St Brigas 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.

St Brigas provides accommodation and personal care for up to 17 people with learning disabilities. At the time of the inspection there were 16 people living at the home. We undertook this unannounced inspection of St Brigas on the 9 and 11 April 2018.

The care service is not in line with the values that underpin the Registering the Right Support and other best practice guidance. This is because the service is currently registered for 17 people which is over our best practice guidance of registering six people or less.

At the last inspection the service was rated as Requires Improvement. At this inspection we found the service remained Requires Improvement.

At our last comprehensive inspection we found two breaches of legal requirements. We used our enforcement powers and served a Warning Notice on the provider following this inspection. This was a formal notice which confirmed the provider had to meet the legal requirements. We followed up this warning notice and found some improvements had been made but there was still a breach of legal requirements. At this inspection we reviewed these breaches and found improvements had been made in following the principles of the Mental Capacity Act. However quality assurance systems had failed to assess, monitor and mitigate risks relating to the health, safety and welfare of service users which arise from carrying on the regulated activity.

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 could be at risk of cross infection, due to lack of liquid hand soap and paper towels at the point of care.

Environmental risks to people posed by hot surfaces and the lack of checks to hot water temperatures were not managed in line with the Health and Safety Executive’s guidelines.

People received their medicines when required although medicines were not always stored at the manufacturer’s recommended temperatures. Medicines records did not always reflect the person had received their topical medicines and medicated toothpaste as required.

People's care plans contained guidelines for staff to following relating to people's individual needs and risk assessments were in place.

People were support by staff who had suitable checks prior to working with vulnerable people.

People were supported by staff who were able to identify abuse. People and relatives felt staff were kind and caring and relatives felt able to visit whenever they choose.

People were supported by staff who had received supervision and an annual appraisal and training to ensure they were competent in their role. Staff and relatives felt able to raise any concern with the registered manager and that they were approachable.

Staff demonstrated how they provided people with privacy and dignity.

Care plans had important information relating to people's individual needs, although information could be recorded about people's individual end of life wishes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 27 February 2017 and was unannounced. It was carried out by one ¿adult social care inspector.¿

St Brigas Residential Home for Adults with Learning Disabilities provides accommodation and personal care for up to 17 people with learning difficulties, autism spectrum disorders, mental health conditions and other complex diagnosis.

At the time of the inspection there were 15 people living at the home. The accommodation is arranged over three floors with some office space at the top of the house. There is an area set up as a day centre on the ground floor which includes a kitchen, art room and music room. In the residential part of the ground floor there are a number of communal spaces including a lounge, further kitchen, wet room and dining room.

A registered manager was responsible for the service. This 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 carried out a comprehensive inspection of this service on 12 and 14 October 2016. Breaches of legal requirements were found as there were ineffective quality assurance systems in place to make sure ¿any areas for improvement were identified and addressed.¿

After the comprehensive inspection, we used our enforcement powers and served a Warning ¿Notice on the provider on the 18 November 2016. A Warning notice is a formal notice which confirmed the ¿provider had to meet the legal requirement in relation to effective ¿quality assurance systems, by 22 February 2017.¿

We undertook this focused inspection to check they now met this legal requirement. This ¿report only covers our findings in relation to these requirements. This means the rating of these key questions remain the same. ¿You can read the report from our ¿last comprehensive inspection, by selecting the 'all reports' link for on our website at ¿www.cqc.org.uk

We found some actions had been taken to improve how well ¿led the service was.

The provider had a new recruitment policy in place and a new quality assurance system for ensuring satisfactory checks were in place prior to new staff starting. There was a twice a day medication check which ensured stock control and records were accurate relating to medicines management. Care plans were being evaluated to ensure they were current and up to date.

Although some improvements had been made we found at the time of the inspection the provider had not met all the legal requirements relating to our Warning ¿Notice. Quality assurance tools were not in place for overseeing all the quality relating to medicines management and care plans which were actions needed following the notice. Quality audit tools are important as they support the provider to identify areas for improvement. We fed this back to the deputy manager who took action following the inspection and sent us examples of audit tools they planned to use.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection was unannounced and took place on 12 and 14 October 2016.

St Brigas Residential Home for Adults with Learning Dissabilities provides accommodation and personal care for up to 17 people with learning difficulties, autism spectrum disorders, mental health issues and other complex diagnosis. Most people at the home were unable to communicate verbally and some found it difficult to interact with visitors. During the inspection there were 15 people living at the home. The accommodation is arranged over three floors with some office space at the top of the house. There is an area set up as a day centre on the ground floor which includes a kitchen, art room and music room. In the residential part of the ground floor there are a number of communal spaces including a lounge, further kitchen, wet room and dining room.

At the last inspection, in July 2015, we found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider was not recording all recruitment checks or accidents and incidents. Some people did not have risk assessments to reduce the risk of harm. The provider was not following the principles of the Mental Capacity Act 2005 when people lacked capacity to make decisions. Staff were not using personal protective equipment when handling soiled laundry and there were no systems to keep this separate. We found the home was not well led because the auditing systems which were in place had not identified all the shortfalls found. Since the last inspection, the provider shared changes they had made in the home. They told us all concerns had been rectified. Although there had been some improvements, we found there were still concerns.

The registered manager was also the provider and they were only present on the first day of inspection. A registered manager is a person who has been registered with the Care Quality Commission to manage the service. They are a ‘registered person’. 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 was supported by a deputy manager and team leaders.

People told us they felt safe but we found there were risks to their safety. There were concerns about the medicine management in the home. Medicines taken ‘as required’ rather than regularly did not have written protocols for staff to follow and there were medicine errors which had not been identified by the provider’s audits.

Where people lacked capacity to make decisions the principals of the Mental Capacity Act 2005 were not always followed. This meant some people were at risk of having their human rights breached.

There were quality assurance systems in place, but these had not picked up all concerns found on this inspection.

Staff and relatives told us there were enough staff to support people. There was a recruitment process in place but the provider had missed some checks which increased the risk of harm to people. Staff told us they had an induction and had received a lot of training. There was good understanding of how to support people.

Staff knew how to protect people from avoidable harm or abuse and had received training in safeguarding. They told us they would be confident reporting any concerns to the management and staff knew who to contact externally. The provider understood when they were responsible for informing the local authority and CQC about safeguarding.

Staff and the provider had understanding about Deprivation of Liberty Safeguards and what process to follow.

Staff supported people to see a wide range of health and social care professionals to help with their care. Staff supported and respected the choices made by people. Staff knew how to respect people with different religious needs.

People had a choice of meals, snacks and drinks, which they showed us they enjoyed. When people expressed they wanted somethin

People we spoke with told us they enjoyed living at St Brigas and like the staff. They told us they were involved in their care and support.

Observations demonstrated that staff offered people choices in all aspects of their support. Staff interacted positively with people and had a good understanding of people’s needs and preferences.

We looked at four people’s care records and saw that people’s needs were assessed and care plans implemented to meet these needs. Care plans we viewed showed evidence of being reviewed and updated appropriately.

We found that people’s needs in relation food and drink were being met by the home. One person told us “the food is lovely here”. We observed the lunchtime meal and saw that people were supported by staff to maintain their independence in this area.

The home had effective systems in place to manage medications safely. Although we found that the administration of some types of prescribed medications were not being recorded appropriately.

The provider has effective systems in place to monitor the quality of the service provided. This included collecting and acting upon the views of people and their relatives about the service.

We spoke with six staff during our inspection. All the staff we spoke with told us that the service was managed well and communication was good. They said their views were listened to by the provider and suggestions they made to improve the service were considered and acted on.

Not everyone living at St Brigas communicated verbally with us; however we made observations during our visit that suggested people were secure and settled. For example, we saw people sharing smiles and laughs with staff and other people showing an interest in our visit. One person enjoyed showing us around the home and was happy to show us their personal room. Comments on feedback forms from relatives were also positive and indicated that people were happy. One relative wrote that a person's confidence had 'soared' since living at St Brigas. Another person wrote that their relative always seemed 'content and happy'.

From the records that we viewed and the observations we made, we saw that people's care was personalised and that staff were knowledgeable about the people they were supporting. People were treated respectfully and there was evidence of positive relationships between staff and people being supported.

Where people may have concerns or complaints, there was a procedure for managing them and we saw examples of how this was done. Where people indicated that they may be unhappy through their behaviours, these were recognised and addressed.

We carried out this unannounced inspection on the 23 and 27 July 2015. At our last inspection in June 2013 no concerns were identified.

St Brigas provides accommodation for up to 17 people who have a learning disability and who require support and personal care. At the time of the inspection there were 15 people living at the home. St Brigas has 17 bedrooms, most have en-suites. There is a communal dining room, conservatory, art room, music/activities room, quite room, kitchen for people to use and make their own drinks, two offices, outside front and rear gardens and an outside wood work room. On the third floor is another office, staff sleeping room and staff bathroom.

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 ae 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 was present on the second day of the inspection.

The registered manager confirmed staff had appropriate checks and where staff had worked at the service for a number of years they monitored their suitability through supervisions. People were not being protected from the risk of infections due to staff not using gloves, aprons and red disposable laundry bags. Environmental and individual risk assessments did not contain guidelines to show how risks were being managed.

People who were unable to consent to care and treatment did not have mental capacity assessments completed or best interest decisions in place that confirmed who had been involved. Staff demonstrated how they give people choice around their daily support. The service was identifying when people might be at risk of having restrictions placed on their liberty and applications were in place to confirm this.

Staffing levels at the home were good and staff were skilled in communications with people, especially if people were unable to communicate verbally. Staff felt happy and well supported by the management team. Training was provided to staff so they could understand and support people with their individual care needs. There was enough staff to ensure people had their one to one support. People received their medicines safely by staff who had received training. Medicines were accurately being recorded and adequately stored.

People were supported by staff who demonstrated a kind and caring approach. People received consistent support from staff who knew them well. People and relatives felt safe and were happy with the care. People had support to access activities and their local community. People received a service that was based and their personal needs and wishes. Changes in people’s needs were quickly identified and contact was made with their health care professional.

There was a lack of robust audits that identified areas of concern found during the inspection. There was a complaints policy with an easy read version available to people and relatives. Annual surveys were sent to people, relatives and professionals about the quality of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.