This inspection took place on 29 June 2017 and we gave 24 hours notice of this inspection to ensure there would be someone on site during our visit.

Darlington Road provides care and accommodation for up to seven people with a learning disability and complex needs. On the day of our inspection there were seven people using the service. Darlington Road is a large detached bungalow with a small first floor extension. It is set in its own grounds with a large enclosed garden with pond and 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 (CQC) 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.

Darlington Road was last inspected by CQC on 1 and 4 March 2016 and was rated Requires Improvement overall and in four areas; Safe, Effective, Responsive and Well-led. We informed the provider they were in breach of a number of regulations including the management of medicines, safety of premises and equipment, good governance and supporting staff.

Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had ensured improvements were made in these areas and this had led the home to meeting the above regulations.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff training was up to date and staff received regular supervisions and appraisals.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

Accidents and incidents were appropriately recorded and investigated and risk assessments were in place.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People who used the service and their relatives were complimentary about the standard of care at Darlington Road.

Staff treated people with dignity and respect and encouraged people to be as independent as possible.

People who used the service had access to a range of activities in the home and within the local community based on their likes and interests and to help meet their social needs.

Care records were person-centred and reflective of people’s needs.

The provider had an effective complaints policy and procedure in place.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.

This inspection took place on 1 March 2016 and 4 March 2016. 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 4 March 2016.

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

Darlington Road provides care and support for up to seven people who live with a learning disability. The service does not provide nursing care. Darlington Road is a large bungalow with a small first floor extension. Externally there is a large 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.

There were systems and processes in place to protect people from the risk of harm. We saw that individual risk assessments were in place that covered the key risks specific to the person. 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.

People received their medicines as prescribed but medicines were not always stored correctly and the records were not always accurate.

There was a procedure in place to monitor accidents and incidents.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. Staff had not always received regular supervision, and yearly appraisals to monitor their performance had not taken place.

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 received confirmation after 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.

We saw that people were provided with a choice of healthy food and drinks to help ensure their nutritional needs were met. Staff demonstrated knowledge of people’s likes, dislikes and special dietary requirements. The service worked with a dietician where necessary. The care records we viewed also showed us that people had appropriate access to health care professionals such as dentists and opticians.

People who used the service had a range of communication abilities. Some people could communicate verbally whilst others used noises, signs or gestures which staff were able to describe in detail and interpreted well. Throughout the inspection there was a relaxed atmosphere and staff interacted with each other and with people who used the service in a very friendly and respectful manner.

The scales used to weigh people had been broken for approximately nine months.

The garden at the service was not being adequately maintained to enable people to utilise it safely. Staff were doing their best to maintain it in their own time but the service no longer had a gardener.

We looked at support plans and found that they were written in a person centred way and included a good level of detail. The documents within people’s support plans were not always completed fully. The review of these documents also needed to be more clearly recorded.

We observed that people were encouraged to be as independent

The majority of the people living at Real Life Options found it difficult to express their experiences of living at the home. We spoke to all seven people and four visitors and those able to tell us themselves or through a visitor said that they enjoyed living there and felt supported by staff.

We found that the nutritional needs of people living at the home were met. One visitor said, “The food is top class”. Staff and visitors told us that people often choose to go out for meals as they like to socialise.

At the inspection, we found a homely atmosphere, with clean and tidy surroundings. We spoke to staff and they told us they were proud to work there. One visitor took us to their relative’s bedroom and said that they were very pleased with it.

The premises provided a safe, warm and suitable environment for people to live in. We spoke to one visitor who said, “They are always doing something in here to make things better for people”.

We looked at staff records at the home and found that staff were suitably qualified, skilled and experienced to be able to care and support people living at Real Life Options.

People and visitors told us that if they had any complaints they would not hesitate to speak to the staff. One visitor said "Staff will do anything to help as they are very approachable".

We spoke with one person who used the service. They told us about an upcoming celebration, which they were looking forward to.

We also used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of three people, who spoke very highly of the quality of care, the environment and staff at Darlington Road. They all told us that it had provided them with sense of security and safety for their relatives.

One relative told us, "The manager is very approachable. He knows what is going on and has the best interests of people who use the service at heart. When things don't go as smoothly, he will look into it. He deals with anything that comes up. I feel I can say anything to him, and he puts my mind at rest. He encourages staff to think creatively about how to meet people's needs. I hope he never leaves."

People who used the service were respected, and where appropriate, their relatives, friends and representatives were involved in decisions about care delivery. People experienced care, treatment and support that met their needs and protected their rights.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.