This unannounced inspection took place on the 18 and 21 December 2018.

At our last inspection on the 31 October and 2 November 2017 we found that the key questions ‘is the service safe?’ and ‘is the service well-led?’ were rated requires improvement. This was because we found that the provider had not always followed their recruitment policy and had not always informed the CQC about notifiable events that had taken place in the service. During this inspection we found that these shortfalls had been addressed.

Simone's House 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.

Simone's House accommodates five people in one adapted building. People living at the service were younger adults with mental health needs and /or physical or learning disability. Each person had their own bedroom and the ground floor bedroom was ensuite. There were communal bathroom and shower rooms, lounge/ dining area and kitchen. There was an activities room situated in the garden. When we inspected, the provider was in the process of building a conservatory so that people living in the home could have a greater choice of where to sit and better access to a quiet communal space.

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 and relatives told us staff were kind and courteous. We observed staff’s interactions with people and their relatives and found them to be professional, empathetic and caring.

People told us they felt safe at the service and staff demonstrated how they would recognise and report safeguarding adult concerns. Both the registered and deputy manager reviewed people’s records to ensure all safeguarding concerns were identified and reported to the appropriate body.

The registered manager assessed staffing need and ensured there were enough staff on duty for example to support people to go out when they wanted to undertake activities.

Medicines were administered in a safe manner and stored appropriately. People were supported by staff to access the appropriate health care to ensure both their physical and mental health needs were addressed.

People were provided with a healthy choice of meals according to their needs and given support to eat when they required. Staff reminded people to drink enough fluid to remain hydrated.

The registered manager assessed people’s needs prior to offering a service. We observed that there was often a transition process during which the registered manager worked with healthcare professionals to familiarise the person with the service and to monitor the suitability of the placement. People had person centred care plans that were reviewed on a regular basis with them, their family and professionals to ensure the level of care provided was still appropriate.

The registered manager worked in line with the Mental Capacity Act 2005 (MCA) and applied for Deprivation of Liberty Safeguards (DoLS) authorisations when people might have been deprived of their liberty and were assessed as not having capacity to make decisions about their care and treatment.

The provider worked in partnership with healthcare professionals and commissioning bodies for the benefit of people using the service.

The registered manager and director kept their learning up to date by engaging in various activities such as enrolling in relevant training and attending provider forums at the local authority.

This unannounced inspection took place on the 31 October and 2 November 2017.

Simone's House provides accommodation for up to five adults who have a range of needs, including acquired brain injuries, learning disabilities, and autism. There were five people using the service at the time of the inspection.

At the previous comprehensive inspection on 20 and 24 October 2016 the service was found to be Good overall but we found a breach of the regulations. This was because the registered manager had not informed the Commission of notifiable incidents as they are required to do by law. Registered persons must notify the Commission without delay of any allegation of abuse in relation to a service user and of any incident, which is reported to, or investigated by the police.

To address this breach the provider sent us an action plan and we conducted a focussed inspection on the 28 March 2017 to look at Well- led. We found at inspection that the registered manager had only partly met the regulation as they had failed to report one incident and did not have a central register of accidents and incidents to monitor and analyse all accidents that took place at the service.

At this inspection although we found that the registered manager was reporting to the Commission notifiable incidents, we found there was on recent occasions some delay in the notifications being sent. We brought this to the registered manager's attention. There was a discussion to clarify and confirm that the incidents were notifiable and the registered manager agreed to address this matter promptly and to take action to prevent reoccurrence of similar failures from happening.

We found, at this inspection the registered manager had oversight of accidents and incidents which occurred at the service. Staff recorded accidents and incidents and made the registered manager aware of these. The registered manager also explored with staff the measures required to ensure the accidents or incidents did not reoccur.

The provider had recruitment procedures in place but had not identified that one person’s criminal record check needed to be applied for according to the provider’s procedure. We saw that other recruitment checks had been completed. The provider immediately addressed the matter when we pointed this to them. The registered manager ensured there were sufficient staff on duty to meet people’s changing support needs.

The registered manager reported safeguarding adult concerns appropriately and staff understood their responsibility to report concerns.

People had risk assessments to keep them safe and positive risk assessments were undertaken to support people’s right to make choices and decisions. The provider had applied for Deprivation of Liberty Safeguards (DoLS) authorisations appropriately and was aware of their responsibilities under the Mental Capacity Act 2005 (MCA).

There were systems in place to ensure medicines were administered safely and these were being followed.

Staff were given appropriate training and supervision. They knew about people’s health conditions and supported people to access appropriate health care. They kept robust records to keep health professionals informed of people’s physical and mental health. Staff supported people to eat a healthy diet and to remain hydrated.

People described staff as “Good” and “Kind.” We saw caring and empathetic interactions between staff and people. Support was provided in a sensitive manner so that people’s dignity and privacy was respected. Staff supported people’s diversity needs and took action to ensure people’s right to a family life was supported.

People were involved in planning their care in a person centred way and were supported to undertake meaningful activities.

The registered manager had empowered people to raise concerns and people told us they knew how to complain and felt any complaint would be addressed thoroughly by the registered manager.

The registered manager was approach

We carried out an unannounced comprehensive inspection of this service on 20 and 24 October 2016. A breach of a legal requirement was found because two safeguarding concerns and one police incident were not reported to the Care Quality Commission as required under the Regulations. After the comprehensive inspection, the provider submitted an action plan, dated 29 November 2016, detailing what they would do to meet the legal requirements in relation to the breach.

We undertook this focused inspection on 28 March 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Simone’s House on our website at www.cqc.org.uk.

Simone's House provides accommodation for up to four adults who might have a range of needs, including acquired brain injuries, learning disabilities and/or autism and people recovering from a stroke. There were three people using the service at the time of the inspection.

The service had a registered manager who had been in post since February 2014. 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.

At our focused inspection on 28 March 2017, we found that the provider had not followed all of their plan of action, and that the legal requirement had not been fully met.

The provider failed to notify CQC of one serious incident, however, they had sent through three notifications appropriately and as required.

The service did not have a central register of accidents and incidents to monitor and analyse all accidents and incidents that took place at the service.

The registered manager and staff working at the service were aware of the service’s responsibility to submit statutory notifications.

We could not improve the rating for well-led from requires improvement because the provider had not fully complied with the regulation. To improve the rating requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Simone’s House provides accommodation for up to four adults who might have a range of needs, including acquired brain injuries, such as people recovering from a stroke and learning disabilities and/or Autism. There were four people using the service at the time of the inspection.

The inspection took place on the 20 and 24 October 2016.

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.

At the last inspection on the 24 and 25 September 2015 the provider was not meeting the legal requirements in relation to ensuring that there were detailed recruitment checks carried out on new staff before they started working with people using the service, ensuring that there were systems in place for the proper and safe management of medicines, ensuring there were sufficient numbers of staff deployed in order to carry out their duties and ensuring there were systems in place to assess and monitor the quality of service provision. At this inspection we found the provider had made improvements in these areas.

Staff supported people to have access to the health care services they needed and made sure people received the medicines they needed safely.

The provider carried out checks on staff before they worked with people using the service.

There were enough staff employed to keep people safe and meet their needs

The registered manager had not reported to the Care Quality Commission all notifiable incidents and events. Therefore we had not been aware of significant events that had occurred to see what had taken place and action the registered manager had taken.

You can see what action we told the provider to take at the back of the full version of the report.

Staff had access to the training they needed.

The risks people experienced had been assessed and there were plans in place to minimise the likelihood of harm.

The provider and staff in the service obtained people’s consent before they provided care and support. Where people lacked the capacity to make decisions about their care, the provider acted appropriately and in people’s best interests.

The provider had a policy and procedures for people using the service and others about how to make a complaint. They provided information for people using the service in formats they could understand.

People’s needs had been assessed and care plans informed the staff how they should support people.

People took part in a range of different activities which they chose to engage in both in the service and in the community.

Staff felt able to contribute their ideas and they felt valued and listened to.

Simone’s House provides accommodation for up to four adults who might have a range of needs, including acquired brain injuries, such as recovering from a stroke and learning disabilities such as Autism. The service offered both permanent and respite support to people. There were two people living in the service and a third person visiting for short respite periods at the time of the inspection.

This was Simone’s House first inspection since registering in 2014 as people only started using the service in 2015.

The inspection took place on 24 and 25 September 2015 and was announced. The provider was given 48 hours’ notice because the location was a small care home for adults who are often out during the day and we needed to be sure that someone would be in.

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.

There were concerns regarding how the management and support workers were being deployed in the service. The staff team was small and both management and support workers sometimes worked long hours without taking a break.

There were systems in place to record some of the medicines being delivered to the service. However, we found some medicines stored by the service where the quantity had not been recorded. Therefore it was not possible to carry out an accurate audit on all medicines where the amount had not been recorded clearly.

Although there were recruitment procedures in place and everyone working with people had a criminal check carried out and two references obtained, sufficient information on one support worker’s had not been sought. There was also contradictory information on their file so it was not clear where they had previously worked.

There were some systems in place to monitor the safety and quality of the service. However, these had not been fully effective in highlighting the shortfalls identified during this inspection.

Feedback from people using the service, a relative and professionals was positive. People said they would talk with the registered manager if they had a concern or complaint as did the relative we spoke with. Professionals commented that the management and support workers were passionate about caring for the people using the service and that they had seen an improvement in how people were engaging with others. Support workers told us the registered manager supported them and was visible in the service.

We observed people enjoying activities in the service and the service had a welcoming and relaxed atmosphere. People were supported to maintain relationships with those important to them. People were helped to follow their religious beliefs and attend their preferred place of worship.

People were assessed prior to moving into the service. Their care was personalised and reflected their choices and individual needs. People were encouraged to be as independent as they could be.

The health and nutritional needs of people were being met. Staff had received support from healthcare professionals and worked together with them to ensure people's individual needs were being managed.

There were procedures in place to recognise and respond to abuse and staff had been trained in how to follow these.

The deputy manager and support workers received support through supervision and to enable them to carry out the duties they performed. They had an induction programme in place that included providing training to ensure they were competent in their roles.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Where necessary, people’s capacity to make decisions about their lives was assessed and those people involved in the person’s life had their views considered.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to how management and support workers were being deployed in the service, medicines were not always being recorded when they were stored in the service, recruitment procedures did not always obtain sufficient information about new staff and there were shortfalls in the carrying out and recording in the monitoring of the quality of the service.

You can see what action we told the provider to take at the back of the full version of the report.