This inspection took place on the 24 March 2017 and was unannounced. The Foam provides accommodation and support for up to three people who may have a learning disability, autistic spectrum disorder or physical disabilities. Although the service is not accessible to people in wheelchairs it had been adapted in areas to better suit the needs of people with mobility issues. At the time of our inspection three people were living at the service.

The previous inspection on 25 and 26 November 2015 found five breaches of our regulations, an overall rating of requires improvement was given at that inspection. The provider had not ensured staff that were lone working had the right skills, information or competency to provide support to people. Robust recruitment processes had not been completed to ensure staff were suitably employed. Medicines had not always been managed safely and the environment posed a risk to people’s safety. Peoples care plan documentation had not been kept up to date and the support people received did not always meet their needs. The providers systems for monitoring the service was not effective and feedback had not been responded to appropriately. The provider sent us an action plan following this inspection to tell us how they would improve. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

The service had a registered manager in post. The registered manager also had oversight of two other services. A registered manager is a person who is 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. The registered manager was present throughout the inspection.

The service is a small single storey style house. People’s bedrooms were all located on the same floor as the communal living/dining room, bathroom, kitchen, and office which was also used as a sleep in room for staff. There was a large enclosed garden to the rear of the property.

Staffing was sufficient and flexible to meet people’s needs and staff had appropriate training and experience to support people well. Recruitment processes were in place to protect people and ensure staff employed were suitable for their roles.

There were safe processes for storing, administering and returning medicines. Staff were trained to administer medicines and had descriptive guidance to follow to support people with their individual needs.

Robust safeguarding and whistleblowing guidance and contact information was available for staff to refer to should they need to raise concerns about people’s safety. The registered manager reviewed safeguarding information on a regular basis to ensure staff had the most current information to refer to.

People were supported to manage their individual behaviours and staff demonstrated they had the right skills and knowledge to respond to this appropriately. Throughout the inspection when people became anxious staff were able to defuse the situation and prevent a further escalation of anxieties. Risk had been assessed and action taken to reduce the risk of harm people may be exposed to. Appropriate checks were made to keep people safe and safety checks were made regularly on equipment and the environment.

There was good management and oversight of accidents and incidents. The registered manager and provider analysed reports to determine satisfactory action had been taken to prevent repeating incidents and to identify any patterns which may require further monitoring.

Parts of the environment had been refurbished and decorated creating a more homely environment for people.

The registered manager demonstrated a clear understanding of the process that must be followed if people were deemed to lack capacity to make t

The people we spoke with were positive about the service. People told us that the staff were nice and one person told us that they felt safe living at the service. They said “The staff do a very job of that”. One person told us in respect of their goal to move towards independent living, “It is good now because it is all written down”.

We saw that the provider had systems in place to obtain consent from people in relation to people’s care and support.

We saw that people’s care records had been updated to include decisions and guidance for staff to be able to respond to people’s behaviour effectively and consistently.

We saw that people were protected from the risk of abuse because staff knew how to recognise potential abuse and what action to take if they suspected abuse.

Staff told us they were supported in their role, we saw that staff received supervision, attended staff meetings and knew the systems to support them working alone.

We saw that there were systems in place to regularly monitor the quality of the service.

Overall, people gave us positive feedback about the service. People told us they were happy living at the service, the staff were nice and treated them with respect. One person said the service was “rubbish” because of the way it was run; there were not enough staff on duty to support them in their goal to live independently. We saw they were involved in updating their care plan to reflect this goal during the inspection. Relatives told us "The staff there are excellent". Relatives, staff and people had not always been given information around changes to staffing levels showing how service delivery was to be maintained.

We saw that people were involved in making decisions around day to day matters. Decisions were not always recorded on people’s records to show their rights were being upheld and decisions were reviewed. A person did not always receive consistent responses from staff to their behaviour. The manager said the guidance needed reviewing.

There was a system in place to monitor staff training. Staff told us they did not always feel supported in their role because they were unclear about their duties, supervision and staff meetings were not always frequent and they were not aware of systems to support them lone working. This meant that staff were not always supported to care for people safely.

We saw that the environment was suitable for people’s mobility needs and adequately maintained. There were systems in place to regularly monitor service delivery.

This inspection took place on the 25 and 26 November 2015 and was unannounced.

The Foam provides accommodation and support for up to three people who may have a learning disability, autistic spectrum disorder or physical disabilities. Although the service is not accessible to people in wheelchairs it had been adapted in areas to better suit the needs of people with mobility issues. At the time of our inspection the service was full.

The service is a small single storey style house. People’s bedrooms were all located on the same floor as the communal living/dining room, bathroom, kitchen, and office which was also used as a sleep in room for staff. There was a large enclosed garden to the rear of the property.

The service had a registered manager in post at the time of our visit and was present throughout both days of the inspection. The registered manager also had oversight of two other services. 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.

The Foam was last inspected on 19 and 24 March 2015 and had been rated as requires improvement at that inspection. The Care Quality Commission (CQC) issued nine Requirement Actions after this inspection. Areas of concern were: the support people received with their activities as a sufficient number of staff were unavailable, risk assessments were not kept updated and staff did not always adhere to risk measures implemented, robust systems to mitigate the risk of staff lone working were not in place, feedback was not being acted on to drive improvement, medicines were not managed safely, peoples food preferences were not being respected, an accessible complaints procedure had not been displayed and complaints had not been acted upon, documentation and records were not up to date, accurate or completed at all times, staff recruitment files were missing the required information according to our regulations, and staff were not in receipt of regular supervision to provide them with support and identify areas of improvement in their work. We asked the provider to submit an action plan to us to show how and when they intended to address these shortfalls.

We found that while improvements had been made in some areas, this inspection highlighted that the provider had not fully met the previous Requirement Actions.

The provider had not ensured staff had received sufficient induction training or completed essential training before working alone and without supervision. The provider could not be assured that agency workers had the right skills to be able to deliver support to people in an appropriate way as no spot checks or competency checks were made.

Recruitment files continued to lack the required information as outlined in schedule 3 of the Health and Social Care Act 2008. This had been the case at the previous inspection and was a breach of the Commissions regulations.

Processes for managing medicines safely were inconsistent. We found gaps in safety checks and recordings which had not been satisfactorily investigated. Robust medicine auditing had not been implemented meaning the shortfalls found at this inspection had not been identified sooner.

Risk assessments had been implemented to help safeguard people but not all assessments had been updated when new risks had been identified. Although staff could tell us what action they took to mitigate risks, recorded risk assessments lacked this information.

One person had been assessed as being at risk of dehydration. Staff were not given information to help them understand the amount of fluids this person should receive daily. Recordings of fluid intake were inconsistent and missing which meant this person was at risk of receiving insufficient support with this health requirement.

Peoples care files contained good detail but were not always up to date with the most current information. This meant staff did not always have information which reflected the needs of people to inform their practice.

The service was lacking in leadership. Where shortfalls had been identified in this inspection internal audits had failed to identify these areas in need of improvement. The provider had not taken action in all areas following the pervious inspection meaning some regulations were still being breached.

Staff had a good understanding of safeguarding people and the process which should be followed to report concerns inside and outside of the service. A safeguarding policy was accessible to staff should they need to raise concerns including who to contact and what action should be taken.

People were offered a variety of meals and drinks; we observed staff engage people in making their own choices about their preferred meals. Picture guidance was available to help people understand the choices available. This was an improvement from the previous inspection where people’s choices were not being respected.

People were able to participate in activities which they enjoyed. The previous inspection had identified that a lack of staffing meant people were unable to go out as much as they enjoyed. At this inspection we found that additional staff had been deployed during the day so people were able to go out more and engage in activities of their choice.

People were involved in making their own decisions and assessments of capacity were made to comply with the Mental Capacity Act 2005. People were given information in different ways to help them understand the impact of the choices they made. Staff understood people had the right to make their own choices and they would support them through this.

We observed staff talk to people in a caring way. People were relaxed in the presence of staff and there was good rapport. When people became anxious or distressed staff took the time to support the person manage their behaviours and did this in an unhurried, dignified way.

People were able to complain and policies and processes had been implemented which people could use. When people had complained about the service recorded action had been documented.

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