The inspection took place on 17 May 2018 and was unannounced.

Primrose House is a small, family run home for up to five people learning disability, Asperger’s or Autism. On the day of the inspection five people were using the service.

Primrose House is a large terraced house and offers residential care without nursing. There were shared bathrooms, a communal kitchen, a communal lounge, a dining area and a garden.

At the last inspection on 15 May 2017, the service was rated as requires improvement in two key questions, Safe and Well-Led. This was due to staff recruitment processes not being thorough, risks to people and the environment not being well assessed and managed and quality assurance systems needing improvement. At this inspection we found some improvements in these areas but further development was required to medicine management, staff training and the governance systems to ensure regulatory requirements were understood, met and the service continued to improve. Therefore we rated the service again as Requires Improvement overall.

Throughout the inspection we were assisted by the registered manager who was also the provider. 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.

Medicines were administered consistently and safely. No one was on medication without their knowledge (covert) and no one was prescribed medicine which required additional storage for safety purposes. Staff confirmed they understood the importance of safe administration and management of medicines. We looked at medicines administration records (MAR) and noted all had been correctly completed. Some people managed their own medicines and staff checked they were doing this safely at intervals. The service had a medicines policy but it required updating to reflect current best practice. Some staff had not had formal medicine training either or an assessment of their competency. We also talked to the registered manager about developing “as required” medicine support plans and a recorded system to check the medicine administration records. Although we did not identify medicine management was unsafe at the inspection and there was no impact on people’s care, systems needed to be more robust to reduce potential error.

Primrose House was run like a traditional family home might be. There were some informal quality assurance systems / checks in place for example room checks and checks on people’s medicines. Feedback from people, staff, relatives and professionals was noted, listened to and action taken. Learning and reflection took place in the event of an incident or concern raised and these were used to help drive improvements to people, but there was limited documentation to support these processes. Links with forums which discussed best practice in this area was limited and policies and procedures required updating to reflect current practice. More formal governance processes to checks that standards were maintained would support the development of the service.

People were supported by staff that had received an induction programme and some staff were undertaking further qualifications in health and social care. Staff training however required updating in some areas, for example safeguarding, fire training, medicine management and the Mental Capacity Act.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. The registered manager (also the provider) was committed to employing people with the right skills, values and attitude to work with vulnerable people.

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Primrose House is a small family run care home for up to five people living with a learning disability, Asperger’s or Autism. On the day of the inspection the home had five people living there.

The person in day to day charge of the home was the registered provider. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection of the service on 24 and 25 February 2015, the service was rated as good. One key question was rated as requires improvement (Safe). This was due to concerns over the recruitment process in place. On this inspection we found that other improvements were needed and the home was rated as Requires Improvement.

We found that people who lived at the home were well supported, and received opportunities to lead full, active and interesting lives of their choosing. The home had a positive culture and family like, informal atmosphere, and people told us they were happy living there.

However, some management and governance systems were not well developed or organised. We found policies and procedures were out of date and some records were not well maintained.

Not all risks to people were being assessed or managed, including where risks had altered. We found some risks in relation to the premises had not been assessed or actions taken when a person’s needs had changed.

People were not always kept safe because staff were not always recruited in a way that helped ensure people’s safety. At the last inspection we had identified a concern over some checks not having been made at the point of recruitment of staff. The provider told us they had taken action, and we saw they had obtained the specific checks retrospectively. However on this inspection we found they had still not carried out all the checks needed when recruiting staff or put in place a system to ensure this was done in future.

We did not identify that these areas impacted directly on people’s care; however there was a risk of this happening.

People were protected because staff understood how to raise concerns about abuse and how to protect their rights. Support had also been given to people to help ensure they understood how to raise any concerns they may have. Where people had been assessed as lacking the capacity to make decisions for themselves the home had taken appropriate actions to protect people’s rights, including formal advocacy services. Personal responsible risk taking practices promoted and protected people’s freedom, choice and rights.

People were involved in the running of the home and had strong links with the local community in Ivybridge and the surrounding area. Care plans were regularly reviewed and detailed any areas of need and how they were to be met. People followed activities of their choosing, including sports and leisure, daily household tasks such as cooking and laundry and socialising with friends. People had been involved with staff drawing up plans for both long and short term goals and how they could be achieved.

There were sufficient numbers of skilled and trained staff to support people, and people were encouraged to be as independent as they wanted or needed. Although staff training systems were not well organised, we saw staff supported people with a consistent approach and appropriate communication to meet the person’s needs. It was evident there were good caring and supportive relationships in operation, and a positive culture.

People received their medicines safely. Medicines were stored and administered safely. Some people managed their own medicines with staff overview. This included lockable storage in people’s bedrooms. People could also lock their bedroom doors to maintain their privacy if they wished.

People were supported to have their health and dietary needs met. People were encouraged to be independent with making their breakfasts and packed lunches, and we saw

During our inspection we were able to meet and speak to four of the five people using the service. We were also able to speak to and observe staff as they provided care and support.

We saw that people were able to lead an active and busy lifestyle. People told us about the activities they enjoyed such as regular college courses, art and craft groups and use of community facilities including the local sports centre and coffee shops. One person said " We are always busy doing the things we enjoy and then we tend to get together and chat at tea time"

We spoke to people about the food in the home and asked if they had a choice about what they wanted to eat. One person said " We have anything we want, too much sometimes, there is always lots of lovely food available for us" Another person said " We have a takeaway on Saturdays, and we can help ourselves to snacks and drinks at any time.

Since the last inspection the provider had developed an easy read leaflet for staff and people who used the service about keeping safe and what people needed to do if they suspected an incident of abuse. All the people we spoke to were aware of this updated information.

We saw that the environment was well maintained and people were able when possible to be involved in the running and organisation of their home.

People we spoke to said that they knew who to speak to if they had any concerns. One person said " We either talk all together at the tea table or individually with staff"

During our inspection we were able to meet and speak to all of the people using the service. We also observed staff as they provided care and support.

We saw that people were relaxed and happy in their home. One person said “I love living at Primrose House, the staff have helped me with my independence, I have lots of friends, here and at work”

We saw that staff treated people respectfully at all times, promoting choice and independence whenever possible.

People had been involved in discussions about their support and were able to look at their records and personal information. This involvement ensured that people's specific needs and wishes were understood and taken into account when planning care.

Care plans were detailed and included information about how people wanted and preferred to be supported. This ensured that the care provided was consistent and met people's specific needs and choices.

People were able to maintain contacts with family and friends and were able to lead a busy and active lifestyle. We saw that due to the location of the home people were able to access local community facilities independently.

People using the service were advised about issues relating to safety. However, guidelines were not in place for staff to follow to ensure that people were protected from the risk of abuse.

Sufficient staffing levels and staff training opportunities were available to ensure the needs of people using the service could be met.

The inspection took place over two days on the 24 and 25 February 2015 and was unannounced.

Primrose House provides care and accommodation for up to five people who have a learning disability and other associated conditions such as aspergers and autism. On the day of the inspection there were five people living at the home. The service had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered manager for Primrose House is also the registered provider for the service.

People told us they felt safe and well cared for at Primrose House. Staff had a good understanding of types of abuse and knew what to do if they believed a person was at risk of abuse or harm. People were supported to make choices, and were well informed about risks and how to keep safe in the home and out in the community.

Staffing levels were sufficient to meet people’s needs and to keep people safe. People were supported by a small, consistent staff team who had worked in the home for many years and knew people well. Recruitment practices however were not sufficiently robust to ensure people’s safety. We raised this issue with the manager at the time of the inspection and were told gaps in recruitment checks would be addressed as a matter of priority. We spoke to the provider following the inspection and were told that the required checks had been requested and interim safety measures put in place whilst checks were completed.

People’s medicines were administered safely. People who were able to manage and administer their own medicines were supported to do so safely.

People were supported by knowledgeable and skilled staff. Staff undertook training, which was specific to the needs of people they supported. New staff had time to familiarise themselves with the running of the service and worked alongside more experienced staff until they were competent to work on their own.

Staff understood their role and correct procedures were followed when it had been assessed people did not have capacity to make decisions themselves. This helped ensure people’s human rights were protected.

People were supported to have their health and dietary needs met. People were fully involved in decisions about their diet and were supported by staff when required. Staff monitored people’s general health and well- being and supported people to access health services when needed.

Staff had a good understanding of the people they supported and had formed positive, caring relationships.

People were supported to lead a full and active lifestyle and were able to maintain relationships with people who mattered to them. Positive links had been developed within the local community and this had helped further enhance people’s lifestyle and independence.

People were fully involved in the running of the service and considered Primrose House to be their home. The registered manager had an active role in the running of the home and staff felt well supported.

People were able to raise concerns and felt their views and opinions were listened to and valued. Systems were in place to regularly check the quality of the service and improvements had been made when required.