We carried out an unannounced comprehensive inspection of this service on 10 March 2016. We found that the service required improvement to become Safe, Effective, Caring and Well-Led. We identified breaches of Regulations 9, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection, the registered provider submitted an action plan telling us the action they would take to make the required improvements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Anne’s Community Services – Daleholme on our website at www.cqc.org.uk.

This inspection was comprehensive, to review the improvements made by the provider to meet the Regulations, and to provide a new rating for the service. The inspection was carried out on 12 March 2017 over one day and was unannounced.

St Anne’s Community Services – Daleholme is a purpose built service which provides residential accommodation and personal care. The service is registered to support people with a learning disability. There were five people living there at the time of this inspection.

We found that improvements had been made and the provider was now meeting the Regulations.

The service had a registered manager who had been registered with the Care Quality Commission since 2010. 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.

St Anne's Community Services - Daleholme provided good care and support for the people that lived there. People were encouraged to lead lives in line with their own preferences and choices. The emphasis was on supporting people to be as independent as possible. People were involved in making decisions about their care and how the service was run.

Care and support plans contained clear and up to date information about how people wanted their needs met. There were good opportunities for people to discuss any concerns or ideas that they had.

People were supported in having their day to day health needs met. Health services such as dentists, GPs and opticians were used as required and there were close links with other services such as the local North Yorkshire County Council's Community Learning Disability Team.

Staff were knowledgeable about the needs of each person and how they preferred to live their lives. Staff received the training they needed and were supported through regular supervision meetings with the registered manager. There were safe recruitment practices in place for new staff and there were a sufficient number of staff on duty to meet people’s needs.

There were good systems in place to keep people safe. Staff were confident about their responsibilities in relation to safeguarding and also knew who they could contact regarding any concerns they had about the service. There was a positive approach to risk taking so that people could be as independent as possible. Risks in people's day to day lives had been identified and measures put in place to keep people safe. The focus was on how each person benefited from the activity undertaken.

The staff team were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are safeguards put in place to protect people where their freedom of movement is restricted. Three people at the service had a DoLS authorisation due to the level of supervision provided by staff. Staff had been trained in the MCA and had a good awareness of issues relating to capacity and consent.

The service was well led. Staff told us that the service was well managed and that there was good support. The registered manager promoted a culture of respect, involvement and independence. There were

This inspection took place on 10 March 2016. The provider did not know we were coming. The service was last inspected in June 2014 and it was meeting all the regulations in force at that time.

St Anne’s Community Services – Daleholme is a purpose built service which provides residential and personal care. The service is registered to support people with a learning disability. It does not provide nursing care. There were 5 people living there at the time of this inspection.

The service had a registered manager who had been registered with the Care Quality Commission since 2010. 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.

Staff had been trained to recognise and respond to any safeguarding issues. Staff knowledge and understanding of safeguarding was good. However, we found one safeguarding incident which was being investigated and had not been notified to CQC and other incidents where it was unclear if a notification would have been required..

Risks to people were assessed, and risk assessments gave detailed information to ensure that people could be supported safely by staff. These had been reviewed fairly regularly. Plans were in place to keep people safe in the event of an emergency although this information was not easily accessible for staff. Accidents and incidents were not centrally analysed and considered for trends and to identify ways to minimise risk.

There were no staffing vacancies and there was a regular and consistent staff team. Staff files showed that recruitment was professional and robust to ensure suitable applicants were employed.

Medicine administration was managed safely and carried out appropriately and all staff had received training, although some required up to date training. Medicine storage was safe and appropriate. People were well supported with their nutritional needs and with their general health needs.

Staff had received some training to enable them to meet people’s needs. Other training had not yet been delivered or was overdue. Staff had received supervision and annual appraisal and this was completed in line with the provider's own policy. Some records of supervision were repetitive but showed that the conversation between staff and the registered manager was a two way discussion.

People were asked to give their consent to their care. Where people were not able to give informed consent, their rights under the Mental Capacity Act 2005 were monitored. The Care Quality Commission had not been notified where deprivation of liberty authorisations were in place. We will write to the provider about this. Staff knowledge of mental capacity and deprivation of liberty was poor.

People we spoke with who used the service gave us positive feedback about the service and were satisfied with the care and support they received. We observed that some staff were caring and knew people well but others were less pro-active in their approach to people. Staff did not always show a good understanding of the importance of dignity, privacy and respect.

Care plans were clear and detailed, and reflected people’s preferences. They were personalised and demonstrated input from relevant others. Reviews and updates were recorded clearly. The range of personalised activities offered to people on a daily basis was limited and we observed long periods of inactivity.

The environment was in good condition. Infection control was well managed and staff demonstrated an understanding of ways to minimise the risk of infection.

There was mixed staff morale across the staff team and differing approaches to working with us during the inspection in an open and transparent way. Staff and people who used the service felt the register

Our inspection team was made up of a lead inspector. During the inspection we asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

On the day of the inspection we met five people living at Daleholme. We talked with two people about their experience of care and due to communication difficulties, we observed the interaction between staff and all people who used the service. We talked with four staff including the manager and looked at records. We subsequently talked with relatives of one person by telephone and during the visit we spoke with a sensory therapist who was visiting a person who lived at Daleholme. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that staff learnt from events such as accidents and incidents. We saw evidence of risk assessments which were in place for every aspect of each person's care and support and that these were regularly reviewed. This reduced the risks to people living at Daleholme and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Staff personnel records contained all the information required, which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living there. Staffing levels were appropriate to meet the needs of the service and were reviewed and adjusted to address any changing requirements.

Is the service effective?

People we observed appeared to be happy with the care they received and it was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew each person well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved where possible in discussion and writing their plans of care. Staff spoke with pride about the progress that individual people had made whilst they had been living at Daleholme. The relative we spoke with was able to describe specific benefits to the health and wellbeing of their relative living at the home and the impact that this had had on their daily life. They told us, "I've been very pleased, I know [name of the person] is being well looked after."

Is the service caring?

People were supported by kind and attentive staff. We observed that staff were patient and gave encouragement and we saw that people were supported to do things at their own pace and to be as independent as possible. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included visiting local places of interest and shopping. We observed positive interactions between staff and people who lived in the service.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. Staff told us that they felt well supported by the manager, could discuss any issues and raise concerns.

We were not able to communicate with some people living at the home due to their complex communication needs. We saw however that people were comfortable with staff and that staff knew the people they were supporting well. People appeared relaxed and comfortable in their surroundings.

We found that people were involved in making decisions about their care wherever possible. Where people did not have capacity or needed additional support to make decisions appropriate arrangements had been put in place. This was important to make sure people’s rights were protected.

We confirmed that the systems for the management of medication were safe and well organised.

We found that staff were trained and well supported to do their jobs. This included consistent up to date training, regular supervision and staff meetings.

We saw that an effective system was in place to identify concerns or complaints raised. Regular checks were also carried out by senior management, to monitor the quality of the service and this included people’s ‘satisfaction’ of the service.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were a Registered Manager on our register at the time. This is presently being processed.

We were not able to communicate with all people living at the home due to their complex communication needs. We did however see that people were very comfortable with staff and that staff knew the people they were supporting well. Staff showed a good understanding of people’s communication needs through non verbal communications, signs and vocal sounds.

We found that people had been supported to be involved in making decisions about their care wherever possible. Where people did not have capacity and needed support to make decisions appropriate arrangements had been put in place. Suitable arrangements for planning and reviewing the care people needed were also in place.

We also looked at people’s care records. We found records were accurate, up to date and regularly reviewed. We also saw how people were supported with their communication and included in decision making throughout their treatment and support.

We found that staff were trained and supported to do their jobs well. This included specialised training, regular supervision and staff meetings. Staff also had regular opportunities to air their opinions and had team meetings.

We saw that regular checks were carried out by senior management, to monitor the quality of the service and that the service annually reviewed people’s ‘satisfaction’ of the service.

One person was able to tell me 'its nice here the staff are nice' and 'if I was unhappy I would tell my key worker'. Other people were not able to tell me what they thought but through observations they appeared to be relaxed and able, to access the parts of the home they wanted.