This was an unannounced inspection that was carried out by an adult social care inspector on 1 February 2017.

19 Beech Avenue is registered to provide accommodation for up to eight people who have a learning disability.The accommodation is in a bungalow and a small house

linked by a covered walkway. People who live in the bungalow may also have a physical disability. The people who live in the house may display behaviours that challenge. The provider is in the process of closing the accommodation in the house and will reduce the numbers to five people accommodated in the bungalow. The service is operated by Walsingham who run a number of similar services in Cumbria and throughout the country.

When we last visited the service in August 2015 we rated the services as 'Requires improvement'. We judged that the service was in breach of two legal requirements.

The provider was in breach of Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014: Staffing because we judged staffing levels did not meet people's needs. We also judged that the environmental standards of the property needed to be improved. The house needed to be redecorated and furniture replaced. Some furniture and fittings in the bungalow also needed to be replaced. This was a breach of Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2014 Premises and equipment.

We received a suitably detailed action plan from the provider and we had on-going updates from the registered manager and the operations manager. Staffing levels had been improved straight away and good staffing ratios had continued. People had their care needs met by the staffing levels. We had evidence to show that Regulation 18 had been met.

Walsingham had taken a decision, along with local authority and health professionals, to no longer use the house. Only one person remained in the house and there were plans to close this within the next three months. We had received an action plan and we saw that, where possible, redecoration and replacement of furniture had happened in the house. The provider was now compliant with Regulation 15.

The home had a suitably qualified and experienced 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.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and there had been no safeguarding issues reported in the service. Good risk assessments and risk management plans were in place to support people. Suitable arrangements were in place to ensure that new members of staff had been suitably vetted and were the right kind of people to work with vulnerable adults. There had been no accidents or incidents of note in the service.

The home had increased the staffing levels with a new waking night support worker in place. The registered provider had agreed that this was necessary due to the changing dependency levels of people in the bungalow. Staff were suitably inducted, trained and developed to give the best support possible.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary.

The registered manager was aware of her responsibilities under the Mental Capacity Act 2005 when people were deprived of their liberty for their own safety. This had been done appropriately and consent was always considered for any interaction, where possible.

We saw that the staff team made sure people had proper nutrition and hydration. Staff supported people to eat as healthily as possible.

The bungalow was suitably adapted to meet people's needs and had recent improvem

This was an unannounced inspection that was carried out by an adult social care inspector on 6th August 2015.

19 Beech Avenue provides accommodation for up to eight people who have a learning disability. The accommodation is in a bungalow and a small house linked by a covered walkway. People who live in the bungalow may also have a physical disability. The people who live in the house may display behaviours that challenge.

The service is operated by Walsingham who run a number of similar services in Cumbria and throughout the country.

The service has a registered manager who was on extended, planned leave at the time of this visit. 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.

We judged that there were not enough staff to support people with complex needs. The provider was in breach of Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014 Staffing. You can see what action we told the provider to take at the back of the full version of the report.

The environmental stands of the property need to be improved. The house needed to be redecorated and furniture replaced. Some furniture and fittings in the service also needed to be replaced.

This is a breach of Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2014 Premises and equipment. You can see what action we have told the provider to take at the back of the full version of the report.

Staff were aware of their responsibilities in keeping vulnerable people from harm and abuse. Safeguarding referrals were made appropriately.

Risk management was in place when any potential risk was identified. Accidents and incidents were managed correctly.

The bungalow was suitably adapted for people with complex moving and handling needs.

Recruitment was done appropriately with all checks in place to make sure vulnerable people were protected. The service had suitable arrangements in place to deal with disciplinary issues.

Medicines were ordered, administered, stored and disposed of correctly.

Good infection control measures were in place.

Staff were suitably skilled and had a good understanding of people’s needs. This was because staff had received suitable training and were being given supervision and support. This included training on managing behaviours that challenge. Staff were trained in restraint but had not needed to use this.

We spoke to staff and saw evidence to show that they understood the issues around capacity and consent. A multi-disciplinary approach was taken to decision making and every person in the home had been judged as having restrictions on their liberty. The registered manager had applied for Deprivation of Liberty orders under the Mental Capacity Act 2005, and appropriate meetings had taken place to ensure people's rights had been protected.

Staff had a good understanding of how to support people with complex nutritional needs and food preparation was done well to ensure people were offered a healthy diet.

People in the home saw their GP and the community nurses. Specialist health care providers were also involved in the care of people in the home.

We observed staff treating people in the home with dignity and respect. People were given private time and the staff were good at interpreting their needs. Everyone had access to an advocate.

Suitable arrangements were in place for end of life care when that time came.

We looked at care files and we saw detailed care plans were in place to support frail and vulnerable people. These included behavioural plans and very detailed plans for personal and health care support.

People were taken out on the home’s transport on a regular basis. Activities were in place that met the complex needs of people in the service.

There was a suitable complaints procedure in place and there had been no complaints received about the home.

We had evidence to show that the staff team had supported someone who had moved to more independent living. This had been done well and the team had worked with external colleagues.

Suitable management arrangements were in place during the planned absence of the registered manager. The organisation was supporting the temporary manager and the senior team.

Staff displayed the values that Walsingham judged to be of importance to people with learning disabilities.

Quality checks were in place and the operations manager was aware of the issues in the home around staffing and the environment.

People who lived in the service were given suitable levels of care. They were helped with all aspects of personal care and they were supported to access health care. Each person saw the specialist consultant for learning disability, social workers and specialist nurses for learning disability.

People received suitable and nutritious food and were helped and supported to eat as well as possible.

Staff understood their responsibilities under safeguarding. We spent time with people and checked on notes and did not see anything of concern but we did speak to Cumbria County Council about some issues related to personal finances.

We judged that the house and the bungalow were generally suitable environments for the people who lived there.

We looked at equipment in the home and this met the needs of all the individuals.

The home had suitable staffing levels.

People in this service were treated with dignity, respect and sensitivity and were consulted and involved as much as possible.

They received good standards of care to meet their complex physical, emotional and psychological needs. Care planning was detailed and up to date and guided staff in how to deliver personal care and help people with behavioural issues.

Medicines were managed appropriately and the use of sedative medicines was monitored carefully.

Staff were trained and supported correctly so that the teams could understand and work with the complex needs of people with learning disability.

Walsingham ensured that they monitored the quality of care and services in the home. The manager had systems in place to monitor all aspects of the service.

Records were kept confidentially and securely. Both paper and electronic records were kept and these evidenced that the home ran effectively and for the benefit of people in the home.

We spent some time with people who live in this service. Most of them communicate through their body language and we judged that people were more than satisfied with the care and services provided in this home.