We inspected United Response - 47 Doublegates Green on 10 December 2018. The inspection was announced. When we last inspected the service in April 2016 we found the provider was meeting the legal requirements in the areas that we looked at and rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

United Response - 47 Doublegates Green is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

United Response - 47 Doublegates Green is a large purpose-built bungalow situated on a housing estate close to the centre of Ripon. The service is registered to accommodate a maximum number of five people with a learning disability, some of whom have a physical disability. At the time of the inspection there were five people who used the service.

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. Registering the Right Support CQC policy.

At this inspection we found the service remained good.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. We did note the choking risk assessment for one person did not include guidance for staff to follow in the event of this happening. However, we received confirmation after our inspection from the registered manager that this had been undertaken.

Medicines were managed safely with an effective system in place. Staff competencies around administering medicines were regularly checked. However, we did find the staff signature list for those staff who were responsible for the administering of medicine had not been completed. There were some gaps in the recording of room temperatures where medicines were stored. The senior support worker told us they would take immediate action to address this.

The home was clean and tidy and communal areas were well maintained. Appropriate personal protective equipment and hand washing facilities were available. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

There were enough staff on duty to meet their needs. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported by a team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place. Where there were gaps in training this had been identified and training had been planned.

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.

Staff supported people to maintain a healthy and nutritional diet. People were supported by staff to maintain their health and attend routine health care appointments.

Staff were kind and caring. Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People had access to a range of activities. The service had a clear process for handling complaints.

Staff

This inspection took place on 27 April and was announced. At our last inspection on 14 July 2015 we found that the service had met the previous breaches of regulation that were identified. However, we said we could not improve their rating because to do so required consistent good practice over time.

United Response - 47 Doublegates Green is registered with the Care Quality Commission (CQC) to provide accommodation and personal care for up to five people who have learning disabilities and additional physical disabilities.

At the time of the inspection five people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that the improvements noted in the last report had been sustained. Effective management systems were in place to promote people’s safety and welfare. People received their medicines as prescribed by their GP and staff had received training in the safe handling of medicines. The registered manager completed a weekly medicines audit to ensure that any shortfalls were quickly identified and action could be taken as needed.

Areas around the home had been refurbished and redecorated. The environment was clean and audits undertaken by the manager reduced the risk that people would be exposed to the risk of cross infection.

Staff were trained in, and understood the principles of, the Mental Capacity Act [MCA] and understood and followed the correct procedure when these principles were applied. Staff understood and had received training in how to recognise abuse and how to keep people safe from harm. Risk assessments guided staff in how to keep people safe and how to support people. The registered provider ensured suitable recruitment checks were completed and there were enough staff on duty to meet people’s needs.

People were involved with menu planning and staff ensured they had nutritious food. People were supported to access their GP and other health care professionals when needed. Staff received training which was relevant to their role and this was updated as required.

People were supported by staff who were kind and caring and understood their needs. Good professional relationships existed between people who used the service and the staff and interaction was respectful. People’s dignity was respected and they were provided with the space to be private.

People were supported to undertake a range of activities which included maintaining and developing independent skills. They were also supported to choose and attend hydrotherapy and day centres of their choosing. The manager held meetings with the staff so they could contribute to the running of the service. Regular audits were undertaken to ensure people lived in a service which was safe and well run.

We carried out an announced comprehensive inspection of this service on 5 February 2015.We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to: Regulation 12 (Safe care and treatment) due to inaccurate medicine records;

Regulation 15 (Premises and equipment) due to failure to maintain appropriate standards of cleanliness and adequate maintenance of the environment.

Regulation 11(Need for consent) because the provider did not always act in accordance with legislation to gain the consent of service users in relation to their care and treatment.

Regulation 17 (Good governance) because people were not protected by the systems in place that assess and monitor risks relating to health and safety.

After the comprehensive inspection, the provider wrote to us with an action plan to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 14 July 2015, to check that the provider had followed their plan and to confirm that they now met with the legal requirements. Because it is a small service we contacted the registered manager the day before the inspection to check that people would be in. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for United Response – 47 Doublegates Green on our website at www.cqc.org.uk

United Response – 47 Doublegates Green is a care home registered for up to 5 people with a learning disability. It is a large purpose built bungalow situated approximately one and a half miles from the centre of Ripon. The bungalow has five large, single bedrooms and two spacious bathrooms. The building has been designed to support people with complex needs and mobility difficulties. There is an enclosed, wheelchair accessible garden outside to the rear and parking to the front. At the time of our inspection there were 5 people living there.

The home employs a registered manager who has worked at the home for seven years. 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.

Areas within the home’s environment had improved. We saw hallway areas had been re-decorated and work was on-going as decorators were present during our visit to the service. Where kitchen cupboards were broken these had now been repaired.

The systems for staff to follow to minimise the risk of infection had improved. All of the bathrooms were clean and we saw that staff had cleaning schedules in place to follow. This ensured that all areas within the home were regularly cleaned and maintained well.

The medication procedure regarding the booking in of medicines had been reviewed and updated. The procedure now informs staff to check all medicines when booking them in to ensure that all prescribed medicines were correctly dispensed by the pharmacist. These risks were now reviewed by the registered manager through the checks that took place to monitor the quality of the service.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are safeguards put in place to protect people where their freedom of movement is restricted. All of the people at 47 Doublegates Green had a DoLS authorisation due to their restricted mobility. Improvements had been made to a number of decisions being made about restrictive practices used for some people with regard to the MCA. Best interests meetings had been arranged with the appropriate people such as relatives, or professionals involved in people’ s care, to ensure any decisions made were in the persons best interest.

Improvements had been made to the management systems in place at the home in making sure the service was operating safely and effectively. The processes for monitoring and reviewing improvement now provided clear instruction for staff.

This inspection took place on 5 February 2015. Because it is a small service we contacted the registered manager the day before the inspection to check that people would be in.

United Response – 47 Doublegates Green is a care home registered for up to 5 people with a learning disability. It is a large purpose built bungalow situated approximately one and a half miles from the centre of Ripon. The bungalow has five large, single bedrooms and two spacious bathrooms. The building has been designed to support people with complex needs and mobility difficulties. There is an enclosed, wheelchair accessible garden outside to the rear and parking to the front. At the time of our inspection there were 5 people living there.

There was a registered manager in post at the time 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 and associated Regulations about how the service is run.

We have told the provider to take action to make improvements in a number of areas.

We identified that there were risks to people's safety in the service. Some areas of the service, such as the kitchen, had not been maintained adequately and there were infection control risks in bathrooms and toilets. We also found an error in the recording of one person’s medicine. These risks had not been identified by the manager through the checks that took place to monitor the quality of the service.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are safeguards put in place to protect people where their freedom of movement is restricted. All of the people at 47 Doublegates Green had a DoLS authorisation due to their restricted mobility. However, we found a number of decisions about care and treatment had been made without regard to the MCA.

Staff were knowledgeable about the people they supported and received the training they needed to support them in their roles. Staff had a good understanding of each person’s needs and preferences. They spoke with people sensitively and in a caring manner. There was clear information in care plans about how people liked to communicate and this was followed through in practice. People had good opportunities to participate in community activities in line with their particular interests. People were supported to lead fulfilling lives in line with their own preferences and choices

People were supported in having their day to day health needs met. Health services such as dentists, GPs and opticians were used as required and there were close links with other services such as the local North Yorkshire County Council Learning Disability Team. People were given a variety of healthy meals as part of their diet which were prepared according to their individual needs.

Staff had received training in safeguarding and told us they were confident about their responsibilities should abuse be suspected. Staffing levels were sufficient to keep people safe, however there had been occasions where the staff team were placed under pressure to provide sufficient cover due to sickness and absence. This was being monitored by the manager.

There was a caring and supportive culture in the service which was based around giving people fulfilling lives. The staff team were focussed on delivering care and support which met people’s needs in a person centred way.

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

The people who live at 47 Doublegates Green were unable to tell us their views about the outcome areas we looked at because they had complex needs which meant they were not able to tell us their experiences. Instead we spent time in the dining room, observing three people who were in at the time of our visit.

We telephoned and spoke with relatives and friends of people living at the home. We also spoke with people's care managers about the care and the support they received at 47 Doublegates Green. Everyone we spoke with told us the overall care at the home was ‘extremely good’.

We saw from people's care plans that people were supported to live as independently as possible. The home had carried out an assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with had received training in safeguarding adults.

We reviewed the level of staffing for the home. Records showed there was always enough staff to support people with their care needs.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.

We were unable to speak with the people who used this service because they were unable to communicate verbally. They also had complex needs, dual sensory impairment and physical and mental disabilities.

When we carried out our inspection we did see staff interacting with people who used the service. They were talking with them, giving them choices and encouraging and supporting them with whatever they were doing.

The people who live at 47 Doublegates Green were unable to tell us their views about the outcome areas we looked at because they had complex needs which meant they were not able to tell us their experiences. Instead we spent time observing a mealtime, whilst some people were still at home and before everyone went out to their various activities. We also had opportunity to observe how care was being provided.

We telephoned and spoke with relatives and friends of people living at the home. We also spoke with people's care managers about the care and the support they receive at 47 Doublegates Green.

One relative said “The staff have built up a rapport with people living there and they have continuity in the staff group. My relative is really happy. If I had to give the home a score I would give them 11 out of 10.”

Another relative said “I love the home. My relative is getting wonderful and exceptional care the best they have ever had. They have never looked back. My relative is happy where they are and is well cared for.”

A visitor to the home told us “The staff are very caring and supportive and are interested in the young people they care for. 47 Doublegates Green is a very good home. The meals always look good when I visit. Overall I am very impressed.”

A care manager said that they felt that people’s care needs were being met. They told us “The staff at the home go that extra mile. I have no concerns about the service.”

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.