This inspection took place on 11 April 2017 and was unannounced. Clarence House provides care for people living with a learning disability. It provides accommodation for up to 21 people who require personal and nursing care. At the time of our inspection there were 18 people living at the home.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered and managed safely. Although PRN protocols were usually in place we found two occasions where they were not and it was not clear what dose of medicine had been given.

The provider did not act consistently in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social and leisure activities. They were supported to maintain relationships that were important to them.

Staff and people who lived at the home felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

This was an unannounced inspection carried out on 15 April 2016.

Clarence House and The Granary can provide accommodation and care for 21 people who have a learning disability. There were 19 people living in the service at the time of our inspection. The accommodation is two properties that are linked by a courtyard.

There was 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.

Medicines had not consistently been safely managed. Background checks had not always been completed before new staff were appointed. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including financial mistreatment. People had been helped to avoid the risk of accidents and there were enough staff on duty.

Staff had received most of the training and guidance that the registered persons said they needed and they knew how to support people in the right way. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had worked with the relevant local authorities to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the support they wanted to receive and they had been given all of the support they needed, including people who could become distressed. People had been helped to enjoy a wide range of interests and hobbies and there was a system to resolve complaints.

Quality checks had not always ensured that problems in the running of the service were quickly resolved. People had been asked about how they would like to improve their home. Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

We observed that people who used the service were supported with all aspects of everyday living tasks. We spoke to people and observed them carrying out a variety of tasks which, staff told us assisted people to retain skills and abilities. We noted people were happy and relaxed and everybody had a sense of purpose and their own responsibilities.

We reviewed the procedure for obtaining consent to care, treatment and support. We found there was a comprehensive consent document in place, to obtain people’s consent.

People had detailed person centred care plans in place. These helped us to understand the needs of people and in particular those with complex needs and those people who had limited verbal communication skills.

We observed people being supported to eat and drink sufficient amounts, and people were assisting with food preparation. We observed lunch and noted people had a choice of food and those who required assistance were assisted. We checked to see that medication was being administered appropriately and found that there were robust medication procedures in place, and people received their medication when they needed it.

We saw people were supported to make choices and decisions for themselves. Staff knew the people well and were able to communicate effectively with people and were able to understand what people were saying.

Two people who we spoke to spoke very positively about living at the home. We were shown the quality monitoring procedures and noted the provider had systems in place to use feedback to improve the quality of care people received.

As well as talking with people who lived at the home, we used a number of different ways to help us understand everyone’s experiences. This was because some people had complex needs which meant they were not able to tell us about their experiences. We looked at records including personal care plans. We spoke to the manager and staff who were supporting people and we observed how they provided that support.

We saw people were given support to make choices and decisions for themselves wherever they could do so and staff were aware of how each person communicated their needs, wishes and choices. We saw people were treated with respect and dignity and in a way which maintained and developed their independence.

Where they were able to people told us things like, “Personally I’m really happy here, I think it’s a good place to live”, “I feel safe living here, I have my own keys for my room as well” and “Staff always listen to me.”