About the service: United Response – 2a St Alban’s Close accommodates up to four people with learning disabilities in a purpose built building. Four people were using the service at the time of the inspection.

People’s experience of using this service: During our inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. Care records were not always regularly reviewed or up to date. This had been identified via the provider’s audits but had not yet been actioned.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion.

Family members told us their relatives received a good service and were happy they were safe. Accidents and incidents were recorded and reviewed. Risk assessments were in place but not all records were up to date. The registered manager understood their responsibilities about safeguarding and staff had been appropriately trained. Arrangements were in place for the safe administration of medicines.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions.

People’s needs were assessed before they started using the service. Staff treated people with dignity and respect and helped to maintain people’s independence where possible.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The provider had a complaints procedure and family members were aware of how to make a complaint. People, family members and staff were regularly consulted about the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last inspection the service was rated Good (published November 2016).

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Enforcement: Details of the action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The inspection took place on 2 September 2016 and was unannounced. We carried out our last inspection in January 2016 when we found the provider had breached four regulations which were regulation 10 (person-centred care), regulation 12 (safe care and treatment), regulation 18 (staffing) and regulation 19 (fit and proper persons) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

At the inspection on 2 September 2016 we found improvements had been made with regard to these areas.

United Response - 2a St Alban's Close provides care and support for up to four people with learning disabilities. Nursing care is not provided.

At the time of this inspection the home did not have a registered manager as they had left two weeks before our inspection. A new manager was in post on the day of our inspection. 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.

Staffing levels had been reviewed since our last inspection and both relatives and staff we spoke with were confident there were sufficient numbers of staff in place. Each shift had an allocated leader who was nominated at each handover.

Recruitment procedures followed were found to be safe as relevant background checks had been carried out. We recommended the registered provider ensured candidate applications forms were kept on file for us to review. Risks to people had been identified, assessed and reviewed. Relevant mental capacity assessments had been completed and DoLS authorisations were in place.

Relatives were able to visit their family members at all times and they spoke positively about the care provided by staff. Staff received support through their induction, training and regular supervision and appraisal support. Team meetings were held on a monthly basis and were a good record of discussions which had taken place.

A number of quality management systems had been introduced by the registered manager which ensured continuous improvement of the service. Relatives and staff spoke positively about the support they received from the registered manager.

Care plans were very person-centred and contained detailed information which meant staff were able to provide effective care. Relatives were invited to attend reviews and told us staff also attended reviews for their family member which related to other services they received.

Relatives were aware how they could complain if they were dissatisfied and systems were in place to record and respond to any concerns.

Staff knew about people’s likes and dislikes and how they wanted to receive their care. People were supported by staff to access a range of activities and events in the community and were also stimulated within the home.

Effective systems had been introduced which ensured the safe management of medicines. Staff received medication training and had their competency checked. Medicines were stored correctly and MAR charts showed people received their medicines as prescribed.

Relatives and staff felt people living in the home were safe and protected from harm. The privacy and dignity of people was well managed by staff who discussed this at regular team meetings. Relatives and staff were confident people’s privacy and dignity was maintained and through our observations, we saw this happened.

The living environment was clean and all maintenance certificates were up-to-date. Fire safety was well managed with evidence of staff training and regular checks of equipment.

This was an unannounced inspection carried out on 06 January 2016. Our last inspection took place on 24 July 2013 and we found the provider met the regulations we looked at.

United Response - 2a St Alban Close provides care and support for up to four people with learning disabilities. Local shops and community facilities are a short walk away in the Harehills area of Leeds.

At the time of our inspection the service did not have a registered manager. A registered manager is a person who has 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. We found there was a manager in post who was intending to register with the CQC.

Relatives felt their family members were safe and staff knew how to identify different types of abuse as well as who to report concerns to. Where action had been identified in response to a safeguarding incident we saw this had taken place. We found risk assessments in place in care plans, but saw these were not regularly reviewed and some required more detail. There was a risk to people’s safety because medicines were not always managed consistently and safely. We saw fire safety was well managed.

Mental capacity assessments had been completed as part of the application for Deprivation of Liberty Safeguards (DoLS), but these assessments were not decision specific. People’s care plans contained sufficient and relevant information to provide consistent care and support.

We found there were insufficient numbers of suitably qualified and experienced staff consistently on shift. We saw recruitment was generally well managed, but found the manager had started working unsupervised before the provider had received a response from the Disclosure Barring Service (DBS) regarding their suitability to working with vulnerable adults.

Staff were suitably qualified and competent in their roles and relatives confirmed this. Staff received an appropriate induction and a range of further training. Some gaps existed in staff supervision records.

There was opportunity for people to be involved in a range of activities within the home or the local community. People had access to food and drinks. People received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity, but we witnessed poor practice on the day of our inspection.

The manager was appreciated by staff and they were supported by an area manager who regularly visited the service. People had been given opportunity to comment on the quality of service, but we were unable to see how their feedback affected service delivery. Complaints had been recorded, but the details including the response to these were not available to us during the inspection.

We found breaches of regulations 19, 12, 18 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

This was an unannounced inspection carried out on 06 January 2016. Our last inspection took place on 24 July 2013 and we found the provider met the regulations we looked at.

United Response - 2a St Alban Close provides care and support for up to four people with learning disabilities. Local shops and community facilities are a short walk away in the Harehills area of Leeds.

At the time of our inspection the service did not have a registered manager. A registered manager is a person who has 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. We found there was a manager in post who was intending to register with the CQC.

Relatives felt their family members were safe and staff knew how to identify different types of abuse as well as who to report concerns to. Where action had been identified in response to a safeguarding incident we saw this had taken place. We found risk assessments in place in care plans, but saw these were not regularly reviewed and some required more detail. There was a risk to people’s safety because medicines were not always managed consistently and safely. We saw fire safety was well managed.

Mental capacity assessments had been completed as part of the application for Deprivation of Liberty Safeguards (DoLS), but these assessments were not decision specific. People’s care plans contained sufficient and relevant information to provide consistent care and support.

We found there were insufficient numbers of suitably qualified and experienced staff consistently on shift. We saw recruitment was generally well managed, but found the manager had started working unsupervised before the provider had received a response from the Disclosure Barring Service (DBS) regarding their suitability to working with vulnerable adults.

Staff were suitably qualified and competent in their roles and relatives confirmed this. Staff received an appropriate induction and a range of further training. Some gaps existed in staff supervision records.

There was opportunity for people to be involved in a range of activities within the home or the local community. People had access to food and drinks. People received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity, but we witnessed poor practice on the day of our inspection.

The manager was appreciated by staff and they were supported by an area manager who regularly visited the service. People had been given opportunity to comment on the quality of service, but we were unable to see how their feedback affected service delivery. Complaints had been recorded, but the details including the response to these were not available to us during the inspection.

We found breaches of regulations 19, 12, 18 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

Staff were friendly, patient, polite and treated people in a respectful way. During lunch staff encouraged people to be independent and make choices but at the same time assisted people when they required support. It was clear from our observations that staff knew the people they were supporting very well.

People’s needs were assessed and care and support was planned and delivered in line with their care plan.

People who used the service benefitted from equipment that was comfortable and met their needs.

There were effective recruitment and selection processes in place. People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We were unable to communicate verbally with people who use the service to find out their views and experiences, although one person did confirm they liked living at the home.

We observed the care being given to people as part of this review and saw staff centre the care on each individual. Care practices were of a very high standard.

We spoke to a person who visits the service on a very regular basis. They were very complimentary about the care provided. They said, “I’ve no doubts about the care, they look after (name of person) very well. I can visit when I want and they always ring to let me know if they have any concerns. (Name of person) is very happy there.”

Staff told us people received very good care and people’s needs were always met. They said people get good support with their health and social care needs and other professionals are always consulted when appropriate.

The manager told us about the different systems they have in place to make sure people’s needs are identified and met, and people are treated with respect. One staff said, “The manager spends a lot of time working with us and talks about respect and dignity. We are all very good at promoting people’s rights; it’s always at the forefront of what we do.”

Staff said they work very well together as a team and most staff had worked at the home a long time so knew people who use the service very well.

Staff said they get good support from the manager and care provider, and had received enough training to equip them with the knowledge and skills to do their job well.

Staff provided appropriate care to people and it was clear they knew the people they were supporting very well.

People’s individual needs, and their likes and dislikes were taken into consideration when care was planned and delivered. Where people were unable to consent their preferences were discussed and reviewed with others who had sufficient knowledge.

Care and support was planned and delivered in a way that ensured people’s safety and welfare. Care files contained good evidence to show risks had been identified and how these should be managed.

The provider had appropriate arrangements in place to manage medicines.

There were enough staff to meet people’s individual needs, which included frequently accessing the local and wider community.

Effective systems were in place to identify when people were unhappy, concerned or not their usual self. Concerns or comments would be dealt with promptly and appropriate action taken where necessary.