This unannounced inspection took place on 7 December 2016 and was conducted by an adult social care inspector.

Our last visit was on 13 April 2015 when the service was rated as 'Requires improvement'. We had judged the service to be in Breach of Regulation 9 because care planning was not up to date and staff were not following the care plans. At this inspection we judged that staff were following the written plans and the plans had been updated. The service had met the required action.

The Eyrie is a house in a residential part of Moresby. It can take up to six people with a learning disability. Accommodation is in single rooms with shared facilities. The service is run by Walsingham Support Limited who deliver care and services to vulnerable adults across the country.

The home had a 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.

Safeguarding was high on the agenda for the team with staff being suitably trained.

Suitable risk assessments were in place. There had been no reportable accidents or incidents in the service but staff understood how to deal with any issues.

Good arrangements were in place to ensure that new staff were recruited appropriately. Established staff were monitored and any problems of care delivery were dealt with through supervision or disciplinary actions.

Medication was managed on behalf of people in the home. We checked on ordering, storage, administration and disposal of medicines and these were in order. People had their medicines reviewed on a regular basis.

The house was clean and orderly and staff were aware of how to prevent cross infection.

Staff were given suitable levels of training and support to ensure that each of them were helped to develop in their role. Staff received regular supervision, their practice was observed and they received annual appraisals. They were given good levels of training and staff we met had a breadth of knowledge about how to care for people who lived in the home.

The registered manager understood her responsibilities under the Mental Capacity Act 2005. Some people in the service did have their liberty restricted for their safety. This was done legally and in the least restrictive way possible. Issues around consent were dealt with appropriately and where decisions needed to be made on behalf of a person this was done as a 'best interest' review.

People in the home were supported to access health care when necessary. People visited the local GP surgery and went out to dentists, opticians and chiropodists. Some people had the support of dieticians or specialist consultants.

The service had improved the menu planning in the house and people were now encouraged and supported to have a healthy diet.

We observed staff supporting people in a caring and sensitive way. People were treated with dignity and respect.

The registered manager and her team reassessed people's needs so that they could develop suitable care plans and person centred plans. We saw that this process was being developed and improved in the service to ensure the changing needs of people in the house could be met.

The service had a suitably qualified and experienced manager who was registered with the Care Quality Commission. She promoted the rights of the individual and encouraged staff to adhere to the values of the organisation.

The home had a detailed quality monitoring system in place. External and internal audits were routinely completed. Any problems identified were dealt with through action planning.

Records management had improved in the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; This is a summary of what we found:

• Is the service caring?

We observed affectionate and patient care being delivered to individuals. Staff acted appropriately and understood the personal, health and emotional needs of people in the home. We asked people about this and we were told that the staff were nice.

We saw that the management team were alert to any inappropriate attitudes in team members.

• Is the service responsive?

We saw that staff kept a very close watch on people and that they could predict people's needs even when they did not communicate verbally. Staff offered people options and choices. We saw that where people were able to ask for things the staff responded promptly. This service used an independent advocate who helped the team to discover what people's needs and wishes were.

• Is the service safe?

We saw that there was a strong emphasis on keeping people safe in this home. This was done through careful care planning and behavioural management. There was a good quality assurance system operating in the home.

Medication was reviewed regularly and administered and stored correctly

Staff were suitably trained in understanding, preventing and managing any potential abusive issues.

New staff were only taken on once the manager and the organisation were sure that background checks were completed.

• Is the service effective?

People in this service had detailed care and behavioural plans. This meant that the staff team could help people get the right kind of care and services.People in the home had the support of social workers, psychologists, health professionals and specialists in learning disability. We had evidence to show that the detailed care plans were being followed closely.

• Is the service well led?

The service had a new manager who was in the process of registering at this location. The manager was new to the home but had worked for Walsingham for a number of years. She had previously managed a residential home and had also managed a domiciliary care service.

We had evidence to show that she was managing all the systems in the home appropriately. We were told by staff that they considered the home was well led and that staff team were working well together.

We also saw that there were good quality monitoring systems in the home. The management team monitored all aspects of the service. The home was also subject to external quality monitoring and auditing.

People who lived in The Eyrie found it difficult to articulate their opinions verbally so we spent some time just sitting with people and observing their interactions with each other and with staff. Most people were quite relaxed in their own environment and they interacted well with staff.

We looked at the written plans of care and saw evidence to show that the staff team followed these plans. People also had person centred plans that helped them to have the kind of activities and social interactions they preferred. There was evidence to show that people had specialist care from visiting professionals.

People were given good quality meals and staff were careful to monitor the food and fluid intake for individuals. No one in the home had any signs of malnourishment. People were encouraged to take a healthy diet.

On the day of our visit the home was clean, warm and comfortable. Each bedroom was personalised and nicely furnished. Four of the six bedrooms had been redecorated. The shared lounge and dining room had been decorated as had the hall and stair way.

We checked on recruitment in the service and we saw that new staff had been recruited appropriately with all necessary checks completed.

We looked at a wide range of records kept in the service. We could see that the new management team in this home had updated and improved a number of records. Generally we saw good record keeping in the home and good systems were in place to ensure the service ran smoothly.

People living in the home had a variety of learning disabilities and were not always aware of,what medicines they were prescribed. This meant that they were unable to talk with us about their medicines in a meaningful way. Not everyone living in the home could communicate verbally, but one person we spoke with appeared to be relaxed in her surroundings and told us that she was ‘happy’.

Some of the people who lived in The Eyrie were able to tell us of their experiences. They were positive about being in the home:

"I like it here...this is my house...[the staff] are my friends."

"It is nice here...I am OK".

Some people could not express themselves verbally but could show us that they were happy and relaxed in their own home.

We had evidence to show that the staff understood their responsibilities in relation to care but could also support and help people to make appropriate decisions. Consent was sought and care delivered in the best interest of the individual.

The home was suitably staffed with experienced and trained staff. People in the home could tell us they liked the staff group and had grown to trust them. We saw respectful and sensitive care being delivered. We judged that people received suitable levels of personal and health care.

There had been no formal complaints about the quality of care and support provided. There were policies and procedures in place to help people make complaints if necessary.

We looked at the way medication was managed in the service. We found some areas where the service was not compliant. The controlled drugs storage and management needed to be improved and arrangements for 'as required' medication were not in order. A compliance action was made.

People were able to tell us or show us that they felt safe, comfortable and well cared for in this service.

This was an unannounced inspection that took place over two days, the 13th and 14th of March 2015.

The Eyrie is a purpose built house that can provide a home for up to six people with a learning disability. It is operated by Walsingham who have a number of similar services in the country.

The house is on the main road in Moresby and is near to local shops and accessible by public transport. The home has transport so people can go out with staff.

All accommodation is in single rooms and the house has suitable shared facilities and a small enclosed garden.

The home has a 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 and associated Regulations about how the service is run.

Staff in the service had received suitable training and support in understanding and dealing with any safeguarding issues. There had been a delay in staff reporting an allegation of possible abuse.

There were suitable systems in place to recruit staff and to deal with any disciplinary matters.

The environment was safe and infection control procedures were in place. Some staff were a little neglectful in carrying out some routine tasks that kept people safe.

Medicines management was done well and staff had suitable training and checks on their competence. Despite all of this there had been some medication errors and the organisation was dealing with these problems.

Staff received suitable induction, supervision, and appraisal and were supported to develop in their role.

The registered manager and the staff were aware of their responsibilities under the Mental Capacity Act 2005. Suitable actions were taken if a person was judged to be deprived of their liberty.

All staff in the home were trained in managing any situations where restraint was needed. Suitable plans were in place to guide staff on restraining people safely.

People saw health professionals and both health prevention and treatment were being dealt with appropriately in the home. Specialists and consultants came to the service to help the staff support people with complex needs.

The home was adapted to meet people’s needs.

The staff team provided people with good quality, home-made meals and snacks. People were encouraged to eat well.

People responded well to staff and we saw kind and caring support being given by staff.

Some people in the home needed specific support because they displayed some behaviours that were challenging. Staff were encouraged to look at how they supported people in this.

Staff encouraged people to be as independent as possible and one person went out unaccompanied.

People in the home had advocacy support when they found it difficult to speak for themselves.

We looked at care files that contained assessments of need, care plans and person centred plans. We found that some of these were not up to date. We also had evidence that staff were not following the written plans of care.

People had suitable and appropriate activities planned each week. The staff encouraged people to be as independent as possible.

Concerns and complaints were handled appropriately.

The home had a suitably experienced and qualified registered manager who was supporting a relatively new team. She was working on developing an open and transparent culture in the home.

The service had a quality assurance system and a plan for improvement. We saw that issues were identified through quality monitoring. We noted that some of the problems in the service had not been identified through quality assurance.

The service was good at working in partnership with other professionals.