We inspected Bevern View on 8 and 14 June 2018. The first day of the inspection was unannounced. We previously carried out an inspection at Bevern View in March 2017 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found risks to people’s safety were not always well managed. The requirements of the Mental Capacity Act 2005 were not always followed and decision specific mental capacity assessments were not always in place. People’s dignity was not always respected and accurate and complete records were not in place for everybody. The provider sent us an action plan to tell us how they would address these issues.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, and check that the service now met legal requirements.

Bevern View 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. Bevern View is a purpose-built home which accommodates up to 11 people living with profound and complex physical and learning disabilities and communication needs. The home provides nine, full time residential care places, with two places available for short term respite care. At the time of the inspection there were nine people living at the home and one person receiving respite care.

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. Although Bevern View provides accommodation for more people than recommended in Registering the Right Support this did not impact on people because they received care and support that was person centred.

There was no registered manager at the service. However, there was a manager working at the home and responsible for the day to day running of the service. They were in the process of registering with Care Quality Commission. 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 improvements were needed to some aspects of record keeping. This was to ensure best interest decision discussions, in relation to mental capacity assessments and consent, were recorded. Other records were well completed.

People received care and support that was exceptionally person-centred. People were supported to live their lives to their full potential and get enjoyment from each day. They were supported to live full and busy lives. They took part in a wide range of activities of their choice. These were meaningful, were fun. This had a positive impact on people’s well-being.

Staff knew people really well. They were passionate about ensuring people received the care and support they needed. They promoted people’s independence and treated them with kindness, understanding and patience. People were supported to make their own decisions and choices throughout the day. There was a happy and enjoyable atmosphere at the home.

Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after. There were systems in place to ensure medicines were ordered, stored administered and disposed of safely.

Staff understood the procedures in place to safeguard people from the risk of abuse and discrimination. There were enough staff, who had been safely recruited, to meet peop

We inspected Bevern View on the 23 March 2017 and the inspection was unannounced. Bevern View provides care and support for people living with profound physical and learning disabilities and complex communication needs. The service is registered to accommodate up to 11 people, nine full time residential care places for both male and female clients, with two places available for short term respite care. At the time of the inspection there were nine people living at the service and two people receiving respite care.

The service had a registered manager in post. 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 a 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 not able to communicate with us using speech, we therefore spent time observing how staff and people interacted and gained feedback from people’s relatives. One relative told us, “It is brilliant here. I’m really happy and there is nothing that I can think of that can be improved.” Another relative told us, “(Person) loves it here. Staff are very competent and the manager is very approachable.”

People received their medicines on time and in a safe manner. However, prescribed fluid thickener had been left in easy reach of people which posed a risk. People’s privacy and dignity was not consistently upheld or protected. Where CCTV was used at night, consideration had not been evidenced on how the provider planned to uphold and respect people’s dignity and right to privacy. Staff were heard talking about people’s care needs in front of other people and often referred to people using terms which did not uphold and respect their dignity.

The provider was not consistently working within the principles of the Mental Capacity Act 2005. Mental capacity assessments were not in place to demonstrate whether people could consent or not consent to the use of restrictive practice. Accurate, complete and contemporaneous records had not been maintained.

Statutory notifications had not been routinely submitted to CQC by the provider. A notification is information about important events which the provider is required to tell us about by law. The registered manager acknowledged this shortfall and submitted the notification during the inspection. However, we have made a recommendation for improvement.

The management team were dedicated to the on-going improvements of Bevern View. A quality assurance framework was in place, but the positive improvements were still in the process of being embedded and implemented.

Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the service. The registered manager had a range of tools that supported them to ensure the quality of the service being provided. Despite this system in place, the provider and registered manager had failed to recognise that policies and procedures had not been updated to reflect current legislation and guidance. We have made a recommendation about internal review of policies and procedures.

Staff and relatives felt staffing numbers were sufficient. One relative told us, “Oh yes, there is definitely enough staff.” Staffing levels were based on the needs of people and systems were in place to assess staffing numbers.

Incident and accidents were consistently recorded. However, they were not subject to a formal audit to monitor for any emerging trends, themes or patterns. We have made a recommendation about the internal review and monitoring of incidents and accidents.

Risks to people were identified and managed appropriately and people had personal emergency evacuation plans in place in the event of an emergency. Positive relationships had been developed between people as well as between people and staf

The inspection took place on 12 March 2015 and was unannounced.

Bevern View is registered to accommodate up to 11 people, nine full time residential care places for both male and female clients, with two places available for short term respite care. The purpose built service specialises in providing accessible support to people from the local area who have profound learning and physical disabilities. The premises require 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 people’. Registered people 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 manager had applied to be registered and this was being processed.

At the time of our inspection there were nine people living at Bevern View.

People were safe at Bevern View. Relatives we spoke with told us they had no concerns and were very happy with the care their loved ones received.

Staff we spoke with were familiar with safeguarding principles and were aware of the home’s whistleblowing policy. All staff received safeguarding training and regular refresher training. Risk assessments were in place to protect people from harm and the management monitored and reviewed incidents to ensure any action required was taken. People’s needs had been assessed and individual care plans devised and developed. Care plans were regularly reviewed when changes to people’s health and wellbeing had occurred.

People spoke highly of the activities and opportunity for social engagement. The provider employed a dedicated activities coordinator and throughout the inspection, we observed group activities including a birthday party designed to involve and entertain all of the people there.

Medicines were stored safely and in line with legal requirements. People received their medicines on time; people were supported in ways tailored to their particular need to be able to receive their medicines safely.

Incident and accidents were consistently recorded. These were reviewed on a regular basis to monitor for any emerging trends or patterns and any lessons to be learned.

People were treated with respect and dignity by staff. They were spoken with and supported in a sensitive, respectful and caring manner. People were seen laughing and smiling with staff. Staff took trouble to develop the best communication possible with people.

We saw that people were provided with a balanced diet. This was tailored to people’s preferences and took into account intolerances and allergies.

Staff commented they felt well supported by the team leaders, manager and nurse. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Plans were in place to promote good practice and develop the knowledge and skills of staff.

Staff told us they felt valued and inspired by their manager’s hands on approach to deliver person centred care. They said their aim was to provide the best quality of life possible for the people at the home despite their extreme individual challenges. This aim was being used in practice by all staff and the manager.

Our inspection of Bevern View was facilitated by the registered manager and the deputy manager. During our visit we spoke with five staff members including the manager and the deputy and three parents of people who use the service. People using the service were unable to communicate verbally but one person we spoke with was able to communicate with support from a staff member and using gestures to indicate a yes or no response.

During our visit we saw that the home was clean and well maintained and we observed a homely, interactive environment that was focused on creating an atmosphere that was suitable to the needs of the people living there. We viewed the records of four people who use the service, three of whom live at the home permanently, one who attends for regular respite stays.

We were told that people were encouraged to make choices about their lives and we saw that staffing levels were managed to enable people who use the service to participate in activities away from the home as much as possible. We observed people being supported by staff who were familiar with their needs and we saw that activities within the home were interactive and that staff ensured people could participate as much as possible.

Parents we spoke with told us they were happy with the care provided. One parent told us "He's as happy here as he is at home." Another parent we spoke with told us "It's a very happy home. He's always excited about coming back."

During our inspection we found that the premises were clean and well maintained and the atmosphere was relaxed and homely.

We found that comprehensive and well maintained person centred support plans enabled care workers to meet people's assessed needs in a structured and consistent manner.

Appropriate staff training, risk assessments and safeguarding policies and procedures ensured that people using the service were safe.

In accordance with their individual care plans, people were supported to make choices about their daily lives. They were involved with the running of the home and were able to influence decision making processes.

People using the service were unable to communicate verbally. However positive comments from their relatives indicated a high level of satisfaction with the home and the services provided:

“I’m very happy with the home. It is such a stimulating environment and the staff are all so caring – and so enthusiastic”.

“There is nowhere else like this and I’m so pleased that we found it. My daughter has everything she needs here”.

Appropriate arrangements were in place in relation to storing, administering, handling and recording medicines.

Care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

People’s visitors told us that their relatives enjoyed living at the home and that staff were patient, caring and kind. They told us people were never rushed and that there was enough staff on duty to support them when needed. They told us that Bevern View was home from home and that they liked the fact that everyone knew each other.

People’s relatives told us they enjoyed the entertainment and activities on offer at the home. They told us that the staff put in a lot of effort into finding out what people enjoy and making sure that these activities happen for them. They said there was a wide range of activities on offer both in the home and in the community.

People’s relatives told us that visitors are always welcomed and that their relatives were happy and well cared for. They told us that they were always kept informed of any changes in their relative’s health and that they felt the care provided could not be better.

Staff members we spoke to told us that they were happy working in the home, that the team worked well together and that they had received the training they needed to meet individual’s care needs.