registered manager to prevent these happening again.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities and autism. Each person had a key worker who assisted them to learn about safety in and outside of the home. Staff had received training about protecting people from abuse. The staff and management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Records were kept to assist people to monitor and maintain their health. Staff had been trained to

We undertook an unannounced inspection of Overcliffe House on the 30 September 2016. Overcliffe House is a care home providing personal care and accommodation for up to twelve adults with learning disabilities and autism.

At our last inspection on 6 March 2015 the service met the regulations inspected.

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 person-centred, and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's needs. Care plans were reviewed monthly and were updated when people's needs changed.

Relatives informed us that they were satisfied with the care and services provided. Relatives also told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People needed support with their finances as they did not have the capacity to do so. Records showed checks were being carried out by staff and the registered manager.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

The premises were clean and tidy. There was a record of essential maintenance carried out at the home. Bedrooms had been personalised with people's belongings to assist people to feel at home. However, the water temperatures in the home were not controlled and had reached temperatures above the recommended safe water temperatures. Although, the registered manager told us the issue had been reported and were waiting for this to be fixed by the housing association. we identified that there were inadequately controlled risks being presented to people using the service in the meantime.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that the relevant authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

A satisfaction survey had been carried out in July 2016 and the results from the survey were positive. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

There was a management structure in place with a team of support workers, registered manager and the provider. Staff spoke positively about working at the home. They told us management were approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concern

One inspector conducted this inspection. This was a follow up to our inspection of 12 June 2014 where we identified that people did not always experience care and support that met their needs and protected their rights because assessments and documentation of needs were not always recorded. The provider wrote to us and told us they would be compliant by 8 July 2014. At the time of our visit all people living in the home were attending a day centre and the majority of staff were with them.

We spoke with the registered manager and deputy manager to follow up on the actions they had told us they had taken following our previous inspection. We considered all the evidence we had gathered under the outcome we inspected. We used the information to answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

Is the service safe?

There were systems in place to ensure people's needs were assessed and risks were identified. Personal and environmental risk assessments were carried out, reviewed and control measures were put in place to help manage risk. Care was planned in a way that ensured people's safety was a priority and care was reviewed regularly to support this.

Is the service effective?

People were supported in promoting their independence and community involvement. People's health needs were met and there were records kept where health information was recorded. Decisions in relation to promoting people's independence had been recorded to show that the risks had been assessed and written plans were in place to manage the identified risks and ensure the safety and welfare of people who lived at the service.

Is the service caring?

Records showed that people and their families were involved in their care and were encouraged to do so. Records relating to behaviour support demonstrated that people's likes and dislikes were taken into account when planning their care and that staff adopted strategies to support people's choice in their care.

Is the service responsive?

People's needs were assessed before they moved into the service and care was planned in response to these assessed needs. Individual objectives and goals were established and staff responded to the needs of individuals in a way that promoted choice and independence.

Is the service well led?

We saw evidence of learning and monitoring of the quality of service delivery. The management of the service focused on meeting the needs of individuals and we viewed records that demonstrated a focus on the individuals in the service and meeting their needs. The manager and deputy manager told us that staff, people who use the service and their families were involved in shaping those services.

One inspector conducted this inspection. We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not always able to tell us about their experiences. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service caring?

Our observations showed that people had a positive experience of their care and appeared happy, settled and relaxed. They were provided with the support they needed from staff. The person we spoke with at the service told us that if they had any problems they could talk to the staff and they would help. They added, the staff were “Nice”, and they looked after them well.

Is the service responsive?

We saw that people’s needs were assessed before they moved into the service. The accommodation was used flexibly to meet people’s needs. For example, one person’s mobility had become restricted following an accident. Therefore, they had moved to a bedroom on the ground floor to ensure their safety while moving about the service.

There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.

Is the service safe?

There were systems in place to ensure staff were competent in being able to meet people's needs safely and effectively. We saw that new staff received an induction to the service.

There were systems in place to monitor health and safety within the service. These checks included water temperature checks and tests of portable electrical appliances. We also saw that audits were undertaken of medication.

We saw that the service was well maintained. There was a system in place to report and monitor repairs needed at the service.

There were arrangements in place to deal with foreseeable emergencies.

Is the service effective?

Staff ensured people’s privacy and dignity was upheld. For example, we saw that staff knocked on people’s doors to their bedrooms and bathrooms before entering.

People were supported in promoting their independence and community involvement. We saw that the service used a system of support that focussed on promoting people’s independence.

People were given opportunities to participate in activities they enjoyed. For example, the day of inspection people were visiting a beach to enjoy the warmer weather.

People’s health needs were met and staff recorded health information on people’s health records. We saw that people’s appointments with health professionals were recorded.

There were enough staff on duty to meet people’s needs effectively.

However, not all decisions in relation to promoting people’s independence had been recorded to show that any risks had been assessed. There wasn’t always a written plan in place to manage the risks to ensure the safety and welfare of the individual.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included meetings with people living at the service and surveys provided to people, their relatives and visiting professionals. There were opportunities provided to staff for them to feedback about the service. We saw that there was a complaints process in place and there were systems in place to monitor staff training and competency.

Most of the people using this service had limited verbal communication and were not able to tell us directly about their experiences of the service. Two people spoke with us and we observed people interacting positively with staff in a range of activities. One person said they “were very happy at the home and liked the activities”.

We spoke with relatives of three people. One person told us “the service was very good and they were very impressed with the very experienced staff and amount of activity”.

We observed that staff demonstrated knowledge and understanding of the people they were supporting and that staff respected the rights of people to consent to day to day activities. We observed that where a person was not able to consent the provider made appropriate arrangements in line with legal requirements.

We looked at care records of four people using the service and saw that risk assessments and care plans were regularly reviewed and people were involved in the decisions about their care. We observed there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care.

We observed that the provider had clear procedures in place to handle medicines prescribed for people using the service and there was clear guidance about adverse events related to the handling of medicines.

We found there were systems in place for people and their relatives to make a complaint about the service if required.

Most of the people who used this service had limited verbal communication and therefore were not able to tell us directly about their experiences of the service. However, some people were happy to talk with us and told us that they were involved in a wide range of activities and interests. One person told us that they were able to plan their activities on a monthly basis. We were told by one person that they "were very happy...the staff are really nice".

One person told us that they had recently been involved in a review of their care and felt that staff listened to and respected their opinions.

People told us that they had been on holiday last year and that they knew where they were going on holiday this year.

We found that there was a professional and personable relationship between service user's and staff. Staff understood the needs of people using the service and were able to meet the individual needs of people.

There were systems in place which enabled the provider to assess the quality of the service being provided, and where necessary, changes could be made to ensure that people benefited from receiving a quality service.

Most of the people who used this service had limited verbal communication and therefore were not able to tell us directly about their experiences of the service.

People told us that they were involved in a wide range of activities and interests. One person showed us some intricate embroidery that they were doing. Another person said that they liked taking photographs. We looked at some of their photographs which showed the many local and far away places that they had been to.

One person said that they wanted to go to the pub that evening. A member of the care staff replied that they would take them and anybody else that wanted to go.

People told us that they had been on holiday last year and that they knew where they were going on holiday this year. They said that they were flying by plane to get there.

One person showed us the communal lounge. They said that it was comfortable.

Some people who lived in the home showed us their bedrooms. They said that they liked to spend time in their rooms and indicated that they had all the things that they needed.

In the home's annual survey, one relative commented that care staff, "Went that extra mile".