About the service: Samuel Close (1,2,3) is a 'care home' and accommodates up to 16 adults with learning disabilities who require personal care across three separate homes, each of which have separate adapted facilities. At the time of the inspection, 15 people were using the service.

•Care plans and risk assessments were not updated following the agency changing its name in November 2017.

•Risks were not always identified in relation to falls and risk management plans were not in place to manage these safely.

•Risks were not reviewed on a regular basis.

•People were not involved in planning their care and support needs.

•People's medicines were not always safely managed.

•The providers quality monitoring systems were not effective.

•People told us they felt safe. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse.

•Accidents and incidents were appropriately managed and learning from this was disseminated to staff.

•People were protected from risk of infection because staff followed appropriate infection control

protocols.

•There were enough staff available to support people's needs.

•Assessments were carried out prior to people joining the service to ensure their needs could be met.

•Staff were supported through induction, training and supervision to ensure they carried out their roles effectively.

•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 supported and encouraged to eat a healthy and well-balanced diet.

•People had access to healthcare professionals when required to maintain good health.

•People told us staff were kind and respected their privacy, dignity and promoted their independence.

•People were involved in making decisions about their daily care needs. For example, what to wear and what to eat.

•Staff understood the Equality Act and supported people's individual diverse needs if required.

•People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

•People were aware of the home's complaints procedures and knew how to raise a complaint.

•The service was not currently supporting people who were considered end of life, if they did this would be recorded in their care plans.

•Regular feedback was sought from people and staff about the service and acted upon if necessary.

•The provider worked in partnership with key organisations to ensure people's needs were planned and met and deliver an effective service.

•Relatives, people and staff were complimentary about the registered manager

Rating at last inspection: Requires Improvement (report published 14 March 2018).

Why we inspected: This inspection was part of a scheduled plan based on our last rating of the service and aimed to follow up on some concerns we had found at our inspection in January 2018.

Enforcement: Please see the 'actions we have told the provider to take' section towards the end of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We undertook an unannounced inspection on 23 and 27 April 2018 of Samuel Close (1,2,3).

Samuel Close (1,2,3) 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.

Samuel Close (1,2,3) accommodates up to 17 adults with learning disabilities who require personal care across three separate homes, each of which have separate adapted facilities. At the time of the inspection, 15 people were using the service.

There was a registered manager in post. 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.

During this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not receive person centred care and were not being engaged with meaningful activities. Staff tended to be more task focused and we observed instances where staff were not caring and did not treat people with respect.

People were supported to maintain a balanced diet. However, people did not experience an enjoyable and sociable experience during their mealtimes.

The homes were clean and tidy. However, the decor was not suitable for people with learning disabilities and sensory needs. We made a recommendation that the service seek advice and guidance from a reputable source about adjustments required to meet the needs of people using the service.

The system in place to manage people’s finances was not robust as there was a lack of external auditing conducted to ensure people were not at risk of financial abuse.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, and specific to each person and their needs. Care plans were regularly reviewed and were updated when people's needs changed. Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risks to people were identified and managed so that people were safe.

Systems were in place to make sure people received their medicines safely.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from the management team.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act 2005 (MCA). Best interests decisions were made where people lacked capacity to make specific decisions for themselves, in line with the MCA. People were supported to have 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 supported with their nutritional and hydration needs. Staff were aware of people’s dietary requirements and the support they needed with their food and drink.

Procedures were in place for receiving, handling and responding to comments and complaints. We saw evidence that complaints had been dealt with appropriately and in a timely manner.

Staff told us that they received up to date information about the service and had an opportunity to share good practice and any concerns they had at team meetings. Staff spoke positively about working for the service.

The quality of the service was monitored and regular audits had been carried out by management. There were systems in place to make necessary improvements when needed.

This inspection took place on 1 and 3 February 2016 and was unannounced. We last inspected Samuel Close on 31 January 2014. At that inspection we found the service was meeting all the regulations that we assessed.

Samuel Close provides accommodation and personal care for up to 17 people with learning disabilities. It is set in a small cul-de-sac and is made up of three units. At the time of this inspection the service was providing care and support to 15 people.

There was a registered manager in post at the time of our inspection. 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.

The relatives of people using the service told us their relatives were safe and that staff treated them well. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. Risks to people were assessed and care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed training specific to the needs of the people they supported and they received regular supervision and annual appraisals of their work performance. People were provided with sufficient amounts of nutritional food and drink to meet their needs. People had access to a GP and other health care professionals when they needed them. The manager and staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and acted according to this legislation.

People and their relatives, where appropriate, had been involved in planning for their care needs. Relatives told us they were aware of the complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The manager recognised the importance of regularly monitoring the quality of the service provided to people. Staff said they enjoyed working at the service and they received good support from the manager. There was an out of hours on call system in operation that ensured management support and advice was always available when staff needed it.

We spoke with four people who used the service, five relatives or visitors, two health care professionals, six members of staff and the registered manager during this unannounced inspection.

We saw that staff spoke with people in respectful and appropriate ways. People's rooms had been personalised. Support plans detailed the ways people communicated, individuals likes and dislikes and how to work with individuals to minimise risks. Relatives were "happy" with the services provided, saying "very pleased", "they're at the best place", "staff keep us informed", "we attend annual reviews and are involved in care planning" and "staff provide appropriate care and support". One person said "staff are always changing, you just get used to one and they leave, this can be hard for people".

Staff said they had the required recruitment checks, induction and the training and support that they needed to carry out their role. Generally staff felt that there were enough staff but said that having "more permanent staff would be better for the people who used the service".

We saw the three houses were managed in the same way but operated differently to suit the needs of the people that lived there. Staff worked with people in the best ways to meet their needs, although this was difficult due to the environment and the number of people with autism and challenging behaviours. Staffing levels in the houses were seen to be sufficient during our visit.

When we inspected Bungalow 1, Samuel Close, we used a number of different methods to help us to understand the experiences of people using the service. People had complex needs which meant that it was difficult for them to tell us. We talked to some people who use the service about the activities that they enjoyed doing and we observed positive interactions between staff and people using the service throughout the visit.

The new registered manager appointed in November 2012 and was currently reviewing the home’s procedures and some changes to improve the service had been introduced.

There were processes in place to assess and review the care and support provided for people on a regular basis and observed that there was a schedule of monthly meetings with key workers which had been introduced in the last three months. Staff had knowledge and understanding of the individual needs of the people using the service. We observed staff supporting people in a professional and respectful way. We saw that there were processes and procedures to ensure that their safety and protection was maintained.

When we inspected Samuel Close (1,2,3) in October 2011 we found the provider was not meeting some standards and improvements were needed. The provider wrote to us and gave us a detailed account of the action they would take to achieve compliance with these standards.

We used a number of different methods to help us understand the experiences of people who used the service because people had complex needs which meant that they were mostly not able to tell us. Relatives were invited to speak with us in telephone interviews but none came forward.

One person who used the service told us they liked being at Samuel Close and enjoyed going out for walks and to the shops and restaurants. We spoke with one relative who said they were happy with the care being provided.

We observed staff supporting people to try to do more for themselves and engage in new activities. Staff were more responsive to people who used the service and more mindful of people’s sense of worth than at our last inspection.