Cathedral View is a ‘care home’. People in care homes receive accommodation and nursing or 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. Cathedral View can accommodate up to nine people for short periods of care and support, who have a learning disability, autistic spectrum condition and a physical disability. At the time of our inspection four people were staying there. People had their own bedrooms and shared bathrooms and a shower room. They had the use of a lounge, various areas around the home to sit and watch television, a sensory room and dining facilities. Grounds around the property were accessible.

Cathedral View had been developed and designed in line with the values that underpin the Registering the Right Support, Building 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 lived as ordinary a life as any citizen.

This inspection took place on 28 September 2018. At the last comprehensive inspection in October 2016 the service was rated as Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

A registered manager was in post who had been registered with the Care Quality Commission (CQC) in January 2017. 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. The registered manager was not present during this inspection. The assistant manager was available.

People’s care and support was individualised reflecting their needs and wishes. Prior to each stay they and their family were contacted to make sure their needs had not changed. Any changes were noted in their care records and shared with the staff team. People were supported by staff who knew them well. They had developed positive relationships with staff. Staff anticipated what would make people anxious or uncertain and supported them to cope with these. Risks were well managed promoting people’s independence. Staff knew how to keep people safe and how to raise safeguarding concerns. There were enough staff to meet people’s needs. This was kept under review as their needs changed.

People made choices about their day to day lives. 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. People were involved in the planning and review of their care and support. People’s diversity was recognised and people were treated with fairness, dignity and respect. Activities reflected their interests and lifestyle choices. People said they liked to go to the cinema, garden centres and day trips. They kept in touch with those important to them.

People’s health and wellbeing were promoted. They helped to plan the menu and they prepared their own drinks and lunches. They liked to go out to a local café and pub. People were registered with a local GP and had access to a range of health care professionals. People’s medicines were safely managed. People had access to easy to read information which used pictures and photographs to explain the text. Staff understood how they preferred to communicate encouraging them to express themselves in the wa

We undertook an unannounced focused inspection of Cathedral View on 18 December 2017. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our October 2016 inspection had been made.

The inspector inspected the service against two of the five questions we ask about services: Is the service effective and is the service well led? This is because the service was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

A registered manager was 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.

Cathedral View is a nine bedded care home which provides short term respite breaks for people to give their relative or carer a break from their role as a carer. People who stayed at Cathedral View had learning and/or a physical disability. The level and amount of support people need is determined by their own personal needs. There were three people staying at the home at the time of our inspection.

Improvements had been made to the assessment of people’s mental capacity to make decisions about their care and support. We observed staff supporting and encouraging people to make choices about their stay at the home. Records showed that people’s mental capacity to make specific decisions about their care had been assessed. The outcome of the assessment and best interest decisions were recorded in people’s care plans. Staff demonstrated a good understanding of the principles of the Mental Capacity Act and how to support people in their best interest.

People were encouraged to have a healthy diet and referred to health care professionals if their needs changed. Staff told us they had received adequate training and support to care for people who stayed at Cathedral View. A new registered manager had been appointed and had made some changes to the home such as changing the layout of the communal areas. Systems were in place to identify and action any shortfalls in the service being provided.

This report only covers our findings in relation to those requirements. You can read the report from our last inspection, by selecting the ‘all reports’ link for Cathedral View on our website at www.cqc.org.uk.

This inspection took on 23 August 2016 and was unannounced. Cathedral View is a nine bedded care home which provides short term respite breaks for people to give their relative or carer a break from their role as a carer. People who stayed at Cathedral View had learning and/or a physical disability. The level and amount of support people need is determined by their own personal needs. There were three people staying at the home at the time of our inspection.

The home is purpose built and is set over two floors which were accessible by stairs or a lift. The home has a main lounge with an adjoining dining room. There were several quiet areas and a sensory room that people could use. They also had access to a private secure back garden.

A registered manager was in place as required by their conditions of registration. 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.

Concerns raised in our inspection in August 2015 had been acted on. CQC now received notifications from the registered manager about significant events which have affected people or the running of the home. Medicines were safely managed with systems in place to ensure medicines were accounted for and there were clear records of when people had received their medicines. People’s care records provided staff with adequate information about their likes, dislikes, and their required level of support. People’s support requirements had been assessed before they stayed at Cathedral View. Staff had a good understanding of their needs and risks

Staff encouraged people to make their own decisions and gave them choices about how they would like to spend their day. They supported people in accordance with the principles of the Mental capacity Act. However where people had been identified as lacking mental capacity, there was limited records of how their capacity had been assessed.

People and their relatives/carers spoke highly of the service. Safeguarding procedures were in place and understood by staff. People’s individual risks had been identified and were being managed well. The fire safety arrangements of the home had been reviewed and updated. Effective systems were in place to ensure people’s money was being safely managed and accounted for. Relatives/carers felt that their concerns were acted on and were satisfied with the service being provided.

People were supported to participate in activities which they enjoyed. They were involved in the planning of their meals based on their likes and dislikes. They were referred to appropriate health care professionals if their needs changed during their stay at the home. The home’s environment had been adapted to meet the needs of people.

Suitable recruitment checks had been carried out on new staff to ensure they were of good character before they supported people. Staff were adequately trained and supported to carry out their role. Staffing levels were flexible depending on the support needs of people staying in the home.

We found one breach 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 this report.

We were not able to speak with all people who used the service because of their complex needs. There were four people using the service at the time of our inspection but two of these people were out at other services. We observed care staff interacting with people and undertaking activities with them. One person told us about the film they were watching. Another person was not able to communicate their needs verbally with staff but as they knew this person well they were able to understand what they were communicating to them.

We found personalised care plans were in place for all assessed needs for two of the three people's care records we examined. Risks had been identified and plans were also in place for these. Care staff were very knowledgeable about people's specific needs. Activities were also taking place.

A safe system was in place for the management of people's medication.

People had access to a complaints procedure that was in a format suitable for their needs.

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant they were not able to tell us their experiences. We observed the care being provided, spoke with two members of staff and looked at feedback from relatives as part of the provider's quality assurance process.

People were provided with information about the service provided. This was available in an easy read format using pictures. People's religious and spiritual beliefs were considered when delivering their care. People's needs were assessed and care plans were reviewed and updated to reflect their changing needs. Risk assessments were comprehensive and person centred.

People were provided with information in an easy read format about safeguarding and raising concerns. Systems were in place to protect them from financial abuse. Staff had access to safeguarding training and had discussed policies and procedures at a team meeting.

Staffing levels reflected the needs of people staying at the home. There were sufficient staff with the right knowledge, experience and skills to support people.

Systems were in place to obtain the views of people and their representatives about the service they were receiving. Comments received included, "the staff are lovely. They are very kind" and "very happy, enjoys stays with you". Quality assurance audits were completed to assess and monitor the quality of the service provided.

This inspection took on 12 and 17 August 2015 and was unannounced.

Cathedral View is a nine bedded care home which provides short term respite breaks for carers. People who stayed at Cathedral View had learning and/or a physical disability. They generally lived in their own home with a relative or a carer and stayed at cathedral view when their relatives needed a break from their role as a carer.

There were five people staying at the home at the time of our inspection. The home is purpose built and is set over two floors which were accessible by stairs or a lift. The home has a main lounge with an adjoining dining room. There were several quiet areas and a sensory room that people could use. They also had access to a private secure back garden.

A registered manager was in place as required by their conditions of registration. 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.

Some people’s care records were not always detailed and consistent. The management of their risks and medicines were not always updated and reflected in their care records. People and relatives told us staff were kind and they felt safe at the home. People were able to make choices about their stay. They enjoyed a variety of social activities and meals. Staff knew their responsibility was to support people in the least restrictive way and protected them from harm. When required people were referred to health care professionals to receive additional support and guidance was implemented in the home. People and their relatives concerns were addressed immediately.

Staff were knowledgeable about people’s physical and emotional needs. They had mainly been trained to carry out their role however; some staff required training in the Mental Capacity Act. Plans were in place to address this.

There were sufficient numbers of staff available to meet people’s needs. Extra staff were provided when people required additional support with their care and social activities. There was a low turnover of staff in the home. The home was managed by a registered manager who had knowledge in running homes that provide a respite service. The registered manager led by example and was supportive to people and staff. The representative from the provider regularly visited the home and supported staff but did not carry out any monitoring checks. Plans were in place to improve the monitoring of the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.