The inspection took place on 10 January 2018 and was unannounced. The Boat House is a care home that provides accommodation with personal care and is registered to accommodate eight people. The Boat House provides a service to younger adults with a learning disability and complex needs.

The accommodation at The Boat House consists of a large lounge and dining room, a kitchen and sensory room for seven people to use; there are seven bedrooms on the first floor with a lift to access these. There is one self-contained flat on the ground floor, for one person. This area has a bedroom, lounge and kitchen and has its own front door which leads into the service. The home is located in the town of Tamworth next to the canal. The service has a vehicle people can use and there are good links to public transport and local community facilities.

The Boat House 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection five people were using the service as we placed a condition on the provider’s registration to restrict new admissions into the service, unless we gave written permission. On our previous inspection in July 2017 we found improvements had been made and agreed that the provider could admit one person into the service. During this inspection the provider demonstrated to us that improvements have been made and could now be sustained and as a result we will remove this condition to enable the provider to admit new people.

The service had a registered manager. 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 on 18 July 2017 we rated the service as ‘Requires Improvement’ and we asked the provider to take action to make improvements. We did this as where systems were in place to ensure people’s safety, such as monitors, the provider needed to ensure this did not place restrictions on people. The provider needed to review how people were supported, to ensure they received additional staff support to enable them to be involved with the activities they enjoyed. On this inspection, we found this action had been completed.

On this inspection we found there were sufficient numbers of staff to meet people’s individual needs and keep them safe. People were supported to take part in a variety of activities and hobbies and to maintain their interests. We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to make decisions about their care and where restrictions were identified; applications to ensure these were lawful had been made.

People received care from staff who had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Identified risks were assessed and managed in a way that promoted people’s safety. There was a safe procedure for managing people’s medicines and people received these as prescribed.

The staff were friendly and caring and had the right skills to provide the care and support they required. Staff received an induction when they started working for the service and completed training to support them in meeting peo

This inspection was unannounced and took place on 18 July 2017. The service was registered to provide accommodation for up to 8 people. At the time of our inspection 4 people were using the service as following our previous inspection we placed a condition on the provider’s registration to restrict new admissions into the service. This was because this provider was placed into special measures by us. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. This inspection found that there was enough improvement to take the provider out of special measures, however we need to ensure the provider can sustain these improvements and we will keep the service under review.

There was a manager in the service who was undergoing our assessment to become the registered manager of 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.

Where people’s liberty was restricted, this had been done lawfully to safeguard them. Where systems were in place to ensure people’s safety such as monitors, the provider needed to ensure this did not place further restrictions on people. When people did not receive the support they needed for some activities this needed to be reviewed to ensure people received their care as planned.

People were protected from the risks of abuse because staff now understood where harm may be caused and took action when people were at risk. People were cared for by staff that had the knowledge and skills required to support them. The training was designed to support staff to meet the specific complex needs of people who used the service. Medicines were managed safely to ensure that people received their medicines as prescribed and to keep well.

Staffing was organised flexibly to enable people to be involved with activities and do the things they enjoyed. The staff were developing good relationships with people so they understood how to help them participate with activities that they enjoyed. People were treated with dignity and respect and the staff were kind and caring.

People had access to health care and were supported to attend healthcare appointments when they needed it. People could eat and drink the food they liked and given the time they needed to eat independently. A variety of food was offered and meal times were a relaxed experience.

There were now systems in place to review the quality of the service provided and the provider was committed to developing and improving the service.

This unannounced inspection took place on 6 January 2017. At our last inspection on 31 March 2016 we found that improvements were required across all of the areas we inspected.

The Boat House provides accommodation and personal care for up to eight people with a learning disability. There were four people living in the home on the day of our inspection.

There was not a registered manager in post as they had left the service. An interim manager was managing 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People were not always protected from harm and abuse because the provider and staff did not recognise that some incidents should have been reported externally. Concerns identified during the recruitment process were not fully investigated before staff were able to work with people. People who received additional funding for their support did not always have staff with them as planned. Environmental risks had not been considered to ensure people remained safe whilst they were in the home.

Staff induction training did not provide sufficient information and skills for staff to provide effective care to support people living in the home. Some staff had not received a full induction when they started working in the home. People’s diet needed improvement to ensure their health and wellbeing was maintained. There were arrangements in place to support people with their decision making but this had not been maintained to ensure all decisions made were in the person’s best interest.

People’s care plans did not provide an accurate record of their care, diet and the activities they had taken part in. Care plan reviews did not provide information about changes in care and support needs.

Staff morale was low. Staff felt unsettled because management arrangements were regularly changed. People’s records had not been written by staff with an understanding of learning disability. The provider’s audit programme had identified some shortfalls in the service but no improvements had been made in response to their findings.

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We carried out an unannounced comprehensive inspection of this service on 31 March 2016. We had previously inspected the home on 6 January 2016 and found the service was not well-led. The provider was not assessing people’s risk of harm or their ability to make choices and decisions about their care. Additionally the provider did not have systems in place to monitor and improve the quality of the service people received. We issued the provider with a warning notice and told them improvements were required by 11 March 2016. At this inspection we found that the required improvements had been made although we identified other areas of concern which needed to be addressed.

The Boat House provides accommodation and personal care for up to eight people with a learning disability. There were three people living in the home on the day of our inspection.

There was no registered manager in post at the time of our inspection but a new manager had been appointed and had been in post for four weeks. The acting manager had started the process to register with us. 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 living in the home were funded for one-to-one support however there were times when this wasn’t maintained. Some members of staff did not demonstrate a positive caring relationship with people. People were not encouraged to eat a healthy and balanced diet. The management changes had affected the morale of staff.

Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns. There were processes in place to ensure that staff were trained to care for people and suitable to work within a caring environment. People were supported by staff to manage their behaviours to protect them and others from harm. There were arrangements in place to ensure people received their prescribed medicines at the right time and the correct dose.

Relatives were happy with the care and felt welcome to visit at any time. Complaints and concerns were listened to and reassurance was provided that improvements would be made. There was an effective audit programme in place which identified areas for improvement. Relatives were encouraged to take an active part in their relations care and asked to share their views on the service. People’s care had been reviewed to ensure it met their needs.

We carried out an unannounced comprehensive inspection of this service on 21 September 2015 and found the service was not well-led because the provider was not assessing people’s risk of harm or their ability to make choices and decisions about their care. Additionally the provider did not have systems in place to monitor and improve the quality of the service people received. The provider sent us a copy of their action plan detailing how they would make the required improvements within a time limited period.

We undertook a focused inspection on 6 January 2016 to check that they had followed their plan for improving the leadership arrangements and in the other areas of concern we identified. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Junction on our website at www.cqc.org.uk

The Junction provides accommodation and personal care for up to eight people with a learning disability. There were four people living in the home on the day of our inspection.

You can read a summary of our findings from both inspections below.

There was no registered manager in post at our inspection in September 2015 or January 2016. The acting manager told us they had started the application process to become registered with us but this had only been sent the day before our inspection in January 2016. 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 our last inspection we found that people’s risks had not been identified or assessed. At our focused inspection we found that no improvements had been made. No risk assessments had been undertaken and there was no information provided to ensure people were supported correctly. People’s care records did not provide up to date and relevant information which reflected their current needs.

Some people did not have the capacity to make decisions and there was no information to demonstrate how their capacity had been assessed. Staff did not record how they made decisions in people’s best interest when they were unable to contribute themselves.

The provider had not implemented an audit programme to monitor the quality of the service to identify where they could make improvements in people’s care and wellbeing.

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.

The inspection took place on 21 September 2015 and was unannounced. This was the first inspection for the service which registered with us in May 2015.

The service is registered to provide accommodation for up to eight people with a learning disability who require nursing or personal care. There were two people living in the home at the time of our inspection.

There was no registered manager in post however a manager had been appointed who had started the registration process with us. 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 gaps in the way people’s care was recorded. There were no risk assessments in place to ensure people were supported safely. Staff understood the Mental Capacity Act 2005 but there were no records to demonstrate why decisions were made on behalf of people who were unable to make choices for themselves. The provider recognised the need for an audit programme to measure the quality of the service but this had not been implemented.

People were protected because staff understood how to recognise abuse and report it correctly. People who presented with behaviour that challenged were supported in a way that kept them safe.There were processes in place to ensure suitable staff were recruited to work in a care environment. People’s medicines were managed safely.

Staff had the skills and training they required to care for people. Staff had support from the management team to discuss their career progression and performance. People were provided with a varied diet and enjoyed the opportunity to eat out and visit the pub or cinema. People had regular access to other health professionals to support their health and welfare.

Staff provided a caring environment and recognised people’s individuality. People had opportunities to take part in hobbies or activities which interested them.