We inspected this service on 5 March 2018. The inspection was announced. We gave the service 48 hours’ notice because the service was a small care home for younger adults who are often out during the day and we needed to be sure that they and the staff would be in.

Preceptory Lodge is a residential 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.

Preceptory Lodge accommodates up to eight people in two adapted buildings for people with autistic spectrum disorder or learning disabilities. The service provides personal care and accommodation in a domestic environment. There were six people living at the service on the day of our inspection.

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.

A registered manager was 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from harm by staff that recognised the signs of abuse and were confident to raise concerns.

Personalised care plans and risk assessments were in place and there was enough staff to safely provide care and support. People were supported to make choices in relation to their food and drink and to maintain good health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood the principles of the mental capacity act.

There were safe recruitment processes to prevent unsuitable staff working with vulnerable people. We recommended that the registered manager evidenced more clearly what new staff had learnt during their induction and reflected this in their supervisions.

People's medicines were stored and administered safely. Staff were aware of the infection control measures in place to reduce the risk of the spread of infection.

The care and support people received was person centred. Staff were kind and treated people with dignity and respect and their independence was promoted. They were sensitive to people's needs regarding equality, diversity and their human rights, as their choices and preferences were respected.

The provider had a system in place for responding to people's concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.

The registered manager led a good service. Staff said the registered manager was approachable and supportive and there were good working relationships with health and social care professionals.

Further information is in the detailed findings below.

The inspection took place on the 15 December 2015. The inspection was unannounced. At the last inspection of the service which took place on 17 December 2013 the provider was compliant with all of the regulations assessed.

Preceptory Lodge provides personal care and accommodation for up to eight people with Autism, in a domestic environment. The home is situated in the private grounds of Preceptory Farm, between Selby and Doncaster. There were four people living at the service on the day of our visit.

Preceptory Lodge has a 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.

People told us they felt safe living at Preceptory Lodge. All staff received training in safeguarding adults from abuse and they were clear of the process and policies to follow should an allegation be made.

People were supported to take risks and where any restrictions were in place to support people’s safety these had been appropriately documented and agreed. We saw that checks were carried out on the premises to make sure that they were safe and that equipment was well maintained.

People spoke highly of the staff and said that generally there was sufficient staff to care for people. Rotas were allocated in a way that supported people to access community activities. Recruitment checks were completed before staff commenced work so that only suitable people were employed.

People received their medication as prescribed and we saw that medication reviews were undertaken to ensure that people were receiving the medication they required. Medication was safely stored, administered and disposed of.

Preceptory Lodge was clean and there were policies and procedures in place which helped to ensure high standards of cleanliness and infection control were maintained.

Staff received induction and training to support them in their roles. They had access to a range of training and confirmed that this supported them in carrying out their roles effectively.

Staff received some formal supervision and all confirmed that they received good support. The registered manager confirmed that all staff would be given an appraisal to review their practice and discuss how they were performing.

All of the people living at Preceptory Lodge were able to make decisions and choices. Where any restrictions had been made these had been formally documented and the relevant professionals had been involved. Staff understood The Mental Capacity Act 2005 and were aware of the importance of using this legislation should any decisions need to be made.

Staff had a clear understanding of how to support people with challenging behaviour and they had received training in ways to support people.

People told us they received a varied diet and enjoyed the food on offer. They were involved in choosing what was on the menu and helped with the shopping and preparation of meals.

People’s health needs were kept under review and professional advice was sought where necessary. Staff knew and understood the people they supported which meant that any changes in health were quickly identified and responded to.

The premises were safe and suitable for those living there. The registered manager was seeking advice from an occupational therapist to ensure that the newly registered property was wheelchair accessible.

People living at Preceptory Lodge were well cared for and were happy. There was a positive warm and friendly relationship between those living and working at the service.

People were involved in discussions regarding their care and treatment and signed their agreement to their care records. Equality and Diversity issues were considered and supported.

People had access to a range of information which was available in accessible formats. They had access to external advocacy support where this was required.

Records were stored securely and staff were aware of the importance of maintaining confidentiality.

Privacy and dignity was maintained and people living at Preceptory Lodge were respected. The service responded to people’s changing needs and we saw detailed care records which recorded how people’s care should be delivered.

People were involved in discussions regarding their care and signed their agreement to their care records.

People attended a range of social opportunities and went on holiday. They spoke positively of the range of opportunities they were given which supported them in leading varied and fulfilling lives.

Contact with families and friends was supported and relatives were able to visit the service. Staff supported people in maintaining this contact as they understood the importance of maintaining these key relationships.

People were supported to make choices and decisions and to feedback any concerns. There were appropriate complaints procedures in place should people need to raise any issues.

People spoke highly of the registered manager and staff and we saw that meetings were held. Relatives and other professionals were invited to feedback their views of the service and we saw that there were a range of management systems in place to monitor and review the quality of the service provided. There were clear records, policies and procedures which were regularly reviewed and supported the management of the service.

During our last visit to the home we found that there were not always enough staff on duty to care for people. This was a follow up visit to look at staffing levels to see if improvements had been made.

People told us that they liked the staff who cared for them. They said there were enough staff to care for them. Comments included "The staff are excellent. I know them all well" and "Staff are all alright. There are plenty of them."

We saw that staffing levels were maintained so that people's assessed needs could be met.

People told us that they were able to make choices and decisions in most aspects of daily living but they also said that the current staffing levels were impacting on the choices they could make in regards to the social activities they accessed. They told us however that they were always treated with dignity and respect.

People told us that they were well cared for and liked living at Preceptory Lodge. Comments included "I like it here and I like all the staff. I have a lovely room."

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People told us that the current staffing arrangements were impacting on the care and social opportunities for people living at the home. We were also told that staffing levels placed people at risk as there were not always sufficient staff on duty to meet people's assessed needs.

The home had quality monitoring systems in place to seek the views and opinions of those using the service and other stakeholders. People told us that they could speak to staff and that they had meetings where they could raise issues.

People's needs were assessed and their rights were respected by the staff. People told us they were able to make decisions about how they wanted to spend their time. We saw staff treating people with dignity and respect. People said “Staff knock on the door and I can choose when I get up and go to bed. I choose what I want to do."

People said they were well cared for and said that they liked living at the home. People had support plans and risk assessments in place which helped staff to understand and meet people's needs. We observed staff helping people to maintain their independence and make choices for themselves.

The home had policies and procedures which helped to protect people. People told us that they felt safe and that their concerns would be listened to.

Although people told us that they liked the staff who cared for them, we also found that the majority of staff had not received sufficient training to enable them to meet the needs of people living at the home.

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.