We carried out an unannounced comprehensive inspection at St Erme Campus on 6 and 7 March 2018. At our last inspection on 6 February 2017 we identified breaches of the regulations and the service was rated Requires Improvement. The breaches were in respect of staffing levels, gaps in training, gaps and a lack of detail in daily records, inconsistencies between daily records and monitoring records and ineffective auditing systems. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service safe, effective, responsive and well-led?, to at least a rating of good.

At this inspection we found improvements had been made to meet the relevant requirements. Agency staff were used to help ensure staffing levels were consistently met. All staff had received training to help them carry out their roles and responsibilities. Daily records were completed and contained information about people’s emotional well-being. Information in daily records and other documentation was consistent and, where appropriate, staff were directed to other records for more detailed information about any event or incident. There is more detail in the full report about our findings.

St Erme Campus is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Erme Campus provides care and accommodation for up to twenty people who have autistic spectrum disorders. At the time of the inspection 14 people were living at the service. St Erme Campus is part of the Spectrum group who run similar services throughout Cornwall. The service is made up of three separate houses known as The Lodge, The House and St Michael’s.

The service is required to have a registered manager and there was one in post at the time of the 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.

The care service was established 35 years ago and was designed to provide group living for people with autism. Work had been done, and was continuing, to develop the service in line with the values that underpin the CQC policy, 'Registering the Right Support' and other current best practice guidance. This guidance includes the promotion of values including choice, independence and inclusion. The service was working with people with learning disabilities and autism that used the service to support them to live as ordinary a life as any citizen. For example, structural changes were being made to the buildings to enable people to have more privacy and personal space within the service.

Staff understood how to support people to be independent while protecting them from risk of harm. They were aware of their responsibilities to raise concerns and record any untoward incidents. There were systems in place to help protect people in the event of an emergency. Medicines were managed safely and people were supported to take their medicines as prescribed.

The staff team knew people well and were provided with training to enable them to support people according to their individual needs. Recruitment processes and a thorough induction helped ensure new staff were suitable for the role and able to support people well. Staff received regular supervision and attended staff meetings. This meant they had opportunities to raise any concerns and discuss working practices.

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 servi

St Erme provides care and accommodation for up to twenty people who have autistic spectrum disorders. At the time of the inspection 13 people were living at the service. St Erme is part of the Spectrum group who run similar services throughout Cornwall. The service is made up of three separate buildings known as St Erme Lodge, St Erme House and St Michael’s.

The service is required to have a registered manager and there was one in post at the time of the 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.

There were not sufficient staff on duty at all times to meet people’s individual needs. Staffing levels identified as necessary for the service were not consistently met in any of the three houses. Recruitment practices helped ensure staff working in the service were fit and appropriate to work in the care sector.

Staff received training when they first started work at Spectrum in a wide range of areas including supporting people whose behaviour could challenge staff and others. Training in some areas had not been regularly refreshed.

People were protected from the risk of abuse including financial abuse. The service kept people’s personal monies for them and records of all expenditures. Staff received training in safeguarding adults and were confident about reporting procedures.

Records of how people spent their days were in place. These often lacked detail and did not consistently correspond with other records such as health monitoring charts and incident records.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Records showed applications for DoLS were being made appropriately and some people had DoLS authorisations in place.

One person was under constant supervision in order to keep them safe. The decision for this had been taken appropriately and in consultation with the relevant professionals.

Staff were enthusiastic on the subject of their jobs and spoke positively about people. People were relaxed with staff and approached them for reassurance and support when they needed to. Staff responded quickly and with humour and empathy. They demonstrated an understanding of people’s needs including their preferences, likes and dislikes and communication styles.

There were clear lines of responsibility in place. The three homes were all managed on a day to day basis by a deputy manager with the support of a development support worker (DSW). DSW’s served as a link between the service and Spectrum’s behavioural team. The registered manager had oversight of the service and staff told us she was approachable and had a good understanding of the service. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

We inspected St Erme campus on 9 October 2014, the inspection was unannounced. At the last inspection in June 2013 we did not identify any concerns. St Erme has three residential homes on the campus, they are called The Lodge, The House and St Michaels. In total up to 20 people who are on the autistic spectrum could receive care and support there. On the day of our visit twelve people were living at St Erme. The home is part of the Spectrum group.

The home has a registered manager in place. 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 were happy and relaxed on the day of the inspection. We saw people moving around the home as they wished, interacting with staff and smiling and laughing. Staff were attentive and available and did not restrain people or prevent them from going where they wished. We saw they encouraged people to engage in meaningful activity and spoke with them in a friendly and respectful manner.

Care records were detailed and contained specific information to guide staff who were supporting people. One page profiles about each person were developed in a format which was more meaningful for people. This meant staff were able to use them as communication tools.

Risk assessments were in place for day to day events such as using a vehicle and one off activities. Where activities were done regularly risk assessments were included in people’s care documentation. People had access to a range of activities. These were arranged according to people’s individual interests and preferences.

Relatives and health care professionals told us St Erme was a caring environment and staff had a good understanding of people’s needs and preferences. We found staff were knowledgeable about the people they supported and spoke of them with affection.

The service adhered to the requirements of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards.

Staff were well supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people.

Relatives knew how to raise concerns and make complaints. They told us concerns raised had been dealt with promptly and satisfactorily.

Incidents and accidents were recorded. These records were reviewed regularly by all significant parties in order that trends were recognised so that identified risks could be addressed with the aim of minimising them in the future.

There was an open and supportive culture at St Erme. Staff and relatives said the registered manager was approachable and available if they needed to discuss any concerns. Not all staff felt they were fully appreciated by the larger organisation or that the organisation had an understanding of the day to day demands on them

The Health and Social Care Act 2008 requires providers to notify the Care Quality Commission of events and incidents which may have an effect on services. Whilst we had received notifications as required by St Erme staff, Spectrum senior management team had failed to notify us of incidents and events which might have impacted on the running of their services including St Erme.

At the previous inspection we had identified particular areas of care where improvements were needed. At this inspection we focused on these areas of care and found Spectrum had considered the issues raised in the last report and ensured they were now compliant in all outcomes. They had reviewed people’s care plans, ensured that mental capacity and best interest meetings occurred with all relevant parties involved, infection control practises had improved, repairs to the environment had been addressed and thier quality assurance process was more effective.

We were not able to speak to the people who used the service due to thier complex health and care needs. Therefore we undertook observations of staff interacting with people who used the service. We saw staff respond and approach people in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found there were enough qualified, skilled and experienced staff to meet people’s needs.

Our inspection focused on the service delivered at St Erme House. Many of the people living in the home have limited verbal skills. We were able to speak to some of the people living in the home and they said they were happy living there. We also observed care and this was delivered overall to a satisfactory standard.

People at St Erme were treated with respect and dignity. They had the opportunity to be involved in decisions about their day to day life. The plans of care that explained how people were to be helped, were being changed at the time of our visit to provide clear and easy information for staff to follow. There was information about how incidents involving aggression were to be managed, however the actions staff were to take, particularly in relation to restraint or the restriction of liberty had not yet been agreed by a multi disciplinary team of professionals.

We found that incidents of challenging behaviour were recorded, but that what was learnt from these incidents did not always influence the people's plans of care.

The buildings are currently being redeveloped so that most people at St Erme can have their own flats. This means that the service and the people that are using it are experiencing a period of considerable change. Staff were well trained however staff told us that they felt that communication with senior management in the organisation needed to be improved. We recognised that there were a number of systems for monitoring the quality of the service being delivered, but that these systems sometimes missed basic things, such as an incorrectly filled out medication record.