This inspection took place on 25 January 2018 and was unannounced.

This was the second comprehensive inspection carried out at Solden Hill House. The last comprehensive inspection was 24 February 2016 where we rated the service as Good. The overall rating for this inspection was also Good, however, there were areas that required improvement in the Well Led domain.

Solden Hill House is a care home for adults with learning disabilities. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Solden Hill House does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Solden Hill House accommodates up to 21 people in two buildings on the Solden Hill House site. On the day of our visit, there were 19 people using the service.

Solden Hill House is also regulated to provide personal care to people living in their own homes. On the day of inspection there was one person receiving personal care in sheltered housing on the site of Solden Hill House.

The service had two registered managers for the provision of personal care and one registered manager relating to the residential care. 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.

The provider had recognised that the aging and changing needs of people using the service meant that the existing environment, activities and working practices would need to be updated to meet people’s needs. Although this had been discussed at board level actions had not been implemented to accommodate everyone’s future needs.

The provider did not have enough systems in place to monitor the quality of the service.

There was a strong sense of belonging shared by staff and people using the service. All staff believed in the ethos of the service of providing care that was inspired by the principles of Austrian philosopher, Rudolf Steiner.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

Staffing levels ensured that people's care and support needs were safely met. Safe recruitment processes were in place. People received care from staff that had received training and support to carry out their roles. People were supported to have enough to eat and drink to maintain their health and well-being.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People were supported to express themselves, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

We made a recommendation that the provider refers to research and guidelines on providing residential and supported living for adults with learning disabilities.

This unannounced inspection took place on 24 February 2016. This residential care service is registered to provide accommodation and personal care support for up to 21 people with learning disabilities. At the time of the inspection there were 21 people living at the home.

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 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 felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe but also enabled positive risk taking. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Care plans were written in a person centred approach and focussed on empowering people; personal choice, ownership for decisions and people being in control of their life. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People had caring relationships with the staff that supported them. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to. There was a stable management team and effective systems in place to assess the quality of service provided.

This unannounced inspection took place on 16 October 2014. Solden Hill House provides accommodation and personal care for up to 21 people with a learning disability some of whom have autism and can have some difficulties in communicating and socialising with other people. There were 19 people living at the home during this inspection.

At the time of this inspection there was no registered manager in post; the previous manager had left the home in August 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. The provider had employed a new manager who confirmed that they had submitted an application to the Care Quality Commission in order for them to become the registered manager for the service.

People who used the service told us that they liked living at the home, they showed us their bedrooms and we saw that they had been able to personalise them with their own items that were important to them. Staff understood people and knew their individual needs, we observed them interacting with and encouraging people to be involved in the various activities that were available within the home and in the community. Staff treated people with dignity and respect. Relatives praised the service and told us that staff knew and cared for their family members very well.

Induction and training was in place but this did not include any training for staff on learning disability or autism. The manager responded swiftly to this issue and had plans to introduce additional training so that staff could develop their knowledge or understanding of people’s diagnosis such as learning disability or autism.

We looked at how the service managed the administration of medicines. The procedures to manage risks associated with the administration of medicines were not always followed by staff working at the service.

There were sufficient staff on duty to keep people safe. The manager informed us they also planned to increase the staffing levels in the evenings and weekends to provide more opportunities for people to enjoy their hobbies, interests and outings.

People were involved in the preparation of meals. However alternative meal options were not always available for people to choose from. When people’s food and fluid intake required monitoring, the records made by staff had not always been kept up to date. Although we saw that staff had offered people drinks throughout the day to increase their fluid intake.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? the service well led?.

This is a summary of what we found.

Is the service safe?

We spoke with staff that were knowledgeable about their responsibilities to keep people safe. They were able to tell us how they would raise any safeguarding concerns that they had both within the organisation and, if needed, externally. People were treated with respect and dignity by the staff. We found that people’s preferences in their daily routines had been recorded and carried out. Regular checks had been made of the environment and the equipment to keep people safe such as fire alarms and firefighting equipment. We also found that staff had responded swiftly when people’s need had changed, and that daily records of care contained up to date information of people’s needs. We found that the care records stored in the manager’s office had not always been updated when people's needs had changed. However we saw that the daily care records of people's requirements had been changed.

Is the service effective?

We saw that individualised care plans had been put in place which ensured people’s health and wellbeing needs were met. We found that staff had responded to people’s physical health needs and that referrals to healthcare professionals had been made in a prompt way. We spoke with family members who told us that “ staff are superb, they ring the GP if there are any concerns”. We also found that people’s capacity to consent to treatment had been assessed and that treatment had been discussed with people in order to prepare them for their appointments.

Is the service caring?

We saw that people were supported by knowledgeable, kind and caring staff. We heard staff speak to people in an encouraging and sensitive way which evidenced their knowledge of people’s individual needs. We observed people being supported to partake in activities which were appropriate for their abilities. We found that whenever possible people had been involved in the planning of their care and support requirements and their wishes were respected.

Is the service responsive to people's needs?

People were involved in many and varied activities including pottery, horse riding, swimming and ‘Eurythmy’ which is a speech and movement therapy. People also participated in daily activities such as meal preparation. We found that there was a complaints process in place, and that complaints had been investigated promptly. We spoke with relatives of people that used the service and they told us “We are very satisfied and very, very happy”. Other family members told us “we have never needed to complain”.

Is the service well led?

Staff had a good understanding of the ethos of the service and we found they were knowledgeable of the needs of people who used the service. The provider had a complaints system in place, and people and family members had been asked to provide feedback on the service. We found that the feedback was positive in all aspects, except for the laundry arrangements. We found that while the manager had completed some audits to monitor the quality of the service, there was not an effective system in place to regularly assess and monitor the quality of the service.

We spoke with eleven people who used the service and most people gave positive feedback about the service. One person told us that they wanted to do more and become more independent. We found that some people who had difficulty with verbal communication were not supported with communication tools to offer feedback to the service.

We found that the provider did not have appropriate arrangements to obtain and record consent and that people did not always receive the care and support they required. We looked at the cleanliness of the home and the support that was provided to staff and found that suitable arrangements were in place. We found that the provider did not have adequate quality assurance systems in place and they did not maintain adequate records.

We spoke with people who use the service and they told us they enjoyed living at the home. One person said "There's lots to do" and other told us how they enjoyed horse riding and gardening. We spoke to one person who told us they were going to college to study gardening. We found a number of concerns in relation to record keeping at the home and staff training.