This inspection took place on the 8 August 217 and was unannounced. At the previous inspection of this service in July 2015 we found it was compliant with all the regulations we inspected. The service is registered with the Care Quality Commission to provide accommodation and support with personal care to a maximum of six adults with learning disabilities. Six people were using the service at the time of our inspection.

The service had a registered manager in place. 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.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place. Risk assessments provided information about how to support people in a safe manner. Medicines were stored and administered in a safe manner. However, they were not always recorded accurately and we have made a recommendation about this.

Staff received on-going training to support them in their role. People were able to make choices for themselves where they had capacity and where they lacked capacity family members were involved in decision making. The service operated within the principles of the Mental Capacity Act 2005. Deprivation of Liberty Safeguards where in place where appropriate. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the senior staff at the service. Quality assurance and monitoring systems were in place to help drive improvements at the service.

This unannounced inspection took place on 29 July 2015. At the last inspection in July 2014 we found breaches of legal requirements. This was because risk assessments for people were not being thoroughly recorded. Care plans and risk assessments were not regulary updated and reviewed when people’s needs changed and monthly quality audits were not comprehensive. At this inspection we found improvements had been made and that the service now met the required standards.

Clayhall House is a 6 bed service providing support and accommodation to people with learning disabilities and mental health needs. At the time of the inspection six people were living at the home. The house is situated in a quiet residential area close to public transport and other services. The home is accessible downstairs for people with physical disabilities or restricted mobility. People live in a clean and safe environment that is suitable for their needs.

The service had a registered manager in place. 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.

Appropriate arrangements were in place for safeguarding people. Staff had undertaken training in this area and were knowledgeable about their responsibility for reporting any allegations of abuse. Enough staff worked at the service to meet people’s needs and checks were carried out on prospective staff. Risk assessments were in place about how to support people in a safe manner. Medicines were stored, recorded and administered safely.

Staff undertook training and received supervision to support them to carry out their roles effectively. People were supported to consent to care and the service operated in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported to eat and drink sufficient amounts and had choice over what they ate. People were supported to access healthcare professionals.

The service carried out assessments of people’s needs before they moved in to ascertain if it was able to meet those needs. Care plans were developed and subject to regular review.

The service had a clear management structure in place. People and staff told us they found the registered manager to be approachable and listened to them. The service had various quality assurance and monitoring systems in place. Some of these included seeking the views of people who used the service, relatives and health care professionals.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The service was found to be meeting the Regulations we checked, at the last inspection of the service in December 2013.

Clayhall House is registered to provide accommodation for six people with mental health needs. The home is located in a residential area and accommodation was on two floors. Two people were living at the home at the time of the inspection. At the time of inspection the home did not have a registered manager in post. A manager was appointed and registered with the Care Quality Commission in September 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe and that staff treated them well. Staff understood how to safeguard people they supported. Staff were able to explain to us what constituted abuse and the action they would take if they had any concerns. A relative told us they felt their family member was safe at the home and were happy with the care they received, “I think he is safe there. I feel quite content about the way he is looked after by staff.”

However, some aspects of the service were not safe. Staff had received Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLS) training. Sufficient risk assessments were not in place to give staff information about risks, and how to manage these appropriately. Medicines were appropriately managed and administered by staff.

There were enough staff to meet people's needs. Staff were knowledgeable about people’s needs and responded to them adequately. However, they had not completed specialised training in relation to people’s specific health conditions such as schizophrenia, diabetes or epilepsy. There was inadequate information about the level of care they required, the signs and symptoms staff should look out for and the actions required by staff in the event of a mental health breakdown.

Staff received regular supervision (individual meetings with the manager to monitor staff performance and identify training needs) from the deputy manager and felt supported by them.

People's needs had been assessed and basic care plans were developed so that staff knew how to meet their daily needs. However, people did not have personalised care plans and risk assessments. Although care plans were signed by people who used the service we could not see evidence of how people were consulted about their care needs. Care plans were not regularly reviewed and updated to reflect people’s changing needs. Appropriate health professionals were involved in people's care and staff followed guidance provided by them.

People told us and we observed that staff treated them well and interaction between them was warm and caring. People told us that they were happy with the care that staff provided and that their privacy and dignity was respected.

Systems were in place to monitor and review any issues arising however these were not comprehensive. The provider carried out monthly audits which were basic and outlined positive outcomes in each of the areas checked. However, it was clear from the inspection carried out that there were a number of areas which required improvement. We did not find an audit trail that showed learning from incidents or identified improvements that were required and how these were to be addressed and monitored.

Staff told us that the deputy manager was approachable and felt they could raise any issues with him, which they were confident would be dealt with professionally. Positive feedback had been received from satisfaction surveys sent out to people who lived at the home. Relatives and other stakeholders told us that the staff and provider were approachable. They were confident that any issues raised with them would be listened to and dealt with.

At this inspection we found a number of breaches of the Health and social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have asked the provider to take at the back of the full version of this report.

People who use the service were unable to give us their views because they were out of the service during our visit. This was because they were undertaking a planned activity. We spoke with health and social care professionals who regularly visit all the people who use the service. A person's health worker said "they have used the service for two months and they seem to be happy there."

We found that the provider had made an assessment of people's support needs. Their support had been planned and delivered effectively. People received assistance that safely met their identified needs. A social worker told us "the person I visit has used the service for three months. I have no concerns about the way they are supported. They are able to play football and make frequent visits to the park and cafes." They said the service had promoted the person's wellbeing by assisting them to undertake activities of their choice.

People received support from suitably qualified, skilled and experienced staff. We found that appropriate checks were undertaken before staff began work. We spoke to staff and found they were knowledgeable about people's needs. The provider had some effective systems in place to monitor the quality of the service. They have told us that, as the service is new, auditing arrangements are still under development.

People's medication was stored and administered safely. People's care records were appropriately maintained.