We undertook an announced inspection on 25 July 2017. At our previous inspection on 30 April 2015 the service was rated ‘good’ overall and in the key questions; ‘Is the service safe?’, ‘Is the service caring?’, ‘Is the service responsive?’ and ‘Is the service well-led?’. They were rated ‘outstanding’ for the key question ‘Is the service effective?’.

Belleview provides a supported living service to up to 26 people across a main house and three bungalows. At the time of our inspection 21 people were using the service. The service supported people with mental health needs, learning disabilities or both.

Since our previous inspection a new registered manager had been appointed. The new manager was registered on 4 January 2016. 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 found that whilst people received their medicines as prescribed, safe medicines management practices were not consistently followed. Accurate stocks were not always undertaken and accurate records of medicines administered were not always maintained. We recommend the provider consults national guidance on safe medicines management.

There were sufficient staff to meet people’s needs and safe recruitment practices were maintained. Staff adhered to safeguarding adults procedures and raised any concerns about a person’s safety with the registered manager. Risks to people’s safety were regularly reviewed and risk management plans were in place.

Staff had the knowledge and skills to undertake their role and attended regular refresher training courses. Staff supported and encouraged people to attend healthcare appointments, in relation to their physical and mental health. There continued to be ongoing liaison with the community mental health team in regards to people’s mental health needs. Staff continued to support people in line with the Mental Capacity Act 2005 and provided any support required with people’s nutritional needs.

There continued to be trusting relationships between staff and people. Staff respected people’s decisions and enabled them to make choices regarding their care and how they spent their time. Staff respected people’s privacy and maintained their dignity. Staff encouraged and supported people to maintain friendships and relationships with family members.

Staff sessions had been introduced to review people’s care. This included discussing in detail a person’s diagnosis and medicines, and how this may affect their behaviour. The provider had started to deliver mindfulness sessions to provide people with additional tools and techniques to manage their mental health. The provider supported people to develop their skills, including offering paid employment to some people. Care plans were detailed and regularly updated providing staff with information about people’s support needs. Complaints continued to be taken seriously and managed appropriately.

Systems continued to be in place to review the quality of service delivery and action plans were developed to encourage continuous improvement and ensure accurate records were maintained of all areas of service delivery. Mechanisms were in place to obtain feedback from people, relatives, staff and visiting professionals. The registered manager adhered to the requirements of their registration with the Care Quality Commission.

This inspection took place on 30 April 2015 and was unannounced.

Belleview is a supported living service that provides care and support to adults with a past or present experience of mental ill health. The service is staffed 24 hours and aims to enable people receiving support to become as autonomous and as independent as possible. There were 17 people using the service at the time of our inspection.

We last inspected Belleview in March 2014. At that inspection we found the service was meeting all the regulations that we assessed.

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 2008 and associated Regulations about how the service is run.

People were given appropriate information regarding their care and support and were able to get involved in making decisions about the care and support they received. Staff actively encouraged and supported people to do as much for themselves as they were willing and able to do safely.

Support plans included person centred risk assessments that identified the hazards people might face in their daily lives and provided detailed guidance for staff in relation to supporting people to eliminate or manage appropriately these potential risks. Staff followed guidance and support plans that enabled them manage these safely.

Staff provided the support people required that enabled them manage their medicines safely, people were encouraged to self-medicate and stored their medication in a locked cabinet in their bedrooms

People felt safe, the service had sufficient numbers of staff available to meet people’s needs.

People could be confident that they were protected from staff that were known to be unsuitable, the service operated sound recruitment practices which included the completion of pre-employment checks prior to a new member of staff working at the service.

Staff treated people who used the service with the utmost respect and dignity and were suitably trained to understand and meet the needs of the people they supported.

People benefited from the presence of caring understanding staff who gave them encouragement and helped them develop confidence and self-esteem.

People’s needs were kept under review. Support workers understood people’s support needs, they monitored their progress and took prompt and appropriate action by referring to and consulting with relevant health professionals if individuals needs changed.

People, their relatives and support workers all told us they felt the service was well-led. They found the manager was approachable and took their views on board.

During our inspection we spoke with the proprietor and three members of staff. We also spoke with three out of the fifteen people who lived at Belleview. Most people told us they were happy living there and most felt well supported by staff. People also told us the staff were kind and that they were given enough support to be as independent as possible. One person told us “I like it here. Besides, it can’t be that bad because I decided to move back in having lived in my own flat for a bit last year”. Another person said “the staff treat you well here…they’re a nice bunch. They help me do more things for myself like cooking”.

Overall, we found people using the service received safe care and support from suitably trained and experienced members of staff. We saw staff respected people’s privacy and dignity. We also saw the provider had taken reasonable steps to ensure people lived in a relatively comfortable and adequately maintained environment.

However, although most people told us they were happy at Belleview; the provider may wish to note that people were not always given enough support to enable them to be as independent as they could, such as self-medicating safely. Furthermore, while we found that people’s needs were assessed; the provider may also wish to note that staff were not always provided with enough detailed guidance about how to support people with managing the risks they might face. This meant people might be placed at unnecessary risk of harm and/or abuse.

Belleview supported living service was opened in January 2013. The registered manager told us the main aim of this new service was to enable people who used the service to be as autonomous and independent as possible. During our inspection we spoke with three out of the eight people who currently used the supported living service. We also spoke with the registered provider, the services registered manager and a support worker. People told us they were happy with the overall standard of care and/or support they received at Belleview and that they felt safe living there. People also said the manager and staff who worked at the service were kind and always gave them all the support they needed to maintain and develop their independence. One person we spoke with told us “It’s alright here. The staff are very good and quite friendly”. Another person said “I feel safe here because I get on with the other people that live here. All the staff are nice as well, which is great”.

We also found that staff treated people who used the service with the utmost respect and dignity and were adequately trained to understand and meet the needs of the people they supported.