This inspection took place on 28 November 2018 and was unannounced. We last inspected this service in August 2015 where the service was given an overall rating of good. At this latest inspection the service remained ‘Good’

Care view services is a care home which is registered to provide care to up to 6 people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home specialises in the care of people with a learning disability and mental health support needs. All bedrooms are for single occupation. On the day of our inspection there were 5 people living at Care View Services.

The service had a registered manager who was present during 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 protected from the risks of abuse because the provider had systems in place to minimise the risk of abuse and staff were trained to identify the possibility of abuse occurring. Staff understood their responsibility to act to protect people from the risk of abuse and how to escalate any concerns they had. People were protected from risks of injury associated with their needs because risks had been identified and management plans put in place so staff had the information they needed to minimise risks.

The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out.

We observed there being enough staff on duty to meet the needs of people. People and their relatives told us there were enough staff on duty. There was an over reliance on agency workers however the provider stated they had recently recruited new staff members and would continue to do so. They added that the long-term plan is to have a full team of 11 permanent staff and use agency workers as a contingency.

People’s consent was sought by staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff treated people with dignity and respect and helped to maintain people’s independence. Staff were caring and compassionate towards people living at the home. People were given choices by staff to participate in activities. People who used the service had access to food and drinks and were supported to have food they enjoyed.

People, their relatives and health care professionals had been involved in the planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs.

People and relatives had confidence that they received a good standard of care. The provider had systems to allow them to monitor and improve the service as well as ensure potential risks were well managed. People’s views were sought by the provider and these were acted upon. Staff felt well supported by the management team. The provider understood their legal responsibilities and how to maintain a current knowledge of any changes in the law or social care.

This was an unannounced inspection which took place on 2 December 2014. We last inspected the service on 8 November 2013 when it was identified that improvements were required to the monitoring of the quality of the service. We had received an action plan in respect of actions to be taken. At this inspection we saw that some of the required improvements had been made.

Careview Services Limited can provide accommodation and care to up to six people with a learning disability. All bedrooms are for single occupation.

At the time of this inspection there were six people living in the home and there was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Several staff told us morale was low because they did not feel supported by or listened to by the registered manager. Staff told us they felt the manager ignored them and the people that lived in the home spending most of her time in the office. This meant that there was not an open, inclusive environment in the home. The registered manager had failed to notify us of the Deprivation of Liberty Safeguards that had been agreed.

We identified a breach in the law concerning this. You can see what action we told the provider to take at the back of the full version of the report.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. DoLS applications had been made for all the people living in the home. Not all the staff knew what the DoLS were for and the registered manager had not notified us about the DoLS that had been agreed as was required by legislation.

All the relatives spoken with told us that people were safe in the home. We saw that procedures were in place that ensured that people were kept safe from the risk of harm. Staff spoken with told us they had training so they knew how to keep people safe and were aware of their responsibilities to highlight any concerns they had. Recruitment procedures ensured that only suitable people were employed because the appropriate checks were undertaken.

People were not always protected from risks of injury because staff did not follow risk assessments and there had been occasional incidences of unexplained injury.

People were supported to have their health care and nutritional needs met. Staff and relatives spoken with felt there were sufficient numbers of staff with the appropriate skills and knowledge available to meet people’s needs and keep them safe.

Staff were caring, kind and compassionate towards people and interacted with them as individuals. People were supported to make choices about what they ate and what they did to keep occupied. People were supported to maintain contact with their relatives as they wanted.

Apart from one relative, all relatives spoken with felt involved in their family member’s care. Relatives were aware of how to raise concerns and complaints but they were mostly happy with the service provided.

There were some systems in place to monitor the quality of the service and get the views of relatives so that their views could be used to improve the service.

At the time of our inspection there were six people living at the home. We spoke and met with all the people who lived at the home. Not everyone living there was able to tell us about their experience of living at the home. We spent time observing how people were cared for by staff.

We spoke with four members of staff, the manager, the operations manager and the provider.

We saw that interactions between staff and the people that lived there were friendly and relaxed and staff understood how to meet people’s need.

People lived in a safe and comfortable environment that met their individual needs.

People had received their medicines when they needed them and safely.

The systems in place for the assessing and monitoring of the service had not been effective so improvements that were needed had not always been made.

At the time of our visit there were six people living at the home. We spoke to one person, two staff and the person in charge at the time of our inspection. Not everyone in the home was able to tell us about their experiences of care. We sat in the dining area and observed how people were supported by staff.

We saw that staff were knowledgeable about people’s needs and supported them with compassion and care. People were treated with dignity and respect.

People were supported to have their needs met in an individualised way. We saw that people looked well groomed and dressed in individual styles. Advice was sought from healthcare professionals to ensure people’s health needs were met.

People were supported to live fulfilled lives. One person told us, “I go to bingo”. We saw people involved in daily living activities.

People’s dietary needs were met in a way that met their preferences and that protected them from choking. One person told us, “I like chocolate drinks.” Systems were in place to protect people from the risks of abuse and unsafe care.

There were adequate numbers of staff with the appropriate skills and knowledge to meet people’s needs.

Audits of the service did not always ensure that the service was improved to meet the needs of people.

We carried out this review to check on the care and welfare of people using this service.

We spoke with three people who used the service, two staff members and the manager.

We spent time sitting in the living area observing how staff and people got on with one another. We saw staff were communicating with people and assisted them when help and support was needed. We did not see or hear anyone waiting for assistance when they needed help. We saw staff being patient with people and taking the time to explain what was happening. People’s body language indicated they were at ease and comfortable in their surroundings.

The three people indicated by signs and gestures that they were comfortable when we asked about their welfare. Staff told us of the individual care and support needs they provide to people each day. Information recorded in the care plans we looked at was consistent with what the staff told us.

We saw that people can participate with their preferred activity, some people use the day services whilst other prefer not to. Staff told us of the various activities that are provided for people both on the premises and in the local community.

We saw the way the service monitors the quality of the service it provides. An action plan is completed to detail when any identified improvements will be made.

This was an unannounced inspection which took place on 13 and 20 August 2015. We carried out this inspection to check whether the improvements identified in our inspection of December 2014 had been made. We had received an action plan in respect of actions to be taken. At this inspection we saw that the appropriate actions had been taken in respect of ensuring that the appropriate deprivation of liberty applications had been made. Improvements had been made regarding the running of the home and staff morale had improved.

Careview Services Limited can provide accommodation and care to up to six people with a learning disability. All bedrooms are for single occupation.

At the time of this inspection there were five people living in the home. The registered manager was on extended leave but there was a manager in post to ensure that the service was managed on a day to day basis during the registered manager’s absence. 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 protected from the risks of abuse because the provider had systems in place to minimise the risk of abuse and staff were trained to identify the possibility of abuse occurring. Staff understood their responsibility to take action to protect people from the risk of abuse and how to escalate any concerns they had.

People were protected from risks of injury associated with their needs because risks had been identified and management plans put in place so staff had the information they needed to minimise risks. Staff ensured that consent was obtained and people were involved in their day to day care. The appropriate actions were taken to ensure that any restrictions in place on people’s movements were in their best interests.

People were provided with sufficient food and drinks throughout the day that met their needs. Support and advice was sought where people were not eating or drinking enough to remain healthy. People were supported to see health care professionals to ensure they received medicines and medical treatment as required.

Staff were caring and had an understanding of the needs of the people they were supporting. Staff received the training and supervision they needed to carry out their roles. At the time of our inspection there were sufficient staff available to meet people’s needs.

People were supported to maintain contact with their friends and relatives. Group and individual activities were available for people to take part in if they wanted. People were supported to access community activities such as day centres, organise holidays and take responsibility for carrying out some task such as making drinks for themselves and others in the home.

Systems were in place to gather the views of people so that improvements could be made based on their wishes. Auditing and monitoring of the service continued to improve to ensure that the quality of the service was maintained and improved where possible.