The inspection took place on 8 March 2017 and was an unannounced inspection.

At the last inspection, in January and February 2016, the service was rated ‘Requires improvement’. At this inspection, we found the service had made improvements. The three breaches of regulation concerning medicines management, quality assurance and the sending of key notifications to the Commission had been met.

Tozer House is a residential care home that provides support to a maximum of 15 people who have a range of learning disabilities and some who were living with dementia. The home comprises two houses, Rosemead and Bramley, where people live and a third building with the communal dining area and offices. The buildings are situated around a garden area. The home is located within walking distance of Chichester town centre. At the time of this inspection there were 12 people living there, some on a temporary basis.

The service had a new registered manager. They started in post in October 2016 and were registered with the Commission in December 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.

The provider and registered manager had overseen improvement at the service. There were systems in place to monitor the quality of the service delivery and to drive improvement. Action plans were in place and monitored to ensure that necessary changes were implemented. Records relating to staff training and supervision were in place and up-to-date.

Medicines were managed safely. New systems were in place to ensure that people received their medicines as prescribed. Staff who administered medicines had received training and their competency was assessed. Systems were in place to monitor the administration of medicines and to pick up any omissions or concerns.

The registered manager had notified the Commission of important events as required by law. We discussed the various notifications that services are required to send to the Commission. The registered manager demonstrated a clear understanding of her responsibilities in this area.

Feedback from people, relatives and staff about the service was very positive. People told us they felt safe, that they enjoyed support and friendship from a regular staff team and that they were regularly asked for their views and opinions. Staff felt supported and told us their ideas and opinions were valued by the management team.

People told us staff treated them respectfully and said there were enough staff on duty to assist them. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed.

People had developed good relationships with staff and had confidence in their skills and abilities. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision. Staff were able to pursue additional training which helped them to improve the care they provided to people.

People enjoyed a variety of home-cooked food. Staff were aware of people’s dietary needs and preferences and adapted the menu accordingly.

People were involved in planning their care and staff understood what was important to them. Each person had a keyworker who took the lead in supporting them and coordinating their care.

Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff supported people to be as independent as they were able

The inspection took place on 28 January and 4 February 2016 and was an unannounced inspection.

Tozer House is a residential care home that provides support to a maximum of 15 people who have a range of learning disabilities and some who were living with dementia. The home comprises two houses, Rosemead and Bramley, where people live and a third building with the communal dining area and offices. The buildings are situated around a garden area. The home is located within walking distance of Chichester town centre. At the time of this inspection there were 12 people living there.

The service had a registered manager who was registered with the Commission in October 2015. 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.

In the year leading up to our inspection, there had been significant vacancies in the senior team, including at assistant manager and senior support worker level. People had continued to receive good care and support but there had been a lack of oversight in other areas. This had led to gaps in staff training and supervision and checks on the quality of the service had not always been carried out or used effectively to improve the care that people received. We found that people had not received their medicines safely as there were gaps in administration and records. This had not been identified by the registered manager or provider as there was no audit or check in place to ensure that medicines were administered safely.

The registered manager took prompt action in response to the concerns that we identified. Before our inspection, new senior support workers had been recruited and the registered manager had started to make improvements in how records of staff training and supervision, as well as documents relating to the management of the service, were made and filed. A new staff training matrix had been prepared which made clear which staff required refresher training and could be used as a tool to monitor progress. Supervisions and appraisals were underway, with each senior support worker responsible for supervising a small number of staff.

Staff felt supported in their roles. The registered manager placed high value on a good induction and staff spoke positively of their experiences and the level of support they received. There were enough staff on duty to meet people’s needs and to support them to participate in social activities and to access the community. The staffing level was adapted to reflect changes in people’s needs or to facilitate particular activities. The evening meal was a sociable time, with people and staff eating together. There was a choice of food available and people were supported to make choices and to eat a balanced diet.

There was a happy and open atmosphere at the home. People enjoyed positive relationships with staff and were treated respectfully. People were involved in planning their care and were supported to be as independent as they were able. Staff monitored people’s health and were kept up-to-date via handovers and regular staff meetings. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, occupational therapist or specialist clinics such as for diabetes.

People felt safe at the home and were able to speak up if they had concerns. Risks to people’s safety had been assessed and were managed in order to maximise their independence. Staff knew people well and helped them to make decisions relating to their care and support. We observed that staff took time to discuss options with people and respected their wishes. Staff understood how people’s

We spoke with three people living in the home and two staff. We also spoke with one relative on the telephone. People told that they were happy with the care they received in the home. One person told us "They look after me". Another told us "I like arts and crafts, bingo and discos". The relative spoken with was very happy with the care their family member received in the home.

We spoke with a health professional who told us the home works well with them to meet people's needs. We were told "People are well looked after"

We also spoke with a social care professional who had placed a person in the home and no concerns were expressed. The feeling about the home, we were told "Was very positive". We were told that the home offered care and support as assessed.

We saw from care records that people's care and support needs were assessed and met. We also saw that before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

People who use the service were safeguarded against the risk of abuse because training was taking place.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

We spoke with three people in the home. We were told that they were happy in the home. One person told us that their keyworker would solve any problems, “I would tell if I had a problem”. We were further told “I do like it here, I have a lovely room and the staff get me things”.

To understand life experienced by people in the home we also spoke to relatives, representatives and health professionals.

We spoke to 4 relatives and I representative. We were told by all that they were very happy with the care in the home. One relative told us” I am extremely happy, the staff are wonderful and caring. They are very thoughtful, my [ relative] is very happy and settled there”

Relatives knew how to complain and could discuss any concern which would then be put right. Activities and outings were confirmed as were the completion of surveys. One relative said that sometimes there may be a delay in acting on requests but this was not something the other relative and representative spoken with corroborated.

Relatives were in general happy with the keyworker system but one did say that it would be good if keyworkers had more time available for one to one time with the people living in the home. One other relative also agreed with this and also commented on frequent changes of keyworker.

The representative spoken with told us that the home respected the person’s wishes.

A social care professional told us that people placed in the home have their needs met very well as set out in their support plans. We were told that the home communicates well with them and that the home works well with people to develop individuals’ independence skills.