The inspection was carried out on 11 October 2016, and was an unannounced inspection.

St James House is a care home without nursing caring for up to six people with learning disabilities and other complex needs. Care and support is provided to adults with learning disabilities, autism, schizoaffective disorder and challenging behaviours. At the time we visited there were four people living at the home and two people in hospital.

St James house describe itself as a rehabilitation home. Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination.

There was a new manager at the home. The new manager joined the organisation in August 2016 and they had submitted their application as the registered manager with CQC. 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.

At our previous inspection on 20 October 2015, we found breaches of Regulation 9, Regulation 12, Regulation 13, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan by 15 December 2015. The provider submitted an action plan on 05 February 2016 which showed how they planned to improve the service by 28 February 2016. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

During this inspection, we found that care plans identified clear guidelines for supporting people with behaviour that other people may find challenging. The guidelines included clear descriptions of the behaviour, descriptions of possible and probable causes and strategies for supporting each person to become less anxious and calmer. We found that these guidelines were consistent.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Our observation on the day showed that people had a variety of activities. Activities were diverse enough to meet people’s needs and the home was responsive to people’s activity needs.

People had access to nutritious food that met their needs. We observed that people freely made their cold and hot drinks when they wanted them. The provider had fitted a new accessible kitchen that promoted people’s independence in the home.

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training at start of their employment.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People knew how to make a complaint and these were managed in ac

We inspected this service on 20 October 2015. This was an unannounced inspection.

St James House is a care home without nursing caring for up to six people with learning disabilities and other complex needs. Care and support is provided to adults with learning disabilities, autism, schizoaffective disorder and challenging behaviours. At the time we visited there were four people living at the home and two people in hospital.

St James house describe itself as a rehabilitation home. Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination.

There was a new manager at the home. The new manager joined the organisation in July 2015 and they had submitted their application as the registered manager with CQC. 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.

Medicines were not being managed safely and administered safely. We found medicine errors when we audited medicines in the service and the audits had not identified these.

People were protected against the risk of abuse; they felt safe and staff recognised the signs of abuse or neglect and what to look out for. They understood their role and responsibilities to report any concerns and were confident in doing so. However not all staff had been trained in safeguarding. We have made a recommendation about this.

Staff had not always received training and guidance relevant to their roles. Not all staff had received training in areas considered essential that would enable them to effectively meet the needs of people in the service. Staff had not received regular supervision from their manager and annual appraisals.

The Care Quality Commission (CQC) monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. However, we found that there were different forms of restrictions in the home, which DoLS had not been applied for.

The provider had not fully met people’s health care needs. Health action plans had not been updated nor followed.

Care plans identified clear guidelines for supporting people with behaviour that other people may find challenging. The guidelines included clear descriptions of the behaviour, descriptions of possible and probable causes. However, strategies for supporting each person to become less anxious and calmer were confusing and inconsistent. Clear guidelines for staff were not in place.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. However, they had not identified and responded to gaps, inconsistencies and contradictions in records which required addressing.

Staff were caring and we saw that they treated people with respect during the course of our inspection.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s needs and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff were aware of their roles and responsibilities and the lines of accountability within the home.

The registered manager followed safe recruitment practices to help ensure staff were suitable for their job role.

People were supported to have choices and received food and drink at regular times throughout the day. People spoke positively about the choice and quality of food available. People were involved in activities of their choice.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The staffing structure ensured that staff knew who they were accountable to. Staff meetings were held frequently. Staff told us they felt free to raise any concerns and make suggestions at any time to the registered manager and knew they would be listened to.

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 this report.