We carried out this inspection on the 10 May 2018, and it was unannounced.

Ulcomb House provides support for up to five people with learning disabilities. There were four people living at the service at the time of the inspection. Some people at the service had one to one and two to one support. The service was spread over three floors of one adapted building and had an enclosed garden at the rear. The communal areas included a lounge, a large kitchen, a chill out space and a large conservatory that was used for activities and as a dining space. A gate to the rear of the back garden led to property owned by the provider. This property housed several small buildings including office space for the provider and administrative staff and a maintenance workshop.

There was a registered manager at the service who was supported by a deputy 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.

Ulcomb 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.

At the last inspection on 16 February 2016 the service was rated Good. At this inspection we found that the provider had been unable to sustain the rating of Good as we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to the failure to provide Good Governance.

Staff told us that they had the skills and knowledge to undertake their role. However, some training for staff was overdue. The registered manager had identified this through regular auditing. However, the provider had failed to arrange the training required in a timely manner.

We have made a recommendation about staff training.

The environment had been adapted to meet people’s individual needs. However, some areas of the décor were tired and worn and the service would benefit from re-decoration. The service was clean and staff were aware of infection control and the appropriate actions had been taken to protect people.

We have made a recommendation about the environment.

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 were sufficient numbers of staff to meet people’s needs. Staff had regular supervision meetings and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

Medicines were managed safely. Medicine records were accurate and up to date and people received their medicines on time and when they needed them. Risks to people continued to be assess and there was guidance in place to support staff to minimise risks. There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns.

People’s needs were appropriately assessed and support plans were up to date and accurately reflected people’s needs. People were involved in decisions about their support. Where people did not have capacity to make decisions staff had followed guidance in line with the Mental Capacity Act 2005.

Some people at the service could display behaviours that had a detrimental effect on them and the people around them. There was sufficient guidance for staff to support people to maintain behaviour and manage anxiety.

People continued to be supported to ma

We inspected this home on 16 February 2016. This was an unannounced inspection.

Ulcomb House is registered to provide care and support for up to five people who have learning disabilities and or Autism. People were supported to learn life skills to increase their independence and confidence. At the time of our inspection, there were four people living at Ulcomb House. The people had different levels of independence, and required specific individual support.

There was a registered manager at the home. 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 were protected against the risk of abuse; they felt safe and staff recognised the signs of abuse to look for. Staff understood their role and responsibilities in reporting any concerns and were confident that any concerns would be taken seriously by the registered manager.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s physical and social needs with details of how the risks could be minimised. This enabled the staff to take immediate action to reduce or prevent harm to people.

There were sufficient numbers of suitably trained staff to meet people’s needs and promote people’s safety. Staff were aware of their roles and responsibilities and the lines of accountability within the home. Staff received regular supervision and had an annual appraisal with staff meetings three times a year.

The registered manager followed safe recruitment practices to ensure staff were suitable to work with vulnerable people. Staff told us the management was approachable, very open, and supportive. Staff morale was good and staff talked positively about their roles within the home.

Staff were kind and respectful, and were aware of how to respect people’s privacy and dignity. We observed that staff had formed very positive relationships with the people. We heard that people were encouraged to make their own choices and decisions, which were respected by staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People who had been assessed as lacking capacity to make decisions for themselves, staff made sure their best interests were taken into account. Staff received training in the Mental Capacity Act 2015 and DoLS to enable them to understand the need for referrals and their responsibilities around best interest decisions.

There was a policy and procedure for the ordering, storage, administration and the return of medicines to the pharmacy. These were followed by staff to ensure people received their medicines safely. People had good access to health and social care professionals when required.

People were very much involved in the care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans.

People were encouraged and supported to pursue activities inside and outside of the home. Staff made people aware of what events were happening within the local community. People were also encouraged to keep active and continue learning.

Health action plans were in place and people had their physical and mental health needs regularly monitored. Regular reviews were held and people were supported to attend appointments with various health and social care professionals. This ensured they received treatment and support as required.

Residents meetings took place on a regular basis. Minutes were recorded and any actions required were documented and acted on. People’s feedback was sought and used to improve the care. Peo

We visited the home and spoke with one person who lived in the home, a team leader and a care worker. We observed staff practice when they supported people and we viewed people’s care files and looked at the home’s documentation.

People who lived at Ulcomb House told us that they were happy there. One person said, “The staff reminds me when I forget, look after me and I like them”. They also said that they liked living at the home.

Staff asked for the person’s consent before we looked at their personal file. Each person had a comprehensive plan of support which they had agreed with. The plans included people’s preferences, needs assessment, goals for future independence and risk assessments.

People in the home had received their medication as prescribed.

The home had been maintained and looked in good order generally. People’s bedrooms had been personalised.

Staff had received the training that they needed to care for people and to develop within their job role.

There were systems in place to monitor the on-going quality of the care and environment in the home.

During this time we met and talked with four of the people living there and looked at records. We talked with two staff as well as the deputy manager.

People living at the home spoke positively about their experiences of living in the home. They said they liked living there, and were able to make their own choices about their lifestyles. They said that the staff supported them with making decisions about what they wanted to do. One person said "The staff take us out and are like my friends, there’s a lot to do."

During the course of the visit we met all five of the people living in the home. Two of them were happy to talk, but others were less inclined to do so. One had limited verbal communication.

Comments we received were:

“I like living here.”

“It’s ok.”

“The staff are nice.”

“I’ve got shepherd’s pie tonight.”

“I like my room.”