Archived: Luke's Place

About the service

Luke's Place is a residential care home which can support up to four people. At the time of the inspection three people who were autistic or living with a learning disability were being supported with personal care. People have their own personalised bedrooms and bathrooms and access to shared communal areas such as a kitchen, lounges and a large garden.

People’s experience of using this service and what we found

Right Support

¿ People were not supported to pursue their interests or achieve their aspirations and goals.

¿ People were not being supported to try new things or to follow social interests and past times on a consistent basis.

¿ Reasonable adjustments were not made so that people could be fully involved in discussions about their support, including support to travel where they needed to go. Staff did not always communicate with people in their identified and preferred methods.

¿ People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

¿ The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

¿ The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their support needs.

¿ Staff supported people to take their medicines in their preferred way. People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking.

Right Care

¿ Staff were not promoting people to try new things which may have enhanced their wellbeing and enjoyment of life.

¿ People who had individual ways of communicating such as using symbols or body language could not always interact comfortably with staff as they did not have all the skills necessary to understand them.

¿ Staff were not being supervised to support people effectively. The registered manager was not checking staff competency to perform their job roles.

¿ People’s support plans did not fully reflect their range of needs and promote their wellbeing and enjoyment of life

¿ People were not always receiving kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity.

¿ Staff knew people well as individuals, however in practice, did not support people in line with their identified likes, dislikes and preferences.

¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff knew how to recognise, and report abuse and they knew how to apply it.

Right culture

¿ The management and staff team did not understand the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture. Audits had not been completed in a lot of areas.

¿ People and those important to them, were not involved in planning their support. It was unclear how staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

¿ The service had a negative culture that was at risk of becoming a closed culture. Staff were not supporting people to have a good quality of life or achieve good outcomes.

¿ When people did receive kind and compassionate care from a staff team who had got to know them as individuals, they were happy and relaxed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (report published 13 May 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. This service has been rated requires improvement or inadequate for the last ten consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service was applying the principles of Right support right care right culture. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Luke's Place on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, person centred care and good governance at this inspection. Please see all sections of this full report. Please see the action we have told the provider to take at the end of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Luke's Place is a residential care home which can support up to four people. At the time of the inspection three people who were autistic or living with a learning disability were being supported with personal care. People have their own personalised bedrooms and bathrooms and access to shared communal areas such as a kitchen, lounges and a large garden.

People’s experience of using this service and what we found

Right Support

¿ People were not consistently supported to pursue their interests or achieve their aspirations and goals.

¿ People were not being supported to try new things or to follow social interests and past times on a consistent basis.

¿ Reasonable adjustments were not always made so that people could be fully involved in discussions about their support, including support to travel where they needed to go. Staff did not always communicate with people in their identified and preferred methods.

¿ The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

¿ The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their support needs.

¿ Staff supported people to take their medicines in their preferred way. People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking.

Right Care

¿ Staff were not promoting people to try new things which may have enhanced their wellbeing and enjoyment of life.

¿ Staff did not have all the skills necessary to communicate with people who had individual ways of communicating such as using symbols or body language. This meant people could not always interact comfortably with staff who understood them.

¿ Not all staff had the training to support people effectively. The registered manager was not checking staff competency to perform their job roles consistently.

¿ People’s support plans did not fully reflect their range of needs and promote their wellbeing and enjoyment of life

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity.

¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff knew how to recognise, and report abuse and they knew how to apply it.

¿ Staff had people's best interests at heart and offered them choices in their day to day life.

Right culture

¿ The management and staff team did not understand some of the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture.

¿ People and those important to them, were not always involved in planning their support. Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate.

¿ The service had a positive atmosphere and staff wanted what was best for the people using the service.

¿ People were happy and relaxed being supported at 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

The last rating for this service was inadequate (report published 15 October 2021) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. This service has been rated requires improvement or inadequate for the last nine consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Luke’s place is a residential care home providing personal care to 3 people who were living with different types of learning disabilities. The service can support up to 4 people.

People’s experience of using this service and what we found

The registered manager had worked hard during the pandemic keeping people safe. They had started to make changes to the service following the last inspection. This included an improvement to the culture and leadership of the home. However, the development of the service was limited by a lack of effective and robust oversight by the provider. We had identified this issue at previous inspections. The registered manager was also new in this role and they did not receive the support and direction required to fulfil all aspects of their role.

There was a lack of robust and consistent leadership at the home when the registered manager was absent. There was no plan to manage the home from the provider even when they knew the registered manager was unavailable. Although the culture of the home had improved staff were still reluctant to raise issues and make suggestions to help the service improve. Some staff were concerned about reprisals from speaking with us as part of the inspection process. The service still had a closed culture.

Swift action had not been taken when issues were identified about fire safety at the home. Regular testing of fire equipment was not taking place. Changes in people’s physical and mental health were not fully responded to. Support and guidance from health and social care professionals was not always considered or sought.

We were not confident incidents and accidents were being investigated with timely actions to prevent them from happening again and to consider if harm or neglect had taken place. Care plans were not always updated. Prescribed creams were not always managed in a safe way. There were shortfalls with staff not wearing the level of personal protective equipment as directed by the registered manager.

Staff were not always supported by the leadership structure. Staff members knowledge and skills were not being assessed with support being offered when there were shortfalls. Recently there was a lack of management presence in the home to support and direct staff.

In people’s day to day care people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff spoke with people in friendly and kind ways. They had formed good connections with people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Timely planned action was not taken to respond to a change in people’s mental well-being and to ensure the environment was safe. There was a lack of planning to explore people’s interests and ambitions in life. People were not being encouraged to shape the service. There was a risk these issues could have a negative impact on people’s well-being and safety. We asked the provider to take urgent action. The provider confirmed to us they were addressing these issues.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 May 2020).

At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

We asked the provider to take action about our concerns shortly after the inspection. They produced an action plan which included how they were addressing our concerns.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to; the lack of leadership and the lack of effective leadership of the service and provider’s input to continuously assess and monitor the quality of the care provided. The lack of action and systems to promote people’s safety from potential harm and abuse. Also, the lack of support for staff to perform well in their roles.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request a further action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The home was clean and there was good ventilation. Staff followed government guidance regarding the wearing of personal protective equipment (PPE). The hydro pool was closed to the public, staff used this area to change and to put on and take off their PPE. Staff had supported people to help them to get used to them wearing PPE. Staff, relatives and professionals were supported to enter the home in a safe way. The deputy manager had considered innovative ways to support relatives to see their relative at Christmas.

Luke’s Place is a small residential care home providing accommodation and personal care to four people at the time of this inspection. The service can support up to four people with a range of different learning disabilities and physical needs. The environment of this service was designed and developed in line with Registering the Right Support.

People’s experience of using this service and what we found

We had concerns about how people’s safety was being managed at the home. Some people’s risk assessments were not complete. The provider did not have a robust way of responding to incidents when they happened, to try and prevent them from happening again. Potential safeguarding concerns were not being managed in an appropriate way which promoted people’s safety and rights.

The provider was also not ensuring safety issues relating to the building were being responded to in a timely way. The provider could not evidence certain safety issues had been acted upon. We observed shortfalls with how a person’s medicine was administered. We were also told about an occasion when the home was left understaffed which was an increased the risk to people’s safety.

New staff did not receive adequate support when they started their new roles. Staff did not always have the day to day direction from the leadership of the service and training to do their jobs well.

People were supported to have enough to eat and drink. Staff knew how to support people who had specialist diets and eating requirements. Although, more work was needed to make the meal experience a pleasant and social occasion which promoted people’s choice of food.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were not always caring and thoughtful towards people. At times staff were not mindful of being respectful or treating people as adults. People were not being involved in the planning of their care.

Some events and outings were taking place. But these were not always in line with people’s interests. Staff did not consider and promote people’s goals, interests, and ambitions. Staff were not considering ways to make these happen for people. The provider was not promoting or supporting staff to do this.

There was an inadequate leadership at the home, the provider was not assessing the quality of the service provided and then taking action to make sustained improvements. The provider had not had a positive compliance history with the CQC, since 2016 it has not achieved an overall rating of good.

The service did not apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as people’s rights were not always promoted at the home. Staff and the provider did not look at ways to encourage people to have maximum choice and control of their lives.

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

Rating at last inspection

The last rating for this service was requires improvement (published in 16 March 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. Before this it was rated inadequate for three consecutive occasions.

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to people’s safety, how safeguarding concerns were responded to, how people’s consent is promoted at the home, and the quality of the provider input, at this inspection.

Follow up

We are mindful of the impact of Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. In this instance we will continue to monitor the service.

People’s experience of using this service:

The registered manager was working with the provider and the staff to develop the service in line with the values that underpin 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.

Although significant improvements had been made since our previous inspection in October 2017, the registered manager and the provider acknowledged that further work was still needed to embed their values and philosophy into day to day life at Luke’s Place.

People were not able to tell us in detail about their experience of living at the service. However, they appeared at ease in the presence of staff, and appeared comfortable with the support they were offered. Relatives all confirmed that their family members were happy living at Luke’s Place.

Risks to people’s health and well-being were identified and monitored. Guidance was in place for staff on how to support people with these risks.

Staff were knowledgeable about safeguarding and how to report their concerns internally and externally to local safeguarding authorities.

People`s dignity and privacy was promoted and respected by staff.

People’s care plans were developed and personalised to give guidance to staff on how to support people effectively. However, records of care provided to people did not always reflect the impact of the support provided.

People were encouraged to eat a healthy balanced diet and to drink plenty of fluids. Staff supported people to attend health appointments.

Relatives told us staff were caring and that there was a marked improvement in the way they spoke to people. People`s personal information was kept confidential.

People and their relatives were not always involved in discussions about their care or in developing their care plans. The registered manager was taking steps to address this.

Staff encouraged people to maintain their interests and take part in activities, both at home and within the community. Some relatives felt that people did not always have enough to do or enough structure in their day.

There were enough staff to meet people`s needs. Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider to develop their skills and knowledge.

The registered manager was working to improve the ways in which people and their relatives were encouraged to feedback on the quality of the service provided. However, relatives told us there was still work needed to improve the communication between them and the service.

The provider`s governance systems and processes were improving and the registered manager had a clear plan in place to continue to develop these systems to support ongoing improvements.

Rating at last inspection:

At the last inspection in October 2017 the service was rated ‘Requires Improvement ‘with several breaches of regulations. This was because the provider and the registered manager had not had good oversight of the service. Improvements were needed in the management of medicines, the way incidents were managed and reported and how staff skills were assessed. Improvements were also needed to the culture of the service, including how staff spoke to people, supported them to have goals and the right assistance to achieve them, and involved them and their relatives in planning their care. Improvements have been made since the last inspection and no continuing breaches were found, although work was still needed in some areas.

This service has been rated requires improvement or inadequate for the last five inspections since June 2015.

Why we inspected: This was a scheduled inspection based on the previous rating to assess improvements the provider had made.

Follow up: We will continue to monitor Luke’s place and return to inspect in line with our methodology.

The inspection took place on 18 October 2017. Luke’s Place is a residential care home which supports people who have a range of learning and physical disabilities. Luke’s Place offers ground floor accommodation. The home supports a maxim of four people. At the time of the inspection three people were living at Luke’s Place.

There was a registered manager in place. 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 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 five 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 the report.

Staff had an understanding of what constituted potential harm and abuse, but following these conversations with some members of staff we were not fully confident staff would always respond to safeguarding events. The registered manager and provider had not responded fully to a potential event when a person experienced harm. There had been another occasion when a person potentially experienced neglect. These situations had not been managed in a strong and open way.

Accidents and incidents records were not fully completed, detailing a course of action to try and prevent them from happening again.

People’s medicines were not always being managed in a way which ensured people received their medicines in a safe way and as the prescriber had intended. The provider did not have a current building safety check from the fire service.

People had risk assessments in place with a plan for staff to follow in order to promote people’s safety. The service was being supported by an appropriate number of staff on each shift.

Staff competency was not being regularly observed and monitored. Staff competency after their induction to their work was not being well evidenced. The service was not checking if staff had retained their understanding and knowledge to key areas of their work.

People were being supported to make their own decisions and had sufficient to eat and drink.

The staff were not always caring and respectful to people. The registered manager and provider were not monitoring this element of the service despite historical concerns with how staff have treated people at the home.

We found that people had person centred assessments but their reviews were not meaningful and did not involve the person. People’s goals and aspirations were not promoted with practical plans in place to make them happen. The service was supporting people with some of their social needs but this needed further development, with timely action taken to ensure ideas were developed and put into action.

There was a lack of an open and transparent culture at the home which involved professionals, relatives, the people who used the service, and the community. The culture of the staff group needed further development with systems in place to monitor the culture of the home.

Quality monitoring audits were either not effective or they did not fully test the quality of the service which people were experiencing. Issues were not always responded to and there was no emphasis of developing and improving the service from these audits.

We could see that improvements had been made to the service and the registered manager told us that there was still more work to do.

This service provides accommodation and personal care for up to 4 people with learning disabilities, physical disabilities or mental health conditions. At the time of this inspection there were three people living at the service.

There was a registered manager in place. A registered manager was not required by law at this location because the registered provider was an individual rather than an organisation and previously managed the service themselves. However, to support improvements to the service, the provider recently employed a manager to oversee the running of the service. Registered managers, like registered providers, 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.

At our last inspection on 11 April 2016, the service was in breach of Regulations 9, 11, 16, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service received an overall quality rating of inadequate, and was placed into Special Measures. An existing condition placed on the provider’s registration to restrict admissions remained imposed. We issued warning notices to tell the provider what improvements they needed to make and gave them a timescale to do this. We carried out this inspection to check on the improvements made since the last inspection.

During this inspection we found that significant improvements had been made to the service. As a result, the decision was made that the service would no longer be placed in special measures.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were sufficient numbers of staff on duty and recruitment processes were safe.

Staff had received ongoing training to equip them with the skills to support people. They understood their responsibility to ask people to consent before providing care and demonstrated an understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

People had enough to eat and drink and had access to health care services as appropriate.

Staff had positive interactions with people and treated them with kindness. People’s dignity was upheld.

Person centred care plans had been developed and were currently out for consultation with people’s families. Key worker sessions were held to support people to be involved in planning their care. Relatives were not always as involved as they would like in the full process of assessing their family member’s needs and planning their care.

There was an effective complaints system in place although some family members did not feel that complaints were always effectively resolved. Information was available to people about how they could make a complaint should they need to.

There were systems in place to support people and their relatives to share their views of the service. However, some families felt that communication between them and the service could be improved.

There were effective systems in place to assess and monitor the quality of the service.

This service provides accommodation and personal care for up to 4 people with learning disabilities, physical disabilities or mental health conditions. Following our inspection in November 2016, the Care Quality Commission (CQC) placed a condition on the provider to restrict new admissions to this service. At the time of this inspection there were three people living at the service.

A registered manager was not required by law at this location because the registered provider was an individual rather than an organisation and previously managed the service themselves. However, to support improvements to the service, the provider recently employed a manager to oversee the running of the service. At the time of the inspection, the manager was not registered with CQC but had submitted their application to do so. Registered managers, like registered providers, 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.

At our last inspection on 17 November 2015, the service was in breach of Regulations 9, 10, 11, 12, 13, 16, 17, 18, 19 and 20a of the Health and Social Care Act (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulation 2009. The service received an overall quality rating of inadequate, and was placed into Special Measures.

We carried out this inspection to check on the improvements made since the last inspection.

During this inspection we found that although some improvements were in progress and more were planned, some of the concerns identified at the previous inspection had not been addressed. We identified continued breaches of Regulations 9, 11, 16, 17, and 18, of the Health and Social Care Act (Regulated Activities) Regulations 2014. As a result, the service is still rated as inadequate and remains in special measures. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient numbers of staff on duty although some staff had not received effective training to ensure they had the skills to support people. Staff did not demonstrate an understanding of, or meet, the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards.

Staff recruitment processes were safe.

Risk assessments were in place in relation to people’s basic care needs but were lacking in relation to their behavioural needs.

People had enough to eat and drink and had access to health care services as appropriate, although advice from health care professionals was not always followed consistently.

Staff had positive interactions with people and treated them with kindness. People’s dignity was mostly upheld.

People and their representatives were not always supported to make decisions and were not sufficiently involved in assessing their needs and planning their care.

There was a complaints policy which was also available in an easy to read format although some staff were not aware of this. Relatives were aware of the complaints process but some were not comfortable to raise complaints due to the way complaints had been received by the provider in the past. Complaints were not recorded appropriately.

There was a lot of work still to be done in order to build up the trust of people and their families so that they would be comfortable in sharing their views and be confident that those views would be listened to.

The manager and the provider were developing systems to assess and monitor the quality of the service and some aspects of these were in place at the time of the inspection, whilst others were under development.

The manager had an action plan to address the improvements required at the service, but had only been in post for five weeks at the time of the inspection. Although work had started and positive steps had been taken, changes were not yet embedded in the culture of the service.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

We inspected the service again, to check improvements had been made. We found that a number of large items that may have posed a risk of injury had been removed from the service's grounds. We saw the grounds were free from dog mess in the areas we checked. We saw a double garage had been partitioned to allow staff allocated storage space for items belonging to the service. We found that access to some of those items was easier. This meant people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw the service had its complaints process displayed in an accessible area near the main entrance. The displayed copy was in an easy read and pictorial format and covered all the main elements of how to make a complaint and how the service would respond. This meant people were made aware of the complaints system. This was provided in a format that met their needs.

The people we spoke with during our inspection said their relative was cared for by a sufficient number of friendly staff and he was enjoying life at the service.

We saw people who use the service were engaged in activities they liked and enjoyed. People appeared clean, tidy and well cared for. We found well documented support plans of how the service would meet each person's needs. We saw those needs were met by a competent, friendly and adequate staff team. Staff were completing a program of training and were knowledgeable in such things as protecting people from the risk of abuse. The service had appropriate systems in place to safeguard people from the risk of abuse.

We found the service had a complaints system in place. However, the complaints system was not brought to people's attention in a suitable manner. We saw that some parts of the premises and surrounding grounds were not being used properly.