This was an unannounced inspection carried out on the 8 and 9 November 2016. At the last inspection in March 2015 we found the provider had failed to ensure the premises were properly maintained and suitable for the purpose for which they were being used. At this inspection we found the provider had made the required improvements.

Croft House provides 24 hour care and support for up to seven people with complex learning disability needs. The service provides long term care. It is situated in a residential area close to the centre of Horsforth in Leeds.

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 and associated Regulations about how the service is run.

People told us and indicated by gestures, signs and body language that they felt safe in their home. We saw there was a positive atmosphere in the service and people who used the service had developed good relationships with the staff team. Staff could recognise abuse and knew what action to take to keep people safe.

There were systems in place to ensure people received their medication safely and as prescribed. Medicines were stored correctly and Medication administration record (MAR) charts showed people received their medicines as prescribed.

People had plans in place to manage risks, which staff understood and followed. However, we found the risk management plan records did not always give detailed guidance for staff.

The registered manager and provider had systems in place to make sure staff were recruited safely and there was enough staff to meet people's needs. Recruitment procedures were robust to ensure that staff were suitable and fit to be employed.

People received care and support from staff that had the skills and knowledge to understand their role. Staff training was updated regularly and staff had regular supervision that helped identify training needs and improve the quality of care. However, the provider had not made sure refresher training in moving and handling was available to staff.

The management team and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had made appropriate referrals to the relevant authorities to ensure people's rights were protected. However, two authorisations to deprive people of their liberty had expired at the time of our inspection.

People were supported to eat and drink well and to maintain a varied balanced diet of their choice. People had access to healthcare facilities and support that met their needs.

People received support from staff who showed kindness and compassion. Their dignity and privacy was respected. Staff understood people's individual needs in relation to their care and communication.

People were supported to pursue social interests relevant to their needs, wishes and interests.

Arrangements were in place for people to maintain links with the local community, friends and family.

Staff showed good knowledge of people’s support needs and preferences. However, some support plans did not always give specific, detailed guidance on how support needs were to be met.

There were systems of audit in place to check, monitor and improve the quality of the service.

We inspected the service on 23 March 2015. The visit was unannounced. Our last inspection took place on 11 June 2013 and there were no identified breaches of legal requirements.

Croft House provides 24 hour care and support for up to seven people with complex learning disability needs. The service provides long term care. It is situated in a quiet residential area close to the centre of Horsforth in Leeds.

The home had a registered manager. 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 looked at the arrangements in place for the storage, administration, ordering and disposal of medicines and found medicines were not being stored as per manufacturer’s guidance. Medicines were administered to people by trained care staff.

People received sufficient amounts to eat and drink. We found the dining experience for people using the service was good.

Robust recruitment processes were in place which ensured staff were suitable to work with vulnerable adults.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). We were told that all seven people using the service were subject to authorised deprivation of liberty. People’s care records demonstrated that all relevant documentation was securely and clearly filed.

Staff received regular supervision and annual appraisals. This gave staff the opportunity to discuss their training needs and requirements.

People using the service and their relative had opportunity to give their views and opinions on the service provision. There were regular resident and relative meetings and satisfaction surveys were also distributed to people using the service on an annual basis.

Staff demonstrated a good understanding of how to protect vulnerable adults. They told us they had attended safeguarding training and were aware of the policies in place regarding reporting concerns.

Care plans were person centred and individually tailored to meet people’s needs.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service. However, the provider had failed to respond to the maintenance issues which the quality assurance system had identified. These were in relation to the redecoration required at the home and also areas which required improvements included rotten window frames, stained grouting, wooden shelving very worn and stained, a stained bath, holes in tiles, broken bath panel and wallpaper coming away from the walls.

We looked in people’s bedrooms and found people had personalised their rooms with ornaments and photographs.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The service supported people with a wide range of complex needs. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

During our visit, we saw staff interacting with people in a positive, respectful and caring manner. People experienced care, treatment and support that met their needs and protected their rights.

People appeared relaxed and comfortable in the presence of staff. We observed staff treating people kindly with regard to their dignity and privacy.

We were able to communicate verbally with one person who used the service. When we asked them if they liked the home and the staff who supported them, they replied, “Yes.”

There were effective systems in place to manage and reduce the risk of infection.

The service had effective recruitment and selection processes in place. Appropriate checks were made before people were employed by the service to make sure they had the necessary skills and experience needed for their role.

The home had systems in place to monitor the quality of the service provided.

The service cares for and supports people with a wide range of complex needs. They were not all able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

We could communicate verbally with some people who used the service to find out their views and experiences. They said they were happy at the home. They smiled, nodded and answered ‘yes’ when we asked if they liked the home and the staff who supported them. We saw that people who used the service were comfortable with staff and had good interaction with them. It was clear that staff knew the people they were supporting very well. Staff showed a good understanding of people’s communication needs whether this was through signs or gestures.

We saw that overall, care practices were good. Staff were kind and supportive to people, they treated people as individuals. Staff gave good examples of how people were treated with dignity and respect. They said it was important to give people as much choice in their life as possible and to be discreet when giving support.

However, we did note that on one occasion staff spoke without regard for a person’s dignity. We discussed this with the registered manager at the time of our visit and were assured that this would be addressed.

We saw from some records that people who used the service enjoyed a wide range of activity and were supported to have an active social life and keep in touch with family and friends. Staff said they liked to make sure people who used the service got out at some point each day. However, some people’s records showed they did not get out as often as planned. One person’s records showed they had not been out on any community activities in 11 days, another person’s showed they had been out twice in that time. Staff said that people who used the service would be able to get out more if they had more staff.

Staff said they had a good team who worked well together. They said the home was well managed and the manager worked alongside them. They said the manager was supportive. Staff said that on the whole they had enough staff to meet people’s needs properly. They did however say that it could be ‘hectic’ when all seven people who used the service were at home.