About the service:

• St Raphael’s offers accommodation with personal care for up to 21 people with a learning disability. The accommodation is provided in two adjacent buildings, Fatima House and St Raphael’s itself. At the time of the inspection 11 people were living in Fatima House and eight in St Raphael’s.

• St Raphael’s is part of the Frances Taylor Foundation, a charitable organisation providing a range of services mostly for people with a learning disability.

People’s experience of using the service:

• Although the service was developed and designed according to the values that underpin the Registering the Right Support (Registering the Right Support CQC policy) and other best practice guidance, the provider did not always ensure that care and support to people was being provided in line with these values which include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should expect to live as ordinary a life as any citizen and their safety maintained.

• The provider had systems in place to help ensure people who used the service were safe from avoidable harm. However, these were not always effective.

• During the inspection we found there were risk assessments in place but these did not always identify all risks that people faced and did not always include guidelines for staff to follow to help ensure people were safe from harm and could lead as ordinary a life as possible.

• People’s healthcare needs were not always met because staff did not always take appropriate action when concerns were identified.

• The provider told us they had systems in place to monitor the quality of the service and put action plans in place where concerns were identified. However, these were not always recorded and had failed to identify the issues we found at this inspection so the necessary improvements could be made.

• People received their medicines safely and as prescribed. However, we found some issues relating to the storage and stock management.

• Care and support plans contained a lot of information, some out of date. This made it difficult for staff to find relevant information about the people they supported and for people who used the service to have easy access to this document and be involved in reviews.

• Staff received training. However, we saw that some training was out of date. Staff received supervision, but this was not always consistently undertaken. The registered manager was in the process of making improvements in this area.

• Most people’s records were reviewed and updated monthly. However, almost all reviews stated ‘No change’ by staff even when information stated otherwise.

• Staff had not received training in end of life care. Some people had an end of life care plan in place and the registered manager was in the process of introducing this for everyone.

• There was evidence that people were engaged in activities in house and in the community. There was an activity plan displayed and most people reported they were happy with the activities on offer.

• Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

• People were protected by the provider’s arrangements in relation to the prevention and control of infection. Communal areas were clean. However, some areas were cluttered and used as storage. This could present a health and safety risk

• The environment was tailored to the individual needs of people and areas of the home had been updated and decorated since our last inspection.

• The provider acted in accordance with the Mental Capacity Act 2005 (MCA). People had their capacity assessed before they moved into the home. Where necessary, people were being deprived of their liberty lawfully.

• The provider had processes for the recording and investigation of incidents and accidents. We saw that these included act

The inspection took place on 16 February 2017 and was unannounced. The service was last inspected on 26 January 2016 when we found three breaches of the Health and Social Care Act 2008 and associated regulations relating to person-centred care, safe care and treatment and leadership and governance. Following the inspection the provider sent us an action plan detailing how they would make improvements. At this comprehensive inspection we found the provider had taken action to address the breaches we had identified and improvements had been made.

St Raphael’s offers accommodation with personal care to 21 people with learning disabilities. The accommodation is provided in two adjacent buildings, Fatima House, and St Raphael's itself. Fatima House provides accommodation for 13 people, six on the ground floor and seven on the first floor, and has a lift. St. Raphael's provides accommodation for eight people. All rooms are single and many have en-suite facilities. There were 20 people living at the service at the time of our inspection. One of whom was in hospital.

There was a registered manager in post at the time of our 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 provider had taken action to meet the concerns identified at the inspection of 26 January 2016 and had put systems in place for the safe management of medicines.

The provider had put systems and processes in place to ensure that important information about identified risks was communicated to all relevant staff. This ensured that people were protected from the risk of harm.

The provider had made improvements to the provision of activities for people who used the service and we saw that detailed activity plans were displayed in the home. A range of activities were provided both in the home and in the community, and people were supported to undertake activities of their choice.

The provider had taken action to ensure that people were consulted and involved in developing menus, and these were displayed in the home. People told us they enjoyed the food offered at the service and their likes and dislikes were recorded in their care plans. People’s nutritional and healthcare needs had been assessed and were met.

The provider had improved the way staff communicated with people who used the service and had implemented comprehensive communication guides.

There were enough staff on duty to meet people’s needs at the time of our inspection and people’s needs were met in a timely manner. Checks were carried out during the recruitment process to ensure only suitable staff were employed.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity had been assessed and they had consented to their care and support.

Staff received regular training, supervision and appraisal. The registered manager attended forums and conferences in order to keep abreast of developments within social care.

Care plans were in place and people had their needs assessed and reviewed regularly. The care plans were clear and comprehensive and reflected the needs and wishes of the individual.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. People and relatives were sent questionnaires to gain their feedback on the quality of the care provided.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addres

This inspection took place on 26 January 2016 and was unannounced. The service was last inspected on 11 July 2013 and at the time was found to be meeting all the regulations we looked at.

St Raphael’s provides accommodation and personal care for up to 21 adults with a learning disability. It is divided into three units where people are accommodated according to the level of their needs. There were 21people living at the service at the time of our inspection, including three people living with dementia.

There was a registered manager in post at the service at the time of our 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.

People told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. However, important information about an identified risk for a person who used the service had not been communicated to a visiting activity officer.

The storage of medicines was disorganised. There was no temperature monitoring on the medicines fridge, and there was no protocol in place for medicines prescribed “as required”.

A range of activities were provided both in the home and in the community. However, there were no activity plans displayed in the home, and some people were not supported to undertake activities of their choice.

People told us they enjoyed the food offered at the service and their likes and dislikes were recorded in their care plans, however we did not see evidence that people were consulted or involved in developing menus, and those were not displayed.

There were enough staff on duty to meet people’s needs at the time of our inspection. The registered manager was undertaking a recruitment drive to cover staff vacancies and required the use of agency staff to ensure people’s needs were met. Checks were carried out during the recruitment process to ensure only suitable staff were employed.

Staff had undertaken training on the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). Records showed that people had consented to their care and support.

Staff received effective training, supervision and appraisal. The registered manager sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff. This ensured that the staff team were well informed and trained to deliver effective support to people.

Staff were caring and treated people with dignity, compassion and respect. Care plans were clear and comprehensive and written in a way to address each person’s individual needs, including what was important to them, and how they wanted their care and support to be delivered. We saw that people were cared for in a way that took account of their diversity, values and human rights.

People, staff, relatives and stakeholders told us that the management team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

We found a number of 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.

We looked at the care records of six people and spoke with nine people who use the service and seven members of staff. People who use the service spoke positively about where they lived. One person told us "I have lived here for years, and I am always happy." Another person said "I get support to visit my family and go on holidays, I always have things to do and I don't get bored."

We looked at people’s care records and found that they were written in a format that people could understand. People were asked about activities they wanted to participate in and were supported to be active members of their community.

We found the service had made improvements in relation to care planning and risk assessments following our visit on the 12 January 2013. We found people's needs were met and where there had been a change in a person's health the service had made the necessary changes to ensure people's needs were met.

At our visit on 12 January 2013 we requested the service make improvements in the way in which it recorded the administration of people's medication. We found at our recent visit the service provided staff with additional training and also carried out a weekly audit to ensure people received their medication correctly and the information had been properly recorded.

We checked staffing levels during our visit and found there was sufficient staff to meet the needs of people. However, we have asked the provider to note that staff had not received training in areas such as communication and pressure area care as there were people who use the service who had a communication impairment and were at risk of developing pressure ulcers.

We found the service had a system to monitor the quality of the service to ensure people received safe and effective care. The service had sought the views of people and staff had regular meetings to develop good practices.

During the inspection we talked with seven people using the service, one relative and eight members of staff to get their views about the service provided in the home.

People who talked with us said they were very happy with the care and support they received. We observed that all people appeared cared for. One person said “I have lived here for many years and I am very happy”. One relative said that their family member was very happy and settled in the home.

The service arranged a range of activities for people. Whilst people with a lower level of needs were able to participate in the activities, we did not see as much engagement and interaction with a few older people who were living in the home.

The provider ensured that all people had appropriate care plans and risk assessments. These were overall appropriately completed but had not always been reviewed and updated according to the times that had been identified for their review.

People were appropriately supported with their healthcare needs. The arrangements in place for the management of medicines were however not always adequate to ensure the safety and wellbeing of people.

The feedback we received from people who use the service was very positive. All the people we spoke with said they enjoyed living at the home and that they received good care. They said they could choose how they spent their time and could take part in activities that they enjoyed. People said they enjoyed going out in their local community and seeing people they knew. They told us that they were supported to maintain contact with their families and friends and that they could have visitors at the home at any time.

People told us that they are able to have privacy when they want it and that staff listen to what they have to say. They said that they can have their say about things that are important to them and about the support they receive. The people we spoke to told us that they felt safe living at the home and that they knew who to speak to if they were unhappy about something. None of the people we spoke to had any concerns about the way they were treated at the home.