This inspection took place on 14 and 15 November 2018 and was unannounced. At our last inspection in March 2018, the service was rated as ‘inadequate’ and the following concerns were raised:

The provider had failed to ensure that staff consistently obtained people's consent before any care or treatment was provided. This resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

The provider had failed to ensure relevant health and safety concerns were included in people's care and treatment plans and that medical attention was consistently sought when people were unwell. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

The provider had failed to ensure service users were protected from abuse and improper treatment in accordance with this regulation. This resulted in a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

Systems and processes were not in place to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of people living at the home. This resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made but more work was required to ensure the systems and processes in place were embedded and sustainable.

Following the last inspection, we asked the provider to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe and Well Led, from inadequate to at least good. We also asked them to provide us with monthly reports outlining the actions taken and progress made against concerns raised. At this inspection, we found improvements had been made and systems and processes were in place to continue to monitor the delivery of care and support at the service.

Safeharbour 260 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.

Safeharbour 260 accommodates up to six people in one adapted building. At the time of the inspection, four people were living at the service.

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 new manager in post who was in the process of making an application to become registered manager of the service. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, there remain some areas where improvements made need to be further embedded to evidence sustained improvement.

People were supported by a group of staff who had been trained to recognise signs of abuse and who understood thei

This inspection took place on 07 and 08 March 2018 and was unannounced. The service was last inspection in November 2016 and at that time was rated as good.

Safeharbour 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. Safeharbour accommodates six people in one adapted building. At the time of the inspection, five people were living at the service.

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. The service did not consistently comply with Registering the Right Support and the registered manager was not aware of the policy.

There was 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.

People were not fully protected from harm and abuse. Accidents and incidents had taken place and had not been reported to the appropriate authorities. Potential safeguarding concerns had not been recognised and acted on appropriately. Systems were not in place to collect this information and learn lessons.

Systems in place to respond to behaviour that may challenge did not provide staff with enough detail on how to use de-escalation or distraction techniques. Restrictions were in place which significantly limited people’s choice and control regarding their participation in daily activities.

There was a lack of good governance and oversight of the monitoring and administration of medication. Staff competencies in administering medication were not assessed, protocols were missing and medication audits in place had failed to identify areas of concern.

Systems were not in place to ensure staff had the skills, knowledge and experience to deliver effective care and support. Not all staff had received training in specialist areas and staffs competencies were not being assessed.

People were supported to maintain a healthy diet and staff were aware of people’s dietary needs and preferences. People were not always supported to maintain good health. Staff did not routinely obtain healthcare advice or guidance when people were unwell.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

Staff were described as kind and caring but for some people, communication systems in place were not effective and did not provide staff with the information and training to communicate with all people effectively.

People were not routinely involved in the planning and development of their care. People were supported to access a wide variety of activities during the day, but did not always have their wishes respected if they did not want to participate in some of the activities.

People’s care records provided staff with detailed information about them, but were repetitive and difficult to navigate.

Relatives were confident that if they raised a complaint, it would be dealt with appropriately.

There was a lack of oversight of the service by the provider and the registered manager. There was a distinct lack of audits in place that would provide the registered manager with a view of what was happening at the service. The audits that were in place were ineffective, inconsistently completed and did not highlight the a

This inspection took place on the 14 November 2016 and was unannounced. 260 Safeharbour is registered to provide accommodation with personal care to six people with a learning disability, and autistic spectrum disorder. At the time of our inspection four people were using the service.

There was a manager in post and she was present during our inspection. 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 and associated Regulations about how the service is run.

At our last inspection in November 2015 we found that the provider was meeting the regulations of the Health and Social Care Act 2008. However some improvements were needed which we found had been made at this inspection.

Relatives we spoke with told us they thought their family members were safe and protected from harm by the staff and the systems that were in place. Staff were aware of their responsibilities to report any concerns about people’s safety, and they confirmed they had received training in relation to safeguarding people from abuse. People were supported by sufficient staff in accordance with the requirements of the funding authority. We found that people received their medicines safely. We identified some areas where improvements could be made to the medicine procedures in place. The registered manager took action to address these at the time of our visit.

A training programme was in place which ensured staff had the necessary skills and knowledge for their role. Workshops were provided to staff to discuss strategies staff used to support people. Staff told us they received support that enabled them to deliver care safely.

Staff sought people’s consent before providing support. Where people were unable to consent to their care because they did not have the mental capacity to do this, decisions were made in their best interests. Staff knew which people had their liberty restricted to keep them safe, but they were unsure about any conditions attached to the authorisations in place.

People were treated with kindness, and respect and staff promoted people’s independence and right to privacy. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health or well-being. People were supported to eat and drink in accordance with their preferences and dietary requirements.

There was a complaints policy in place and staff were aware of the signs to look out for which may indicate people where unhappy. Records showed how complaints had been responded to and the actions taken. Relatives we spoke with all knew how to raise any concerns they may have, and they had confidence that any issues would be addressed.

Relatives and staff told us the service was managed well and in people’s best interests. Systems were in place to gain feedback from these people to enable the service to make any required improvements. Audits were undertaken regularly to monitor the quality of the service provided.

Our inspection was unannounced and took place on 17 November 2015.

The provider is registered to accommodate and deliver personal care to six people who lived with a learning disability or associated need. Five people lived at the home at the time of our inspection.

The manager was registered with us as is required by law. 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 systems did not fully demonstrate safety or always confirm that people had been given their medicines as they had been prescribed.

Not all staff had received the training they required to fully equip them with the skills they needed to support the people in their care, but this was being addressed.

Staff were available to meet people’s individual needs. Staff received induction and the day to day support they needed to ensure they met people’s needs and kept them safe.

Staff knew the procedures they should follow to ensure the risk of harm and/or abuse was reduced. Recruitment processes ensured that unsuitable staff were not employed.

Relatives felt that people were supported by an adequate number of staff who were kind and caring.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

Staff supported people with their nutrition and dietary needs to promote their good health.

All people received assessments and/or treatment when it was needed from a range of health care and social care professionals which helped to promote their health and well-being.

Systems were in place for people and their relatives to raise their concerns or complaints.

Relatives and staff felt that the quality of service was good. The management of the service was stable. However, registered manager and provider had not undertaken regular audits to determine shortfalls or see if changes or improvements were needed.

People were unable to express their views verbally, so we observed how staff supported them. We spoke with four members of staff, the registered manager and the director of care for the home. We also spoke with two representatives over the telephone in order to get their feedback about the care and support provided to people in the home.

The representatives we spoke with told us they were happy with the care and support provided to their relatives. One relative said, “We are really happy with everything. We attend the reviews and contribute to the way the support and care is provided. We have no concerns.” Another relative said, "We are very happy with the care provided."

We found that systems were in place to ensure people’s consent was always obtained before any support was provided.

We saw that people’s needs were assessed, and support plans were developed in consultation with people’s representatives. Staff we spoke with were able to tell us about people’s needs. This ensured they received support in a way they preferred and in their best interests.

We found that systems were in place which ensured people received their medication as required.

The recruitment procedures that were followed ensured that only suitable staff were employed to work in the home.

The provider had a complaints procedure in place to enable people and their representatives to share their concerns.

People were unable to express their views verbally, so we observed how staff supported them. We spoke with one relative, five staff, and the manager and director of care at the home. We also spoke with two relatives over the telephone in order to get their feedback.

We saw that that staff encouraged people to be independent and make choices about their day.

Relatives spoken with told us they were happy with the support provided by the home. One relative told us, “The staff are respectful, approachable and provide excellent support. I am involved in the discussions about my relatives support plan, and the staff keep me informed. I am very happy with the way they are looked after”. Another relative said, “I am impressed and happy with the service provided, they meet my relatives needs and maximise their independence”.

We found that people’s needs were assessed, and support plans were developed in consultation with people’s representatives. Staff spoken with were able to tell us about people’s needs. This ensures they receive support in a way they prefer.

We found that arrangements were in place to ensure that people were safeguarded from harm.

Staff spoken with told us they felt supported by the management team. They confirmed they have regular training opportunities. This ensures staff are able to deliver care to an appropriate standard.

We found that systems were in place for assessing and monitoring the quality of service provided.

We carried out this review to check on the care and welfare of people using this service. There were four people living at the home on the day of the visit and no one knew we would be visiting. We met three people who live at the home and spoke with three staff.

We saw that people were very relaxed and at ease with staff and within their home

environment. The atmosphere was calm, relaxed and homely.

We saw that staff interacted well with the people who lived there, in a warm and positive manner. People had a good rapport with the staff.

We looked at care records for two people living at the home and found their records

provided clear and up to date information for staff to follow so they could assist people with the care and support they needed.

We saw that people living at the home took part in various activities so that they had an interesting and meaningful lifestyle.

People are offered a choice of meals and are encouraged and assisted to eat a balanced diet.

People’s opinions are sought, so that the home is run in the best interests of the people who live there.