This was an unannounced inspection carried out on 19 January 2017.

Clarendon Beechlands provides accommodation and personal care for 18 people who have specific mental health needs. The accommodation comprises of eighteen single en-suite rooms. There were 18 people living in the service at the time of our inspection visits.

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.

At the last inspection of the service on 6 April 2016 we asked the provider to make improvements in care plans and risk assessments which were not sufficiently detailed to ensure staff had adequate information to ensure people were cared for safely. We received an action plan from the provider which outlined the action they were going to take. This advised us of their plan to be compliant by July 2016. At this inspection we found that improvements had been made to care plans and risk assessments. These now covered all aspects of people’s needs and included safety when outside the home, travel, finances, health and daily routines.

At the last inspection we also asked the provider to take action to ensure that quality assurance systems were put in place, to assess and monitor the quality of care effectively, to affect changes and protect people from harm. At this inspection we found that improvements had been made and a robust quality assurance system had been developed to drive improvement in the home.

There were appropriate arrangements for the recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines.

Care records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through having detailed daily records for each person.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. They were observant of people and responded to their needs quickly.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship before working with them on a one to one basis. Staff felt there were enough staff to keep people safe and ensure people could attend activities and have planned trips out from the home.

Staff worked as a team to ensure people received the appropriate level of observation to keep them and others safe. The provider had recruitment procedures that ensured staff were of a suitable character to work with people at the home. Staff had received training in the areas considered essential for meeting the needs of people in a care environment safely and effectively.

Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. Staff were observant of people and responded to their needs quickly.

The provider ensured all notifications required by law had been sent to us in accordance with the legislation.

This was an unannounced inspection carried out on 14 & 21 April 2016.

Clarendon Beechlands provides accommodation and personal care for 18 people who have specific mental health needs. The accommodation comprises of eighteen single en-suite rooms. There were 18 people living in the service at the time of our inspection visits.

There was no registered manager when we inspected, however an acting manager had been appointed and had commenced the registration process with us. 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.

Checks undertaken to ensure the quality and safety of service provision, were not robust which meant a number of shortfalls not being identified or addressed.

Some quality checks were in place, however these did not cover the assessment and monitoring the quality of care to ensure care plans and risk assessments were up to date.

There were not always enough support staff on duty to provide everyone with all of the support they needed. Support staff knew how to respond to documented concerns so that people were kept safe from harm; however some new people that recently moved into the home did not have all the information support staff required to keep them safe. Medicines were managed safely and background checks had been completed before new support staff were appointed.

Support staff did not always respond appropriately to people who had specific communication needs. People had been supported to eat and drink enough and they had been helped to receive the regular healthcare assistance they needed.

Support staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where 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. The acting manager had not taken all of the necessary steps to ensure that people’s legal and human rights were protected, as we could not be assured people living in the home had full capacity to make decisions.

People were spoken with by support staff respectfully; however, some support staff did not always recognise people’s right to privacy and dignity. For example by knocking on doors before entering private rooms.

Support staff had consulted some people about the care they wanted to receive and had recorded the results in individual care plans. People were regularly asked about their food choices and what activities they would like to undertake. People had been consulted about the development of the service. However their care plans to guide and direct support staff on how to provide care did not always reflect person centred care or promote people’s independence.

Complaints had been investigated and responded to appropriately.

Tests to ensure that the environment was safe were undertaken regularly. There was a business continuity plan to ensure the effective running of the service in an emergency. Individual evacuation plans had not been produced for all those living in the home, and were not readily available in an emergency.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans and assessments of potential risk were not sufficiently detailed with information to keep people safe.

You can see what action we told the registered persons to take at the end of the ful

We spoke with five people who use the service. We also spoke to five members of staff.

One person told us “The staff are great, they helped me to fix my new TV to the wall.” Another person told us “I have been playing my guitar all morning. I like doing this. I play love songs.” We found not all people experienced care, treatment and support that met their needs and protected their rights. The needs were not met of people whose behaviour could impact adversely on other people. We found that there were no social activities organised for people using the service.

People were protected from the risk ofphysical and emotional abuse and staff knew how to raise any concerns. We found that the staff had, or were shortly due to have, training in the safeguarding of vulnerable adults, and knew how to raise concerns. However, we found some records relating to people’s finances were inaccurate.

Although the provider had introduced audits in relation to finances, medication, care plans and incidents, we found that some of the audits did not contain action plans to address deficits. We also found that actions taken as a result of these audits were not documented. We found that records relating to people’s care and treatment were accurate, appropriate and fit for purpose.

The service is managed by an appropriate person. We found the manager had undertaken training relevant to their role and provided a sufficient level of support to staff.

We spoke with four people using the service. Three people told us they felt safe with staff at the service. One person commented: “They look after me.” Two other people told us staff were “alright”. The third person was not able to tell us whether they felt safe, but they told us how staff supported them and they were happy about the personal support they received from named staff. We found the provider did not have effective systems to ensure care workers understood how to identify the possibility of abuse. The provider was not reporting all incidents and allegations of abuse to the appropriate bodies.

We asked two people how they looked after their money. They told us staff helped them to look after their money. One person told us they signed to say how much cash they had. We found that there were systems for protecting people from financial abuse. We found some gaps in financial recording that had not been identified by the provider’s checks.

We spoke with three people using the service. All three knew about meetings held by the provider to get people’s views. One person we spoke said they sometimes attended these meetings and that they could express their views. The other two people told us they did not want to attend meetings. We saw both speaking with staff and expressing their views to them. From speaking with staff, it was clear that people’s views were taken into account. One person we spoke with said they would like help to express their views. We saw that this person was able to talk to staff and staff told us this person had declined support from advocates. We saw that people had been given information about advocacy and they had been asked for written consent to their care and treatment.

The registered manager had introduced audits which she was beginning to use to assess and monitor the quality of the service.

We spoke with five of the 18 people using the service. People were generally satisfied with the support they received. Some of the comments people made were very negative. This was because they did not want to use services and due to their mental health needs, rather than a reflection of the service. As well as speaking with people, we observed the care and support they received throughout our inspection. Two of the people we spoke with said care workers treated them with dignity and respect. We saw that care workers generally spoke with people respectfully. People using the service were relaxed with care workers and responded positively when care workers spoke with them.

The people we spoke with did not know what was contained in their care records and said they had not been involved in deciding what should be in their care plans. They did not know about reviews of their care plans. This showed that people using the service were not supported to make informed choices about their care, treatment and support.

One person showed us they had asked an advocate to raise their views about another service. Other people we spoke with were not aware of any advocacy services. This meant people using the service did not know how to express their views if they were unable to raise them directly with staff at the service.

People's diversity was respected. One person we spoke with had particular needs because she was disabled. She said that staff were meeting her needs with regard to her disability. We saw from care files that people were supported to practice their chosen religions.

Treatment was delivered in a way that ensured people's welfare. People told us they were able to use local medical services including GPs, dentists and opticians. Some people told us they accessed these services independently. Two people told us that care workers supported them when they needed an appointment. Medical appointments were not always properly recorded in people's care records. Care plans did not reflect all advice given by health professionals.

The people we spoke with said they felt safe at the service. They said they knew what they would do if they were worried about abuse. They all told us they thought staff were properly trained and qualified to do their job.

One person said they attended residents' meetings when they were arranged. The other people said either that they did not attend or that they did not know about them. None of the people we spoke with remembered being asked for their views formally. We saw that some people using the service expressed their views about their care and the service to care workers and the manager. We did not see whether views expressed informally in this way were recorded or acted on.