The Bungalow is a service for up to five people with learning disabilities and /or autistic spectrum disorder who may also have behaviours that can be challenging. The service is a single storey property close to the village of Lydd and on the same site as a larger service owned by the provider. There were five people living at the service when we inspected who were all male.

The Bungalow 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.

There was a registered manager at the service who was supported by two deputy managers. 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 3 November 2016, we asked the provider to take action to make improvements related to concerns about fire safety, staff training and induction, management of medicines and completion of records. Also quality auditing systems used by the provider had not identified the shortfalls found at our inspection and complaints had not been dealt with appropriately and this action has been completed.”

People were supported to understand how to stay safe and to recognise when they were vulnerable. Staff had received training about safeguarding and understood their responsibilities in relation to reporting any concerns. The registered manager had built a positive working relationship with the local authority safeguarding team and contracted them as required. People were involved in identifying and managing their own risks. Risk assessments gave staff the guidance they required to keep people safe. Risks to the environment were assessed and mitigated. People were now involved in regular fire drills and equipment had been put in place to alert people with hearing loss of a fire. People and staff understood how to minimise the risk of infection and used personal protective equipment when required.

People were supported by staff who had been recruited safely and staffing levels were based on people’s needs and activities. Staff had a thorough induction when they began working at the service. A comprehensive training schedule was in place to ensure staff had the skills they required to meet people’s needs. Staff told us they were supported by the registered manager and deputy managers. All staff attended regular supervision meetings and completed annual appraisals. The registered manager and staff team worked closely with other agencies to ensure they had the knowledge required to meet people’s needs and follow good practice.

People’s medicines were managed safely and in the way they preferred. People were encouraged to be involved in managing their medicines if appropriate. Some people at the service were living with long term health conditions such as diabetes or epilepsy, there was clear guidance for staff about how to support people with their health. People were supported to access health professionals when appropriate and encouraged to take a lead in their appointments. People chose their own menus and were involved in preparing their meals. Staff supported and encouraged them to have a balanced diet.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible;

The inspection was carried out on 3 and 4 November 2016 and was unannounced. The Bungalow is a service for up to five people with learning disabilities and /or autistic spectrum disorder who may also have behaviours that can be challenging. The accommodation is provided in a single storey accessible building located in a quiet area outside the town of Lydd. Off street parking is available in a car park attached to an adjacent service. The premises provide single bedroom accommodation for an all-male household and at the time of inspection was full.

At our previous inspection of this service in December 2015 we found the service was not meeting the required standards in respect of providing an effective system for the monitoring of service quality. We took enforcement action to require the provider to address this shortfall quickly, there were also additional breaches in a number of regulations and we asked the provider to tell us how they were going to address these. This inspection was to assess whether the improvements they had told us about had been embedded and were now everyday practice.

There was a registered manager in post. A registered manager is a person who is 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 registered manager has oversight of two services at this location but spent the majority of her time in the larger service. A deputy manager has been appointed and they were located at the bungalow and had helped with the progress made to date.

People said they liked living at the service, they were supported to develop independence skills and some would now like to move on to more independent living. Relatives told us that they were satisfied with the delivery of care to their relatives and felt they were kept informed as and when needed. We contacted health and social professionals and feedback showed that some had reservations about service quality but felt the registered manager was working hard to raise standards and the arrival of the deputy manager and her presence on a regular basis at the bungalow had helped to bring about gradual improvement. Staff also spoke positively about the presence of the deputy manager on influencing change in the service.

Our inspection highlighted that the provider had taken action to address a number of the previous breaches of regulation and also some of the good practice recommendations we had made; the number of continued breaches however was disappointing where some breaches had not been fully addressed and improvement embedded into everyday practice so quality monitoring procedures although improving were still not fully effective.

Some of the people we met showed a much improved personal appearance and also their willingness to engage with staff and others. There was good evidence that people were supported to access healthcare when they needed to and received appropriate support for all their health needs, however some important records on pain management, frequencies of seizures and risks related to nutrition were not well completed consequently they were unable to provide a complete understanding of people’s needs in these areas.

There was good progress in regard to: the content of staff recruitment files - to evidence that all necessary checks on the suitability of new staff were being made, the management of medicines, and improvements to fire arrangements and staffing levels. Some minor shortfalls were still evident in these areas for example, one recruitment file had one gap in the employment history that had not been accounted for and we have asked the registered manager to complete this with the person concerned. The communication book showed us that staff had been left to undertake medicines ordering wi

People were busy, they told us that they ‘had been to the pantomime’ and enjoyed it. One person had fallen in’ love with Cinderella’ and was making models. This person was in and out of the office ‘talking’ about showing friends at day care.

We observed a major refurbishment updating and re-fitting kitchen and bathrooms, moving the laundry room to an outside facility. Staff and service users were watching and advising.

On the day of the inspection there were only four people living in the home. The home manager said they were looking for a fifth person and were redecorating one of the rooms. We saw the single rooms were individual, minimalist to an Arsenal supporter’s room. One person was in their room, they complained to the manager that a carer had made the bed and put ‘stuff on upside down’. The manager said he would speak with the carer.

People were clearly encouraged to be independent, making day to day decisions about their care and participating in social activities. Staff were attentive to individual needs with a robust interaction between people and carers. We saw pictorial menus on the wall. People liked to shop and help with chores, nobody liked to cook but all could make toast or sandwiches. One person had requested that staff purchase surprise Christmas gifts from a provided list.

We saw that the environment was adequately maintained and that there were systems in place to monitor service delivery as well as the health and safety of the service.

People told us they were happy living at the service and the staff were nice and they could talk to any of the staff if they had a problem. People told us that “the staff help me”. A relative told us that their relative had “never been happier”, they had a “lovely bedroom” and they were “treated so well by the staff”. They added that the staff were “interested” in their relative and talked to them. When they spoke with their relative by telephone, they were “always full of excitement”.

We saw that people were involved in making day to day decisions about all areas of their lives and care. People were encouraged to be independent and participate in social activities they enjoyed. People had their needs met and they were supported to reach their own goals. We noted that a person had a visible injury which the staff had not noticed for a week. Therefore treatment had not been considered and the incident had not been documented. However, the manager took this very seriously and took appropriate action. The staff were supported and had their training needs met. Staff told us they would ask staff and managers for advice and support. Staff told us that the service was “well run”, “people seem happy”.

We saw that the environment was adequately maintained and there were plans for redecoration. There was mould in a bathroom and a toilet seat had become unhygienic. There were systems in place to monitor service delivery and the health and safety of the service.

We carried out this unannounced inspection on 8 & 10 December 2015. The Bungalow is a service for five people with learning disabilities or autistic spectrum disorder who may also have some behaviours that other people could find challenging. The service was full at the time of inspection. People had their own bedrooms. The service was accessible for people who needed to use a wheelchair or found stairs difficult. This service was last inspected on 10 January 2014 when we found the provider was meeting all the requirements of the legislation.

There was a registered manager in post. 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 time of inspection the service had suffered from a period of neglect and decline in the quality of service people received through an absence of consistent management support, but a new registered manager had now been appointed and was aware of and beginning to address some of the shortfalls within the service.

People were placed at risk because recruitment procedures were not sufficiently in depth. Medicines were not managed well. The maintenance and cleanliness of the premises was not sustained to a good standard and infection control practice was poor. Some important risk information was not in place and procedures to guide staff in the event of emergency situations was not always clear or in place.

The induction of new staff was poor, and staff had not received training to support the needs of people with specific conditions such as epilepsy, diabetes or those in need of moving and handling. Health plans that guided staff in the support people needed with their conditions were not in place and staff were not provided with information about how to support people’s behaviour that could be challenging to others. Staffing levels needed further review to ensure there was enough flexibility to meet people’s demands and needs.

There was a lack of accessible information to inform people about the service they lived in and their own routines. A range of quality audits were in place to help the registered manager and provider monitor the service, but these were not sufficiently in depth or effective to identify the deterioration in the service, or the shortfalls highlighted from this inspection; the provider was not therefore able to assure their selves that a safe standard of care was being maintained. Records were not always well maintained. People’s relatives were not routinely asked to comment about the service.

Professionals thought with the appointment of the new manager communication with the service was improving. There was a low level of accident and incidents, and staff showed and understanding of safeguarding, they were able to identify abuse and were confident of reporting concerns appropriately.

Staff had received training in Mental Capacity Act 2005, they sought peoples consent on an everyday basis but understood when other people might need to be involved in making more complex decisions on a person’ s behalf. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and had taken the appropriate steps to refer all the people living at the service who met the requirements for a DoLS authorisation. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff showed that they understood people’s individual styles of communication, and how they made their needs known and people were relaxed and comfortable in their presence. A relative told us they were kept informed and about their family members care and treatment plans. Staff monitored people’s health and wellbeing and mostly supported them to access routine and specialist health when this was needed. People liked the food they ate and were consulted about their personal food preferences to inform menu development. Staff received support through occasional staff meetings and had opportunities to discuss their performance through one to one meetings and annual appraisals of their work performance.

We have made two recommendations:

We recommend that the provider identify a suitable nationally recognised staff tool to review present staffing levels against people’s dependencies.

We recommend that the provider reviews best practice guidance in regard to ways of engaging with staff and team building including staff meetings and the suggested frequencies for this to happen.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.