We carried out an unannounced comprehensive inspection on 1 December 2018.

St Winnow provides care and accommodation for up to five people. On the day of our inspection there were five people living at the service. St Winnow provides care and support for people with a learning disability and associated conditions such as Autism and Asperger’s.

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.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharged if needed, people’s independence was valued and links with their community.

At the last inspection on the 3 and 4 May 2016, the service was rated Good overall. However, it was rated Requires Improvement in Well Led. This was due to the service, at that time, though having a manager in post, they had not been registered with us. At this inspection we found that the manager was now registered. At this inspection we found the evidence continued to support the rating of Good overall 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.

Why the service is rated Good:

The service was now well led.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager and management team were very approachable, worked alongside them and made themselves available when needed. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

People were not all able to fully verbalise their views therefore they were not all able to tell us verbally about all their experiences of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. However, two people when asked if they were happy living in St Winnow both said they were with one saying; Yes, I’m very happy here.”

People remained safe at the service. People were protected from abuse as staff knew what action they needed to take if they suspected anyone was being abused, mistreated or neglected. The company ensured staff were recruited safely and checks carried out with the Disclosure and Barring Service ensured they were suitable to work with vulnerable adults. Staff confirmed there were sufficient numbers of staff to meet people’s needs and help to keep them safe. Some people required one to one staffing and this was made available to help keep them safe.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks

The inspection took place on the 3 and 4 May 2016 and was unannounced.

St Winnow provides care and accommodation for up to five people. On the day of the inspection four people were living at the service. St Winnow provides care and support for people with a learning disability and associated conditions such as Autism and Aspergers.

At the time of the inspection the service did not have a registered manager. A new manager had been appointed and was in the process of registering with the Care Quality Commission (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.

At the last inspection we asked the provider to make improvements in the leadership of the service. The provider completed an action plan to tell us how they would address these issues and by when. At this inspection we found improvements had been made. However, since December 2014 this service has not had a registered manager in post. Management changes in the service had meant quality auditing systems had not been effective, and the service had not been well- led. Two managers recruited after December 2014 only stayed in post for a short period of time. The current manager was recruited in October 2015 and at the time of this inspection was in the process of registering with CQC. Whilst systems had improved since the recruitment of the current manager it was too early to judge if these improvements would be sustained. We will continue to monitor this as part of our on-going inspection of the service.

At the last inspection on the 17 and 18 March 2015 we also asked the provider to make improvements to ensure people were safe and to ensure people were fully protected against the use of unlawful or restrictive practice. At this inspection we found improvements had been made. Staff and relatives said people were safe. We saw people were able to move freely around their home and were not being unlawfully restricted.

Staff, relatives and professionals all said there had been a number of improvements in the service since the appointment of the new manager and described the positive impact this has had on the people living there. Comments included, “Fantastic improvements in the short time she has been here”, “The new manager is really on the ball and gets things done”, “The manager is very flexible, has done shifts and leads by example”.

Professionals said they felt staff worked hard to maintain a balance of helping people to feel independent and safe.

We observed the atmosphere in the home was warm and welcoming. People said they liked living at St Winnow and the staff were kind and helped them. The interactions between people and staff were positive. Staff had a good knowledge of people they cared for, and people’s privacy and dignity was respected and promoted.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure they were safe. Staff were well trained and aspects of their training were used regularly when planning care and supporting people in their lifestyle choices. Staff were supported and had opportunities to discuss and reflect on practice.

People’s support plans included clear information about people’s specific needs and preferences. Staff were familiar with this information and could tell us in detail about people’s daily routines and how they chose to be supported. People were supported to have their health and dietary needs met. People were involved in decisions about their diet and were supported by staff when required. Staff monitored people’s general health and well-being and supported people to ac

Some of the people using the service had complex needs. This meant it was difficult for some people to tell us what they thought of the home and the care they received. During our inspection we were able to meet people who used the service and observed the care and support being provided to them.

One person who lived in the home when asked said, “I love living here” and a staff member said, “We are open and honest with each other”.

We met and spoke to the three people who used the service, spoke to staff about the care given and looked at the care records of the people who lived in the home. We looked at other records and observed how staff cared for people.

We saw staff speak to people in a way that demonstrated a good understanding of people's choices and preferences.

We saw that people's personal support plans described their needs and how those needs were met. We saw records showing that best interest meetings had been arranged to determine whether dental work was in people’s best interest.

Staff demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have had.

All the staff we spoke to said that they felt well supported by their colleagues and management. We saw staff received the training they required to carry out their roles.

Records demonstrated that correct procedures had been followed to ensure people's rights, freedom and liberty were protected.

We saw that St Winnow held all records securely to protect people’s confidentiality.

We (the Care Quality Commission) carried out this inspection as part of our scheduled inspection programme. We spoke with four of the five people living at the home.

Two people have their own living area separated from the other people, this included bathrooms and lounge areas.

We saw that staff treated people with consideration and respect. For example, one person can become challenging and anxious when people visit the home. This person was well supported by two staff and the staff responded to questions from this person with patience’s and understanding.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

We raised concerns that the use of locks in the service may restrict people's freedom and not protect their rights. Records did not demonstrate that correct procedures had not been followed to ensure people's rights, freedom and liberty were protected.

One person living in the home was asked if staff were kind and they said, “Yes, I like living here”.

Some people had limited communication and were unable to communicate with us; however we were able to speak to two people living in the home. The people living at St Winnow informed us they were very happy with the service they received. Further information about people experiences in the home was given to us by the staff and management of the home. We also spoke to other professionals about their views and experiences of this home.

During our visit we observed people enjoying themselves and interacting positively with the staff supporting them.

Several people said they liked living in the home and told of their regular visit to family and friends and going out on plenty of different activities.

We were told by one professional who cares for one person living in the home that the registered manager is “co-operative and helpful”.

The inspection took place on the 17 and 18 March 2015 and was unannounced.

St Winnow provides care and accommodation for up to five people. On the day of the inspection four people were living in the home. St Winnow provides care for people with a learning disability and associated conditions such as autism and Asperger’s.

At the time of the inspection the service did not have a registered manager. We were told the previous registered manager had left the service approximately three months before the inspection and a new manager had been appointed to oversee the day-to-day running of the service since this time. We were told an application had been submitted to CQC to register a new manager for the 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.

Although staffing levels had been organised to meet people’s needs and to help keep people safe, there were still concerns about some people’s safety due to the behaviours of others in the home. Not all people had been correctly assessed under the Mental Capacity Act 2005 and its associated deprivation of liberty safeguards. We raised these concerns with the manager. They said they would raise this matter with senior management and inform us of the outcome. We also raised our concerns with the local safeguarding team. The local authority safeguarding team have responsibility for assessing possible risk and taking action if they assess people are unsafe or at risk of abuse.

Prior to the appointment of the current manager the service had not been well-led. Staff said during a period of management change they had felt unsupported within their role. Three managers had been in post within a short period of time. During this period the provider had carried out a range of quality checks. These checks had failed to pick up and address that staff supervision, appraisals and reviews of people’s support plans had not taken place within the timescales agreed by the provider. Staff said they did not feel supported during this time and felt this would have had a negative on the quality of care provided to people in the home. The manager told us these gaps were now being addressed as a matter of priority. We saw people’s support plans had been reviewed and staff told us they felt well supported by the manager. It was however, too soon to know if these improvements would be sustained or see the overall impact these improvements had on people and the service.

People were protected by safe and robust recruitment practices. People were supported by knowledgeable and skilled staff. Staff undertook training, which was specific to the needs of people they supported.

People’s medicines were stored and administered safely. People who were able to manage and administer their own medicines were supported to do so.

People were supported to raise any concerns or complaints about the service. Complaints were taken seriously and responded to appropriately.

People’s support plans included clear detailed information about people’s specific needs and preferences. Staff were familiar with this information and were able to tell us in detail about people’s daily routines and how they chose to be supported. People were supported to have their health and dietary needs met. People were involved in decisions about their diet and were supported by staff when required. Staff monitored people’s general health and well-being and supported people to access health services when needed. People were supported to lead an active lifestyle and were able to maintain relationships with people who mattered to them. Staff had a good understanding of the people they supported and had formed positive, caring relationships.

A system was in place to regularly audit people’s personal finances, medicines and fire safety equipment. Regular audits had been undertaken to ensure the environment remained fit for purpose. The manager had introduced ‘spot checks’ of staff, which would be undertaken during the day and night. Any issues relating to the quality of care being provided was addressed with individual staff members and within team meetings as part of practice discussions.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 ( Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.