St Anne’s Community Services – Norfolk Road is a two-storey house, in a quiet residential area on the outskirts of Harrogate. The service is registered to provide residential care for up to four adults who may be living with a learning disability or autistic spectrum disorder. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

This inspection took place on 6 and 8 November 2018 and was announced. At the time of our inspection there were three adults with learning disabilities using the service.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion so that people with learning disabilities and autism can live as ordinary a life as any citizen.

At our last inspection in February 2016, we rated the service ‘good’. At this inspection, the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. They had been the registered manager since April 2018. A registered manager is a person who has registered with the 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 registered manager also managed two other of the provider’s locations and split their time between managing the three services. They were supported by a deputy manager and area manager.

People who used the were confident and at ease in their surroundings which showed us they felt safe. The provider safely recruited new staff and the registered manager made sure sufficient staff were on duty to meet people’s needs. We spoke with them about deployment within the service to make sure a person was not left unsupervised.

Staff were trained to recognise and respond to safeguarding concerns. They reported any accidents or incidents and the registered manager monitored these to help keep people safe. Medicines were managed safely. Risk assessments contained person-centred information to guide staff on how to safely meet people’s needs.

The environment was clean and generally well maintained. We recommended checking window restrictors regularly to make sure they remained in good working order. The laundry and bannister rails needed repainting to make them easier to clean.

Staff had regular training, supervisions and appraisals to support them to provide effective care.

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.

Staff made sure people ate and drank enough and helped them to attend appointment and access healthcare services when needed.

People and their relatives told us staff were kind and caring. Staff treated people with dignity and respect. They encouraged people to express their wishes and views and be involved in decisions.

The provider was meeting the accessible information standard. Information was provided in a range of accessible ways and staff provided effective support to help people communicate.

Care plans were person-centred and staff showed a good understanding of people’s needs and how best to support them. Staff supported people to take part in regular activities and access their wider community.

The provi

This inspection took place on the 17 February 2016 and was unannounced.

St Anne’s-Norfolk Road is a care home service with no nursing providing care for up to four adults with a learning disability and/or who are on the autistic spectrum. The service is located about a mile from Harrogate town centre in a residential area. There were four people living at the service on the day of the inspection.

A registered manager was employed at this service. 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 observed that people felt safe with staff and they and their representatives confirmed this. Staff had been trained to safeguard adults and were aware of how to recognise and report any incidents of abuse.

People who used the service were kept safe because safety checks were carried out within the environment to ensure it was fit for purpose.

Staff were recruited safely and there were sufficient staff on duty to meet people’s needs. Rotas confirmed the numbers were sustained.

People’s health and safety needs were identified and where necessary risk assessments were in place to support people’s safety.

Medicines were managed safely. We saw that staff checked medicines thoroughly before they were administered. Records were completed properly.

The service was effective because staff used the training they had received to best effect. They knew people well and followed guidance in care plans and from professionals to ensure people received care that reflected best practice.

Staff followed the principles of the Mental Capacity Act 2005 by ensuring that where people could not make their own decisions the best interest decision making process was followed to ensure that people’s wishes were carried out.

People were given a healthy nutritious diet. People were encouraged to be as independent as possible when eating and drinking.

Staff were caring and kind showing people respect. People at this service clearly felt that they mattered and staff reinforced that.

The service was well led with regular audits being carried out. Surveys were sent to people to gather their views about the way in which the service was run.

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 three people living at Norfolk Road. We talked with one person about their experience of care at Norfolk Road. Due to the communication difficulties of another person, we were unable to ask direct questions about their care but we spent time throughout the day observing their interaction with staff and their responses. Following the inspection we spoke with the relatives of two people by telephone. We talked with five staff including the area manager and the manager and looked at records. 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 and the person we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve. The service had policies and procedures in place for assessment of people under the Mental Capacity Act and for Deprivation of Liberty safeguards. On the day of the inspection all the people who lived at Norfolk Road were assessed as having capacity.

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

Is the service effective?

When we spoke with one person, they told us that they were happy with the care they received. In our conversations with relatives after the inspection, they told us that they believed that the needs of their relatives were well met. 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 and written up with their involvement. Staff spoke with pride about the progress that individual people had made whilst they had been living at Norfolk Road. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives and the impact that this had had on their daily life. One relative told us, "He's come on leaps and bounds, he's come out of his shell. He has such a hectic life, we have to fit in with him."

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We observed that people were able to do things at their own pace and were supported to be as independent as possible. People who used the service were invited to complete an annual survey and we saw that their responses to issues of trust, safety and whether they felt happy living at Norfolk Road had received positive responses. 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 saw that where there had been a recent cause for concern, this situation had been reported and recorded appropriately, an action plan had been put in place and staff had access to relevant training to further develop their skills and confidence.

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. Records seen by us showed that complaints were investigated appropriately. People who lived in the service, staff and relatives were asked for their views. 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. A new approach to reviewing the care and support provided had been introduced to ensure greater involvement by people who lived in the service.

People told us they were happy at Norfolk Road. People’s relatives told us that they were happy with the support their relative’s received. Comments included “He’s well looked after” and “Care is excellent, the opportunities to do things is brilliant.” We saw that people looked cared for and made choices about their daily lives.

People had access to food and drink, with staff helping people to make healthy eating choices. People were involved in developing the weekly menus and helping to prepare drinks and meals as much as they were able. Staff monitored people’s weight and sought specialist help when needed.

Systems were in place to manage medication. Staff had been trained and regular audits checked that medication was being administered correctly. Where there had been a problem the appropriate people had been notified, an investigation carried out and plans put in place to prevent a reoccurrence.

The service was fully staffed and staff felt that this was having a positive effect of staffing levels. For example, they could now cater better for people’s choices, including activities, if people wanted to go out or stay at home.

Regular checks were carried out to see if people were happy and receiving a good service. This included audits, quality visits, reviews, meetings and surveys. Relatives we spoke to felt that any issues they raised had been resolved appropriately. A new manager had been appointed and had recently started to work at the service.

We used a number of different methods to help us understand the experiences of people using the service, because some people at the service had complex communication needs. Our methods included talking to people who use the service, observing the care and support provided, talking to staff and looking at records.

People told us they were happy at Norfolk Road and indicated that they were well looked after, with comments including ‘I’m happy, of course I am’ and ‘no worries’. People told us about the things they enjoyed doing with support from the staff, such as going out in the car, going horse riding, playing the drums, going to church and baking. One person told us how they liked to pick out their own clothes and go shopping. We also asked people what the staff were like and how they treated them. The people we spoke to indicated that they liked the staff.

During our visit we observed the way staff interacted and supported people. Staff interacted well with the people using the service. For example, communicating appropriately and asking what people wanted to do. The people who live at the service seemed comfortable and happy with the way staff were supporting them.

People who use the service told us that they can decide for themselves what they want to do and they can go out with others in the home or by themselves. They said that they knew who their keyworker was and would talk to them if they were unhappy. They liked the satff and this was evident throughout the visit.