Upton Grey Close 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.

Upton Grey Close supports adults with learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living in the service. The home is located two miles from the town centre of Winchester. The home is two adjoining houses each with their own access. People were accommodated in single bedrooms with en-suite facilities. Communal areas included; a garden, kitchen dining room and a lounge.

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.

At our last inspection in January 2016 we rated the service requires improvement. There were three breaches of the regulations. We asked the provider to take action to make improvements. For example, we found care plans did not reflect people’s changing needs, the provider had not acted in accordance with the Mental Capacity Act 2005 and the provider had not kept accurate records of how risks were mitigated and how quality was monitored and at this inspection we found action has been completed.

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 are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There have been improvements since the last inspection. Including detailed monitoring of the home. The staff team are stable and feel supported by the registered manager. Records have been improved and are relevant and updated in a timely way when changes occur.

Support staff are very aware of people’s needs and preferences and respond quickly to any concerns by contacting the relevant professionals.

People are supported by staff who are skilled and knowledgeable. Staff are passionate about their role and working with the people living at Upton Grey Close.

People are included in the planning and delivery of care. They were confident in raising concerns and expressing themselves.

People have access to healthcare services when they need them.

Improvements to the management structure had resulted in staff feeling well led and supported.

Further information is in the detailed findings below.

This inspection took place on the 28 and 29 January 2016 and was unannounced. Upton Grey Close is a care home registered to provide accommodation and personal care for fifteen adults with learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living in the service. Four people were accommodated in one house and one person lived in an adjoining house with separate access that also accommodated a staff office and a second staff sleep in room. The two houses people lived in had recently been refurbished. Two other houses were not currently in use as the provider had decided not to use these premises for the time being.

The home is located two miles from the town centre of Winchester. People were accommodated in single bedrooms with en-suite facilities. Communal areas included; a garden, kitchen dining room and a lounge.

The service did not have a registered manager in post as required. The provider had informed us on 20 October 2015 that the service was being managed by the deputy manager. The provider has now successfully recruited to the post of manager and this person has submitted an application to become the 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.

People told us they were safe and their relatives told us people were cared for safely. Staffing levels during the day had recently been increased to meet people’s individual needs. Overnight staffing was provided by one or two sleep in staff. Most staff working in the home were new in post since July 2015. Not all staff had completed the required training to support people with their needs for example; in moving and handling. This meant that some planned activities to the gym had not taken place due to a shortage of trained staff. This was important for a person to help them maintain their mobility. At the time of our inspection staff training needs were being addressed and a plan was in place to prevent a reoccurrence of missed activities.

People were supported by staff who understood how to recognise the signs of abuse and how to report their concerns. The manager had acted on information of concern to prevent a reoccurrence. Risks to people’s health and wellbeing were assessed and plans were in place to guide staff on how to support people safely.

People were supported with their medicines by trained staff who were assessed as competent to do so. Detailed guidance was in place to guide staff on the safe administration of medicines taken when required. We found some recording errors in people’s medicine records. Ensuring people’s medicine records are accurately completed is important to avoid mistakes in the administration of medicines. Although records were not always accurately completed, people had received the medicines they required.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005 and whether applications to deprive a person of their liberty had been appropriately made and authorised. No applications to deprive a person of their liberty had been made. We found the provider had not carried out an assessment of people’s mental capacity to agree to their care and treatment and any restrictions within this. This meant people’s rights under the MCA may not be met.

Staff made prompt referrals to healthcare professionals when people’s healthcare needs changed. However, the information required to inform staff of people’s healthcare support needs and to monitor their progress was not always available and completed as described in their care plan. For example, a person’s exercise regime was not readily available to staff, up to date and monitored in line

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

We met two of the three people using the service and looked at care and support records. We also spoke with a relative, the deputy manager and two care workers. This is a summary of what we found -

Is the service safe?

There were systems in place to safeguard people who use the service from abuse. We saw that support plans included guidance on how staff should support individuals whose behaviour may sometimes be challenging to the service; and that relevant training was provided. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with had a good understanding of people’s needs and interacted positively with them. We saw that they communicated well with people using the service and promoted an inclusive, supportive environment. Staff demonstrated their understanding of using a non-confrontational approach and knowledge of how different individuals may communicate through their behaviours.

People were provided with a choice of suitable and nutritious food and drink and were supported to be able to eat and drink sufficient amounts to meet their needs. A relative told us “Nutrition and diet has improved dramatically, through more one-to-one support”. They said “Quite a few staff enjoy cooking and staff monitor when people have packed lunches that they are eating healthily”.

Is the service caring?

We observed that care workers showed patience and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed. A person using the service told us they enjoyed living at the home. A relative told us: “The staff and support is excellent”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Each person using the service had a named key worker, whose role was to help co-ordinate the person’s care and support. This included involving them in regular care reviews and keeping their relatives informed of changes, if appropriate. We saw that people’s health needs were monitored and referred to health professionals appropriately. This helped to ensure that the delivery of care was responsive to people’s needs and based on up to date information and guidance. The records showed that any concerns were followed up and appropriate action was taken.

Is the service well led?

There were clear lines of accountability within the service. We saw that regular audits of the quality and safety of the service took place and were recorded. For example, there were audits of the premises, equipment and catering. In addition to these, a services manager for the organisation carried out regular checks that were also recorded. There was a monthly improvement log completed by the managers, which was a record of actions taken in relation to audits, incidents, and feedback from people using the service or others acting on their behalf.

People told us that staff checked with them before providing any support or care to make sure they were happy with what was planned. People said they were able to say they didn’t want care or support at certain times and staff respected this.

Although people told us they received good care and support, we found that the care and support plans were not accurate or kept up to date. This increased the risk that people may receive care and support that was inappropriate or unsafe.

People told us they were involved in choosing decorations and said maintenance work was completed quickly when required.

People said they would speak to staff if they had any concerns and said they were confident that action would be taken to resolve their problem. However, we found that complaints were not always recorded and it was not clear what action the provider had taken to investigate complaints and resolve the problem.

Staff felt well supported; however, they did not receive regular formal supervision and had not been given training suitable to their role. This increased the risk that staff would not have the skills and knowledge to deliver care and support to people safely and to an appropriate standard. We have told the provider that action is required to put these things right.

People told us they were well treated by staff. People said they had been involved in writing their support plans and had regular meetings with staff to review the support they needed. We were told there were sufficient staff available to provide the support that people needed.

People told us they felt safe in the home and said they would speak to staff or the manager if they had any concerns. People were confident that any concerns would be addressed.

During this inspection we spoke with two people who used the service and observed the way staff interacted with people. People told us they received the care and support they needed and said they were well treated by staff. We observed staff communicating with people in ways which were set out in their communication plans in order to provide reassurance and minimise anxiety. Staff demonstrated a good understanding of people’s specific communication needs and responded well to questions and requests for assistance.

People were protected against the risks associated with medicines because staff had received suitable training and kept accurate records of the medicines people had been supported to take.

People we spoke with said they were able to raise concerns with the staff or manager and were confident that action would be taken to address the issue. One person said they would talk to the manager if they had a problem and was confident the manager would “sort it out”.