This unannounced inspection was carried out on the 13 October 2016.The home had been previously inspected on 1 and 2 September 2015 and a breach of the regulations had been found. People’s records had not been maintained accurately or completely. Systems and processes had not enabled the provider to assess, monitor and improve the quality of care provided to people. At this inspection we aimed to see what progress had been made to ensure the quality and safety of the service had improved. The provider had told us that they would complete all the actions required to meet the regulations by January 2016, as scheduled in their action plans. During our inspection on 13 October 2016 we found that all the identified actions had been completed.

Primrose House provides accommodation and personal care for up to six people with learning disabilities. At the time of the inspection five people were using the service.

The service 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 felt safe and protected from harm. People's safety was promoted as risks that may cause them harm in their home and in the local community had been identified and managed. Appropriate risk assessments were in place to keep people safe.

Staff understood what constituted abuse and took action when people were at risk of harm. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who use the service.

Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to store medicines.

There were enough qualified and skilled staff at the service. Staffing numbers and shifts were managed to suit people's needs so that people received their care when they needed and wanted it. The provider’s training was designed to meet the needs of people using the service. As a result, staff had the knowledge they required to care for people effectively.

There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. Staff were trained in the principles of the MCA and could describe how people were supported to make decisions; and where people did not have the capacity, decisions were made in their best interests.

People were supported to have a healthy diet dependent on their assessed individual needs. People had a choice of foods and were involved in preparing their own meals where possible.

People had access to a range of health professionals and staff supported people to attend appointments when necessary.

Care plans were informative and contained clear guidance for staff. They included information about people’s routines, personal histories, preferences and any situations which might cause them anxiety or stress. The plans clearly described how staff were supposed to support people in these circumstances. Adapted easy-to-read versions of the care plans were made available to people to facilitate their involvement in the care planning process.

The provider promoted people’s personal interests and hobbies. Social activities were organised in line with people’s personal interests and there was a lively atmosphere at the service. The service maintained strong links with the local community.

People who use the service the staff were very complimentary about the registered manager of the service. People told us that they were accessible and approachable. A positive and open culture was promoted at the service. The provider had effective systems in place to review the quality of the service provided.

The inspection took place on 1 and 2 September 2015 and was unannounced. Primrose House provides residential accommodation and care for up to six people with learning disabilities, including people with autistic spectrum disorder. At the time of our inspection three people were living in the home, as two people were away on holiday.

The home is a two storey building, with a double hand-railed stairway providing access between floors. People had access to an enclosed secure garden.

The home had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Record keeping was not always accurate, as information did not always reflect people’s daily experience appropriately. Information was not always cross referenced between records to ensure staff were aware when people should be monitored to review changes in their health or support needs. There was a risk that trends may not be identified to ensure that any changes required to people’s care were addressed promptly. The provider’s annual house audit and development plan were not sufficiently robust to monitor the quality of care people experienced, or to identify and drive improvements required.

Risk assessments did not always reflect current staff guidance to manage specific risks that may affect people. However, staff communication ensured that this did not place people at risk of harm, because staff understood the actions required to promote people’s safety.

Appropriate recruitment procedures ensured people were supported safely by staff suitable to provide their care, although the provider’s recruitment policy did not reflect all the regulatory requirements. We have made a recommendation that the provider reviews their recruitment policy to ensure it documents all the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

People were protected from the risk of abuse, because staff understood how to support people when they were in a vulnerable position. Staff were able to recognise signs and indicators of abuse, and understood the requirement and process to report concerns.

Equipment in the home was checked and serviced in accordance with manufacturers’ guidance and the provider’s procedures. Regular fire drills ensured staff understood and followed fire safety procedures.

Staffing levels were sufficient to ensure people were supported safely. The staff roster provided flexibility to support people to attend planned appointments and meetings.

People were protected from risks associated with medicine administration, because staff were trained and competent in administering their medicines. Records demonstrated that people received their prescribed medicines at the correct time, and medicines were stored and disposed of safely.

Staff had sufficient training to meet people’s identified needs effectively. The registered manager and deputy manager worked with staff, and so were able to assess staff competency, and provide additional and refresher training to ensure staff demonstrated the skills required. Staff supervisory and general meetings provided opportunities to discuss issues and aspirational wishes. The registered manager used information from these meetings to direct training or guidance to ensure staff developed and maintained the skills required to support people effectively.

People’s decisions were respected by staff. Staff explained the consequences of decisions to people where this could affect their wellbeing, but followed people’s wishes and sought their consent to the care provided. Staff supported people in accordance with the Mental Capacity Act 2005, and understood when it was appropriate to follow the process of mental capacity assessment and best interest decision-making.

People were supported to maintain a nutritious and balanced diet. Staff were aware of risks associated with eating, and ensured people were not at risk of harm due to eating habits or types of food offered.

People were supported to attend planned health appointments. Staff understood when people’s anxieties meant they may not be compliant with health interventions. They supported people to understand the importance of health reviews and appointments, and proactively supported people to confront their anxieties to promote their health and wellbeing.

People were supported in a caring and kindly manner by staff. Staff took delight and pride in people’s achievements, and encouraged their independence and talents. People were involved in discussions about their care, and supported to maintain cultural and spiritual traditions that were important to them. Staff respected people’s privacy, and took appropriate steps to maintain their dignity.

Staff identified changes to people’s needs and moods, and requested investigation by and guidance from health providers as necessary. Communication between staff ensured people received their planned care in accordance with professionals’ instruction.

People were supported to attend a range of activities in the local community, such as college, a day centre and swimming baths. Outings provided opportunities for people to relax together, for example with trips to the seaside. People were able to relax at home and entertain themselves with games, music or quiet time alone as they wished. Staff discussed activity options with people to ensure they participated in activities they enjoyed.

People and their relatives were involved in planning and reviewing people’s care needs, and records reflected people’s individual needs and wishes. Opportunities were provided for formal and informal feedback or complaints through meetings, questionnaires and the provider’s complaints procedure. The registered manager reviewed this feedback to inform actions to address any issues raised.

The registered manager was respected and appreciated by staff and relatives, as they guided staff to care for people effectively and led by example. Staff demonstrated the provider’s values such as respecting people’s rights, and supporting people to achieve life skills and work towards independence.

We found a breach 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 this report.