This inspection was carried out on 18 and 20 April 2018 and was unannounced.

Radnor House is a ‘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. Radnor House accommodates up to 6 people with a learning disability.

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.

Accommodation is over two floors and consists of four bedrooms and two semi-independent flats. There is a kitchen, lounge/dining room and a quiet room that all had access to, along with an enclosed garden.

The home had a registered manager in post who was present on the day of our visit. 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.

Radnor House was last inspected in August 2017. At that inspection six breaches of Regulation were found and it was rated as 'Requires Improvement' overall and inadequate in Safe. We issued requirement notices relating to person centred care, consent, safe care and treatment, staffing, fit and proper person employed and good governance.

We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Many improvements had been made, and the previous breaches found at our last inspection had been met. However, some areas required ongoing improvements. This is therefore the second consecutive time the service has been rated Requires Improvement.

At our last inspection staffing levels were not sufficient, medicines were not well managed, the service was not kept clean, risk assessments were not reviewed, staff had not completed fire drills and recruitment checks were not adequate. At this inspection we found that staff were now recruited safely, they had completed fire drills and the service was clean.

Risks to people were assessed and managed to ensure their health and safety, although some risk assessments continued to need greater detail. There were enough staff to keep people safe, although staffing levels required review to ensure there was always enough staff for all people to take part in appropriate activities.

At this inspection medicines were safely managed and people were supported to lead healthy lives and see health care professionals when necessary. Staff received the necessary training and met regularly to reflect on their practice.

Our last inspection found that systems were not consistently robust to monitor and improve the quality of services and mitigate risks relating to the health, safety and welfare of people. At this inspection we found that this had improved.

Staff and people told us that the registered manager was approachable and they felt the service was well-led. The registered manager and the locality manager told us their vision for the service was to increase people's opportunities to do more for themselves. This would ensure the service was working 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 cit

The inspection was carried out on the 2 August 2017 and was announced at short notice on the day to ensure people were in. At the previous inspection of this service on 3 and 5 June 2015 we found there were no breaches of legal requirements.

Radnor House provides accommodation and personal care for up to six adults with a learning disability whose behaviour may challenge others. There were five men living at the home at the time of the inspection. The accommodation is over two floors and consists of four bedrooms and two semi-independent flats. People have access to a communal lounge/dining room and a quiet room. There is an enclosed garden to the rear of the home.

The home had a registered manager in post who was present on the day of our visit. 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.

Since the previous inspection the service had experienced a change of registered manager and a high turnover of staff. The registered manager had been in post for just over one year and was trying to build a new staff team and address identified shortfalls. Actions towards achieving these improvements had been slow. The provider had not ensured through quality monitoring checks and audits, that adequate progress was being made in a timely manner and improvements made sustained.

At inspection for the majority of the time the atmosphere in the home was calm and relaxed. People were seen to be comfortable around staff and sought them out. Staff engaged well with people but there were not enough staff to meet the demands made on staff time and to meet everyone’s needs.

Some of the people who had complex needs were not adequately engaged in meaningful activity Observations showed them to be bored and sometimes restless. Some people were not funded for staff to provide dedicated one to one hours; staff could not, therefore give them the time and attention they needed. Care plans were person centred and people and relatives were consulted about their support needs, however, care records were not always updated. Staff did not always implement the distraction techniques in place for one person to de-escalate behaviours that were upsetting them and other people were affected by this.

A programme of ongoing staff recruitment was underway; staff records however, failed to contain evidence of the checks made in keeping with legislation requirements. Medicines were not well managed and there was a risk of errors occurring.

Risks were assessed but were not always reviewed and updated to ensure any changes had been taken account of. Health and safety checks and routine tests and checks of equipment were not carried out in either sufficient depth or frequencies, to provide assurance that people were safe. People could be placed at risk from infection because cleaning and infection control practices were poor.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had received training in this and two people were subject to DoLS authorisations. Other people were subject to restrictions and staff managed aspects of their daily care and support but they had not been referred for DoLS authorisations. The registered manager did not demonstrate a clear understanding of the criteria for making an application to ensure the service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff said that they felt supported by the new registered manager and that they were bonding together better as a team and thought they supported each other. Frequencies of formal supervision and appraisal to inform staff development, and performance were however infrequent. Staff meetin

There were five people living in the home at the time of our inspection. Some people were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records and observed some of the support that people were given. We were able to speak with some people using the service with the support of staff.

People’s needs had been assessed and care and support was planned and delivered in line with their individual plan that was flexible and tailored to their needs. The interactions we observed between staff and people using the service were positive. The staff we spoke with were aware of people’s needs and preferences. Many of the records were in an ‘easy read’ format, and included pictures to support people using the service to understand them. They were written in a person-centred way, and included the views and perspective of the people using the service.

People’s physical healthcare needs were addressed.

People using the service had open access to the kitchen. Their preferences were taken into account when menu planning in the service, and people were supported to make their own food where possible.

There were enough staff available to go out with people using the service, and to provide care and support.

The records were clear and well ordered, and whilst detailed the information was easy to find.

Four people were living at the home at the time of the inspection. Some people were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records and observed some of the support that people were given.

People we spoke with said they liked living at the home and they were able to make choices about their lives and things that were important to them. People chose when to get up and go to bed, what to do and what to eat and staff respected their choices. A person said they chose to “eat in my room” and that staff respected this.

Pictures and photographs were available to help people make their choices if they needed them, such as to help them choose what to eat and what activities to do.

People had been asked how they liked their care and support to be provided and were supported to learn and maintain independence skills. People chose how to spend their time at home and in the community. They helped with household tasks and keeping their own rooms clean and tidy to the level of their ability.

People were provided with opportunities to experience a range of activities at home and in the community.

Staff understood people’s needs and had the training they needed for their roles. People had good relationships with staff and were comfortable in their company. A person told us “staff are nice “.

The inspection was carried out on 3 and 5 June 2015 and was unannounced. At the previous inspection in November 2013, we found that there were no breaches of legal requirements.

Radnor House provides accommodation and personal care for up to six adults with a learning disability whose behaviour may challenge others. There were six men living at the home at the time of the inspection. The accommodation is over two floors and consists of four bedrooms and two semi-independent flats. People have access to a communal lounge/dining room and a quiet room. There is an enclosed garden to the rear of the home. .

The home was run by a registered manager who was present on the day of our visit. 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.

The home had taken reasonable steps to make sure that people were safeguarded from abuse and protected from risk of harm. Staff had received training in how to safeguarding adults and knew what action to take in the event of any suspicion of abuse.

Medicines were managed and stored appropriately. Staff received regular training and their competency in giving medicines was assessed, to ensure people received their medicines as intended by their doctor.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. The manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People’s needs had been assessed to make sure that there were enough staff on duty during the day and night to meet people’s individual needs.

People’s health needs were assessed and monitored. A health care professional said that professional advice was sought when it was needed. Health records were written in a format to help people to understand their content.

People were supported to have a balanced diet. Staff understood people’s likes, dislikes and cultural preferences.

New staff received a comprehensive induction, which included specific training about supporting people with a learning disability and behaviours that may challenge. Staff were trained in areas necessary to their roles and also completed additional specialist training such as how to communicate effectively and support people with autism, to make sure that they had the right knowledge and skills to meet people’s needs effectively.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent on a daily basis and understood how people with limited or no verbal communication made their choices know. DoLS applications were being made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily.

Each person who lived in the home had a different way of communicating their needs. Staff understood how to communicate in a personalised manner with each person who lived in the home. Staff spoke with people in a respectful manner, treated them with kindness and encouraged their independence.

People’s care, treatment and support needs were clearly identified in their plans of care and included people’s choices and preferences. Staff knew people well and understood their likes and dislikes. Clear guidance was in place to identify the triggers and action to take when people displayed behaviour that may challenge themselves or other people. This guidance was appropriately put into practice on the days of our visit.

People were offered an appropriate range of activities which included in-house activities and trips in the community. People were supported to keep in contact and visit friends, family members and people who were important to them.

Staff understood the aims of the home were motivated and had confidence in the management of the home. They said there was now a stable staff team after a long period of staff change and that there was good communication in the staff team.

Systems were in place to review the quality of the service and included feedback from people who lived in the home, their relatives and staff. Improvement plans were developed where any shortfalls were identified to make sure that improvements were made and sustained.