This inspection took place on 15 March 2017 and was unannounced.

Following our visit to the service, further evidence gathering in the form of telephone calls and emails to relatives and health professionals was undertaken on 6 April 2017.

At our last inspection of this service in October 2015 we found that the service was not meeting the regulation relating to good governance. This was because effective monitoring of the service was not taking place. We also issued a requirement notice in respect of this breach in regulation. The registered provider sent us an action plan detailing how and when they would take action in order to meet this requirement notice.

At this inspection we found this had improved. We saw a range of audits were being carried out by the registered manager and other senior staff within the organisation. Action plans were produced when any issues were identified and these were completed within appropriate timescales.

Real Life Options – 96 Bishopton Road provides care and support for up to six people who live with a learning disability. The service is in a large detached house with three people living on each floor. Each floor has a communal lounge and dining area. Meals are prepared in the downstairs kitchen however there is a kitchen area upstairs with facilities to make drinks and snacks.

The home had a registered manager in place. 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 the registered manager had also been acting as divisional manager which meant they were not present at the service as often. This arrangement had now come to an end and the registered manager was now dividing their time between 96 Bishopton Road and one other service they were registered manager for. This meant that there was a stronger management presence in the service.

At the time of our inspection there were six people using the service. They had a range of communication skills so although we spoke with everyone during the inspection not everyone was able to respond to us verbally.

Appropriate systems were in place for the safe storage and management of medicines and people were receiving their medicines as prescribed.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of types of abuse, signs to look for and how to report any concerns. The registered provider had a whistleblowing (telling someone) policy in place and a hotline for staff to use if necessary.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed and risk assessments were personalised to each individual. The risk assessments we looked at covered areas such as managing medicines, maintaining a healthy diet and mobility. Accidents and incidents were appropriately recorded and regularly analysed to minimise the risk of reoccurrence.

We found that safe recruitment and selection procedures were in place and appropriate checks were undertaken prior to staff starting work.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff were given effective supervision and a yearly appraisal.

Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivations of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions.

People were supported to maintain a healthy diet and people’s dietary needs and preferences were catered for.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to ex

We spoke with three people who lived at Bishopton Road. One person told us that they were happy living there. Other people we talked to had some communication difficulties but they indicated in their body language and in their interaction with staff that they were happy living in the service. We saw that people were supported to be as independent as possible and make choices about the way they were cared for and spent their time.

We observed that staff communicated with people who lived at Bishopton Road in a respectful way and demonstrated that they understood their individual needs. We saw detailed care plans which had been developed with people who used the service and were regularly reviewed.

The provider had policies and procedures in place to protect people living in the service from the risk of abuse. There were clear processes for recording and reporting any untoward incidents.

The provider had a recruitment policy and undertook required checks. We spoke with three staff during the inspection who told us that support was provided for new staff to ensure that they had training to prepare them for their role.

The provider had mechanisms in place to monitor and assess the quality of the service which involved people living in the service, their relatives and staff. There were regular audits which monitored the quality of care provided and the health and safety of the premises.

We spoke with three people who lived at the home. All of the people we spoke with told us they were very happy with the service which was provided to them. One person told us, “I love it here”.

People told us that they felt involved in making decisions about their care, and that staff listened to them and respected them. One person said, “They listen to me and help me do the things I want to do”.

People told us it was a safe place to live and if they had any problems they would feel confident talking to staff. One person said, “I feel safe here. I’ve never had any complaints, but if I did I’d talk to the staff, or the manager, they’re all lovely here”.

The inspection took place on 1 October 2015 and 12 October 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 12 October 2015.

We last inspected the service in November 2013 and found that it was not in breach of any regulations at that time.

96 Bishopton Road provides care and support for up to six people who live with a learning disability. The home does not provide nursing care. 96 Bishopton Road is a large detached house which has been divided into two units each accommodating three people. Externally there is a courtyard garden. The house is situated close to local amenities.

The home had a registered manager in place. 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 the time of our inspection the registered manager for the service was also acting as divisional manager for the registered provider. We were told that this was a temporary arrangement that had been formally put in place from 1 June 2015 and would cease at the end of November 2015. Whilst the registered manager was performing this additional role a senior member of staff from another of the registered provider’s services in the locality had been tasked with overseeing the day to day running of the home. The registered manager still had regular involvement and visited the service at least once or twice a week.

People who used the service had a range of communication skills. People had some verbal communication whilst others used signs or gestures which staff interpreted. We saw that people were smiling and happy.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination. The registered provider had a whistle blowing hotline and information regarding this is clearly displayed.

We looked at care plans and found that they were written in a person centred way and included easy read documents and pictures making it easier for people using the service to understand them. The care records we viewed also showed us that people had appropriate access to health care professionals such as dentists and opticians. We saw that individual risk assessments were in place and that they covered the key risks specific to the person. The care plan documents were not always completed fully and some were not signed or dated. The review of these documents also needed to be more clearly recorded.

We observed that people were encouraged to be independent and to participate in activities that were meaningful to them. People were listening to music, engaging in craft activities and spending time in the garden. People were also supported to go out into the local community and during our visit one person was taken by staff to a motor sport event.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. Staff received regular supervision and yearly appraisals to monitor their performance.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Some refresher training was overdue but we have received confirmation since our visit that all staff are now booked on to the relevant courses.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

We saw that people were provided with a choice of healthy food and drinks to help ensure their nutritional needs were met. We saw that there was a four week menu in place offering a good variety of dishes and staff also demonstrated knowledge of people’s likes, dislikes and special dietary requirements.

There was a complaints procedure in place and this had been produced in an easy read format with pictures and placed in every person’s room.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection no such trends had been identified but the registered manager demonstrated an understanding of the action to be taken should this change.

We spoke with staff who told us they felt supported and that the registered manager was always available and approachable. Throughout our visit we saw that people who used the service and staff were comfortable and relaxed with the registered manager and each other. There was a relaxed atmosphere and we saw staff intereacted with each other and people who used the service in a very friendly and respectful manner.

We found that the registered manager was not conducting rigorous enough checks of the paperwork and systems in place at the home as a number of areas of concern had not been identified. Documents in care plans were not always correctly completed, signed or dated. Handover records were not fit for purpose, Personal Emergency Evacuation Plans (PEEP) were not regularly reviewed and were out of date, fire alarm test records were not accurate and staff were not up to date with all of their mandatory training.

We found the provider was breaching one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the governance arrangements. You can see what action we told the provider to take at the back of the full version of the report.