This inspection took place on 4 and 8 October 2018 and was unannounced.

At our last inspection on 27 June 2017 the service was rated ‘Requires Improvement’. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 which related to some staff being unable to explain what safeguarding meant and how to report any concerns appropriately, understanding the purpose of people’s behaviour support plans and staff being unaware of some people’s personal risks. We also found a breach of regulation 18 around staff not always receiving the training they needed to provide effective support and understand people’s specific conditions. Some staff were also unbale to explain how the principles of the Mental Capacity Act (MCA) impacted on the people that they worked with.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. At this inspection we found that the provider had used the action plan to address these breaches. All staff had been re-trained in safeguarding, MCA and how to effectively use people’s behaviour support plans.

The problems found at the last inspection had been addressed and we found no further breaches at this inspection. The home is now rated ‘Good’.

Roseneath Avenue 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.

The home is registered to accommodate six people in self-contained flats. Each person has a large flat within the home consisting of a bedroom, living and kitchen area and a bathroom and contained everything the person needed to live independently. Since the last inspection the home had refurbished four of the self-contained flats to a high standard. The home also had a back garden that people had access to. At the time of the inspection, four people were living at Roseneath Avenue.

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.

There was 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.

People had person centred risk assessments that provided staff with detailed guidance on how to minimise known risks in the least restrictive way. Staff were able to explain people’s personal risks.

Behaviour that challenged was recognised and there were strategies in place tailored to each person. Staff understood how to work with people effectively to keep them safe and maintain their well-being.

Medicines were managed safely and people received their medicines on time. Staff had received training in medicines and how to administer them safely.

The home had a good understanding of infection control and staff used personal protective equipment to ensure safe care.

Staff received regular supervision, appraisal and training to support them in the role. Staff also received specialist training in working with people living with a learning disability.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to eat healthily and the home supported people where they nee

This inspection took place on 27 June 2017 and was unannounced. At our last inspection on 16 May 2016, the home was in breach of Regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found out of date food in three people’s flats and we did not find evidence that people’s capacity had been assessed and if consent to care was obtained using the Mental Capacity Act 2005 principles. The provider sent an action plan after the inspection to demonstrate how improvements would be made to meet the breaches.

Roseneath Avenue is a care home which is registered to provide personal care and accommodation for a maximum of six adults. People living in the home have autistic spectrum disorder. At this inspection there were three people living in the home in their own self-contained flats.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Risks had been identified and assessed that provided information on how to mitigate risks to keep people safe. However, one person had not been protected against identified risks to ensure they were safe at all times.

There was a comprehensive positive behaviour support (PBS) and traffic light plan for people who demonstrated behaviour which may put people and staff at risk. However, some staff we spoke with could not explain what PBS was or how they could use it to keep people safe.

Some staff were not able to tell us what constituted a safeguarding incident and who to report abuse to outside the organisation.

Mental Capacity Act 2005 (MCA) assessments had been carried out using the MCA principles by the registered manager. Deprivation of Liberty Safeguards application had been made to deprive people of their liberties lawfully. However, most staff were unable to tell us about the principles of the Act and what this meant for the people they supported.

Not all staff had completed essential training to perform their roles effectively such as MCA, safeguarding, first aid and infection control.

There were systems in place for quality assurance and monitoring. However, the quality assurance system had not identified the concerns we found with training and staff knowledge.

Medicines were being managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were given choices during meal times and their needs and preferences were taken into account. People’s diets were catered for. People’s weights were recorded and monitored regularly.

Care plans listed people’s support needs and were person centred.

There was a programme of activities. These activities took place regularly.

Complaints were recorded and investigated with a response sent to the complainant.

Pre-employment checks had been made to ensure suitable staff were employed by the home.

Appropriate referrals to other healthcare professionals were made.

People were treated in a respectful and dignified manner by staff.

Staff meetings were being held regularly.

Staff felt well supported by the management team and relatives were complimentary about the management of the home.

We identified breaches of regulations relating to training and safe care. You can see what action we have asked the provider to take at the back of the full version of this report.

This inspection took place on 16 March 2016 and was unannounced. We had undertaken a previous inspection on 26 August 2015. During the previous inspection the home was in breach of two legal requirement and regulation associated with the Health and Social Care Act 2008. We found that appointments had not been made with the chiropodist and dentist for people’s needs to be assessed and attended to. We also found that complaints had not been managed appropriately.

Roseneath Avenue is a care home which is registered to provide personal care and accommodation for a maximum of six adults. People living in the home have autistic spectrum disorder. At this inspection there were six people living in the home in their own self-contained flats.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Two staff were unable to tell us they could ‘Whistleblow’ to external organisations such as the CQC and local authority. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

We found out of date food in three people’s flats. This meant that people may not be protected against the risk of food poisoning or other health complications. People were given choices during meal times and their needs and preferences were taken into account. People’s weight were recorded and monitored regularly.

Most risk assessments were updated to reflect people’s current needs and took into consideration people’s health needs. We found one person who was at risk of choking, there was no specific intervention or guidance to staff on the action that will need to be taken to ensure the risk of choking is minimised. The registered manager told us this will be included.

Systems were not in place to calculate staffing levels contingent with people’s dependency levels. We made a recommendation that staffing levels are regularly assessed by the service against people’s dependency needs.

We did not find evidence that people’s capacity had been assessed and if consent to care was obtained using the Mental Capacity Act 2005 principles.

Most staff had been trained. Although training had been provided in safeguarding and MCA, some staff were not aware on how to whistleblow and the principles of the MCA.

Due to risks to their safety people living at the home were not allowed to go outside without staff or relative accompanying them. Appropriate Deprivation of Liberty Safeguards had been applied for people that required supervision when going outside.

Some staff had concerns about the culture; however we saw the management team were taking appropriate action to address these concerns.

There was a positive behaviour support and traffic light plan for people that demonstrated behaviour which may put people and staff at risk. These plans provided information to staff on how to minimise the risk of behaviours that may challenge the service.

Care plans listed people’s support needs and were person centred.

Quality assurance had been implemented to allow the service to demonstrate effectively the safety and quality of the home.

Complaints were recorded and investigated with a response sent to the complainant.

Recruitment and selection procedures were in place. Checks had been undertaken to ensure staff were suitable for the role. Staff had received induction when starting employment.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

We observed caring and f

We undertook this unannounced inspection on 26 August 2015. Roseneath Avenue a care home which is registered to provide personal care and accommodation for a maximum of six adults. People living in the home have autistic spectrum disorder. At this inspection there were five people living in the home in their own self-contained flats.

At our last inspection on 26 November 2013 the service met the regulations we looked at.

The home did not have a registered manager. A new manager had recently been recruited. Like registered providers, registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People who used the service had complex needs and communication difficulties. They did not express their views to us regarding the services provided. However, we observed that they were appropriately dressed and well cared for by staff who were attentive and caring.

We spoke with three relatives who informed us that people who used the service had been treated with respect and dignity. However, the relatives concerned were not fully satisfied with some aspects of the service. This included the lack of communication with them and poor response to concerns expressed.

People’s needs had been assessed. Staff had prepared appropriate and detailed care plans with the involvement of people and their representatives. People’s healthcare needs were monitored and arrangements had been made for them to be attended to. We however, noted that appointments had not been made with the chiropodist and dentist for people’s needs to be assessed and attended to.

Staff were caring and knowledgeable regarding the individual care needs of people. A positive behaviour therapist provided guidance to staff on how to effectively support people with behavioural difficulties. The home had arrangements for encouraging people to express their views regarding areas such as activities and meals provided. People’s preferences were recorded and arrangements were in place to ensure that these were responded to. There were arrangements for people to be engaged in activities both in the home and in the community. Some relatives however, stated that people did not engage in sufficient activities outside the home.

Staff ensured that the dietary needs of people were met and special diets were catered for. Staff were aware of the importance of promoting healthy eating. People had received their medicines. There were suitable arrangements for the recording, storage, administration and disposal of medicines in the home.

There were enough staff to meet people's needs. Staff had been recruited in accordance with the required procedure and provided with essential training to enable them to care effectively for people. Staff had the necessary support and supervision from their managers and other senior staff. They were aware of the needs of people with autism.

Staff knew how to recognise and report any concerns or allegations of abuse. A number of allegations of abuse had been notified to the CQC investigated by the local safeguarding team. Management and staff of the home had co-operated with the investigations and action had been taken in response to the safeguarding action plan.

The home had arrangements for quality assurance. Regular audits and checks had been carried out by the manager and the regional manager. These reflected the CQC standards expected of care services. Relatives of people however, complained that staff were not sufficiently responsive and communication was poor. The home did not have adequate arrangements for responding to complaints and concerns by relatives or arrangements for them to meet and express their views regarding the running of the home and its impact on the care of people.

We found the premises were clean and tidy. The home had an infection control policy and measures were in place for infection control. There was a record of essential inspections and maintenance carried out. Risk assessments had been carried out and these contained guidance to staff on protecting people.

At this inspection there were two breaches of regulation relating to regulations 9 and 16, please refer to the “Effective” and “Responsive” sections of this report for details. You can see what action we told the provider to take at the back of the full version of the report.

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant most of them were not able to tell us their experiences. We spoke with a visiting relative and social worker. The relative said, “The house and the staff are fantastic. If we could move this place closer to the family home it would be perfect.” The social worker told us how the staff had supported the person to become more independent, and able to enjoy activities in the community.

We spoke with one person who told us that they decided what they wanted to do each day, and that they took part in health and safety audits in the home.

Each person who used the service lived in their own self-contained flat at the premises. Two of the six people had two support workers with them throughout the day, and the other four each had one support worker. The staff who we spoke with said that they knew each person’s needs well, and used the support plans and behaviour guidance for information on how to support each person.

The staff who we spoke with were aware of the nutritional needs of the people they supported, and of the signs of possible malnutrition.

The Registered Manager and staff were familiar with safeguarding procedures, including how to recognise and respond to signs of abuse. Safeguarding concerns were reported to the appropriate authorities, and appropriate actions were taken when needed following investigation.

People had been provided with an individualised activity programme. The activities were planned for each person and showed what they liked to do each week. Care plans showed what people needed when engaging in activities for example a person needed increased staffing when they were in the community. People had up to date care and support plans and risk assessments based on their current assessed needs.

The service had systems in place to help protect people from abuse.

Staff were supported to develop their skills and received training relevant to their role. Staff received supervision and new staff completed an induction.

In terms of respecting and involving people who use services we documented the following information. The people have varying ways of communicating their individual needs such as pictorial menu cards, the use of a pictorial menu folder, pictorial activity plans. People communicate using signs gestures and facial expressions. Therefore the use of observation and asking a questions using short sentences and awaiting a response in the form of an expression like a smile or a thumbs up sign were used to interact with the people using the service.

We observed there were pictorial picture cards a menu folder and a menu board to assist people to make their own decisions with regard to meals eaten.

A person confirmed the food was 'nice' when asked about the quality of the food provided.

A person when asked if they were happy with the food smiled and another person gave two thumbs up.

People were observed to enjoy their meals and all of the food was eaten by the people using the service.

When the issue was discussed in relation to dignity and respect one staff member commented 'I observe people listen to what they say and treat them as an individual'.

We spoke with the staff about people's care and treatment. Staff confirmed that if people refuse to attend medical appointments then their wishes are respected and an appointment is made for another day. The fact that they refuse medical appointments is also recorded in their care plan.

A person confirmed that if they did not want to attend appointments that they are 'not made to go'

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A person commented that ‘the service had improved since the new manager had been appointed and they felt that the care they were receiving had improved’

All feedback was positive. People indicated to us using sign and facial expressions that the food was good. When asked are you happy with the food. A person was able to confirm that they liked the food saying ''it is nice particularly roast dinner''.

We asked this person what they had for breakfast and their feedback matched with the choices on the menu.

With regard to cooperating with other providers we observed information on the notice board there was information about to the people that use the service that advocacy information was available.

We observed the manager and staff had read the communication book and read through the book with the person confirming the events of the day.

With regard to safeguarding people who use services from abuse the following information and comments were provided. We observed that staff were speaking to people in a respectful manner. Staff knew how to recognise the signs of abuse. Staff confirmed that they knew how to respond if abuse was taking place.

Staff confirmed they had undertaken training regarding safeguarding adults and this was part of their re-induction.