This was the first inspection of 1 Hamilton Road since the current provider took over the running of the service in March 2017. The inspection took place on 15 and 22 June 2018 and was unannounced.

1 Hamilton Road is a ‘care home’. People in care homes receive accommodation and their 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.

1 Hamilton Road accommodates two people in one adapted building, each person having a separate flat with adapted facilities.

The care service has largely been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. More work was needed to promote these values including choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have 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.

Records relating to premises and equipment safety checks were not all complete.

Staff had not been receiving appropriate support and supervision to carry out their role working with people with complex needs. Supervisions and team meetings were now being scheduled.

Monthly reviews had not been taking place in line with the provider’s policy and were to be re-started.

We have recommended that the provider continues to review the current levels of staff support to ensure both people who use the service receive person centred care and support.

There had been a lack of management stability, which had affected staff morale. Staff we spoke with did not feel informed or that they were listened to and were unsure about some of the management arrangements currently in place.

Quality assurance processes were insufficient to identify and address shortfalls in the service. Action plans were now beginning to be developed to address areas where improvement was needed. An external quality assessor had been commissioned to provide support with this.

Staff understood how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff demonstrated knowledge of people’s support and risk management plans.

There was a programme of initial and refresher training for staff. There had been a lapse in some staff training and competency assessments. Further training and workshops were now being booked.

The service had been recruiting new staff and using agency staff in the interim. The provider was funding specific training for the agency staff to enable them to be effective members of the support team.

Recruitment practices were safe and relevant checks had been completed before staff worked in the service unsupervised.

People’s medicines were stored and managed so that they received them safely.

The service took account of people’s mental capacity and consent.

People were supported to eat and drink enough to meet their needs.

People received regular and on-going health checks and support to attend appointments. People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

Overall the design and layout of the premises met people’s needs.

There was a core group of staff who knew the people they supported well and had developed positive caring relationships with them. People were treated with dignity and respect.

People were encouraged and supported to make decisions about their care and support and staff tried to promote people’s independence wherever possible.

People were supported t