199a – 203a Salthouse Road Lane is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of eight people with a learning disability. Accommodation is provided in three purpose built bungalows.

We undertook this unannounced inspection on 16 March 2017. At the time of our inspection there were 7 people living at the service.

At the last inspection on 5 February 2016, the overall rating for the service was ‘Requires Improvement’. This related to making improvements to medicines management, stopping the practice of wedging doors open and the safe storage of disposable gloves and aprons. Further action also needed to be taken to promote good infection control practices when washing clothing and other items. Some minor incidents between people had not been assessed and scored using the specific risk management tool provided by the local safeguarding team. Risk assessments were completed; but further detail was needed to be included for staff about recognising the signs of changing behaviours. When accidents or incidents had occurred in the service, records of actions taken to review and investigate these were not always in place.

At this inspection we found automatic closures had been fitted to doors so they were no longer wedged open. Disposable gloves were stored away from clients. Records were being maintained of all incidents and the action that had been taken following these and any referrals made to the local safeguarding team and the Care Quality Commission. Risk assessments had been updated and included information to guide staff on how to recognise potential triggers and changes in behaviour. Processes had been introduced to ensure accidents and incidents were analysed within the service by the manager, and further reviews of these were completed by the quality assurance manager and at senior management level.

There was no registered manager in post. The previous registered manager had recently left the service to take up another post within the organisation and a new manager had been appointed to the post in the last month. The service is required to have a registered manager, and as such, the registered provider was not meeting the conditions of their registration. 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. When a service does not have a registered manager in place the rating in well led cannot be rated any more than ‘requires improvement’. A manager had been appointed but had not been through the registration process to become the registered manager. They had been at the service for two weeks at the time of our inspection.

We found improvements were required to ensure people’s specialist dietary records were completed in more detail to reflect what people had eaten and the texture and presentation of the food.

We found further action was required to ensure that the date was recorded when topical creams were opened. Individual ‘pro re nata’ (PRN when necessary) protocols for pain relief needed to be reviewed and include the dosage of the medicine that had been prescribed. These issues were addressed by the manager during the inspection.

Relatives and professionals praised the skills of the core staff team and shared their reservations about the reliance and use of agency staff and lack of continuity of managers in the service.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff and relatives involved.

The environment was found to be clean and tidy throughout. Areas of the service were beginning to look tired. This had been identified by

199A - 203A Salthouse Road is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of eight people with a learning disability. Accommodation is provided in three purpose built bungalows.

We undertook this unannounced inspection on the 5 February 2016. At the time of the inspection there were eight people living at the service.

The service had 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.

We found improvements were required in some areas of medicines management to ensure recording was accurate and stock control was efficient. People received their medicines as required although there had been some occasions when staff could have contacted their GPs to seek advice.

There were policies and procedures to help guide staff in how to keep people safe from the risk of harm and abuse. Staff were knowledgeable about the different types of abuse and knew how to raise concerns. We found staff recorded when incidents occurred between people who used the service and incidents were referred appropriately to the local authority safeguarding team.

People had risk assessments in place which helped to guide staff in how to minimise the reoccurrence of incidents. Staff told us they had read risk assessments for people who used the service and were aware of their responsibilities and the steps to take to minimise risk. However, we found one instance where risk assessments could be improved.

We found the environment was clean and tidy, but improvements were required to stop the practice of fire doors being wedged open and to the safe storage of disposable gloves and bags. Further action also needed to be taken to promote good infection control practices when washing clothing and other items. Equipment used in the service was maintained.

We looked at the recruitment checks the service had carried out for new staff. These showed robust measures were in place to ensure staff were suitable to work with vulnerable people. Staff received an induction and had access to training, supervision and support to help them to develop and feel confident when caring for people and carrying out their roles.

We found people’s health care needs were met. They had access to a range of health professionals and staff were clear about how they monitored people’s health in order to seek medical attention quickly. Comments from health professionals who visited the service were positive about the staff team being helpful and receptive to their help and support.

We found staff had a caring and considerate approach towards people who used the service and found ways to promote people’s independence, privacy and dignity. Staff provided information to people and included them in decisions about their support and care.

People had assessments of their needs and plans of care were produced; these showed people and their relatives had been involved in the process. We observed people received care that was person-centred.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to it. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

Menus were varied and staff confirmed choices and alternatives were available for each meal; we observed drinks and snacks were served between meals. People’s weight was monitored and referrals to dieticians

We were unable to gain the views of the people when we visited due to their complex needs. We observed how support was provided, reviewed records, and spoke with staff.

We found people were involved as much as possible in decisions about care and treatment. Decisions were made in people’s best interest when they were assessed as not having capacity to make the decision. We saw staff offering assistance and communicating with people. It was clear that people consented to the practical care given.

We saw people involved in activities and they could choose what they wanted to do at any time. The staff we spoke with were well aware of people's individual care and support needs.

People who used the service were provided with a balanced and varied diet. Health professionals provided guidance and treatment when required.

The premises were in a good state of repair and were clean and fresh.

There were sufficient staff available at all times to meet people's individual needs.

People had opportunities to comment on the service through meetings and surveys.

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people’s needs and provided reassurance and guidance when needed.