High View Care Services Limited – 9 High View Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. High View Care Services Limited – 9 High View Road does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports up to five people with acquired brain injury. People also had a history of substance misuse and other mental health issues. There were four people using the service at the time of our inspection.

At our last inspection in July and August 2016 our Mental Health Inspection Team inspected the service but we did not rate independent substance misuse services at that time. However, we found areas of good practice and a few areas for improvement including ensuring safeguarding concerns were referred to the local authority and that complaints were responded to promptly. At this inspection we found the provider had taken sufficient action to improve in these areas and we rated the provider Good overall. However, we rated the provider Requires improvement in relation to the key question ‘Is the service effective’ as there was lack of training for staff to protect themselves from physical aggression despite this being a known risk. People were not exposed to the same risk at the time of our inspection.

There was no registered manager in post at the time of 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. A manager had been in post since November 2017 and there had been unavoidable delays in the process of registering with us.

Risks relating to people’s care were well managed and staff were trained to understand people’s behaviours and how to deescalate situations where possible. Staff received training in a range of topics to help them understand people’s needs, including acquired brain injury, mental health issues and substance abuse.

The provider had an in-house psychological therapies team and an occupational therapy team who provided people with individual support and worked with staff to help them understand people’s needs.

People were supported by staff who the provider checked were suitable to work with them. There were sufficient numbers of staff deployed to support people safely and to spend time interacting with people in a meaningful way.

People’s medicines were managed safely, and the provider had robust processes to check people received their medicines as prescribed.

Systems were in place to safeguard people from abuse as the provider trained staff to understand the signs of abuse and the action to take if they had concerns.

The premises were maintained safely with a range of health and safety checks. The premises met people’s support needs as there was sufficient space for people to occupy themselves in their own company or the company of others.

The provider assessed people’s needs and developed care plans to meet their needs and preferences, involving people in the process. People’s care plans reflected their physical, mental, emotional and social needs, their personal history, individual preferences and interests.

The provider was meeting their responsibilities in relation to the Mental Capacity Act 2005 and people received care in line with the Act. The provider followed legal authorisation to deprive some people of their liberty as part of keeping them safe.

People received choice of food and food was provided to meet people’s cultural preferences. Staff supported people with their day to day health and people had access to the healthcare professionals they needed.

Staff knew the people they supported and

This inspection took place on the 27 January 2015 and was unannounced. At our previous inspection in August 2013, we found the provider was meeting the regulations inspected.

We are not rating substance misuse services that we inspected during the pilot phase for our approach to specialist substance misuse services.

High View Care Services Limited - 9 High View Road provides accommodation and support for up to five people with alcohol and drug related problems and /or cognitive impairment resulting from alcohol and drug misuse.

The registered provider Margaret Lakadi was the registered manager for 9 High View Road. She was being assisted in the day to day running of the service by the registered manager of a nearby home run by High View Care Services Limited. 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 using the service told us they felt safe and well cared for at 9 High View Road. They were able to take part in activities and were supported to go out into the community. We saw people were supported to maintain relationships with family members and friends who were important to them.

Staff were caring and treated people using the service with dignity and respect. They received training and support to help them carry out their role effectively.

There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers on each shift were sufficient to help make sure people were kept safe.

People were receiving their medicines as prescribed and we saw these were stored securely and safely.

Care plans were regularly reviewed to make sure the care was current and relevant to people’s changing needs. People were supported to access other services to ensure their health needs were met.

The registered provider communicated a strong person centred ethos and communicated a clear vision about how the care and support was to be provided.

We spoke to three people using the service. They all told us that staff respected their privacy and dignity. One person said “The staff are okay I suppose” another person said “The staff are friendly enough, they are around to help us”.

One person said “The food is okay. I cook what I like to eat”. Another person said “I don’t cook meals for myself but I make sandwiches and tea sometimes”. People said they went shopping with staff and got to choose what food they wanted to eat.

Two people told us staff supported them to take their medications and one person told us staff reminded them when they needed to attend health care appointments.

All of the people using the service we spoke to said if they had any concerns they would tell staff or the manager and they would do something about it.

High View provides accommodation and personal care for up to five people who may have an acquired brain injury or may need support for substance misuse. At the time of our visit all of the people living there were female.

We spoke with four of the people who were using the service. Three of them said it was a good place to live. Only one person told us that they did not want to live there anymore. They all said that staff were “very kind”, “nice and friendly” and “quite good to them”. One person remained in bed while we were there, preferring to get up later in the day.

People all had their own bedroom and they had been able to help choose how it was furnished and decorated. They were able to decide what they wanted to eat and they discussed what they wanted before the weekly shopping trip. We saw that this included items for people who liked Caribbean food. Some people helped to prepare meals and they were all able to make their breakfast or a snack.

There was a programme of activities arranged to suit people’s preferences and they were all able to go out every day with staff. The home has its own minibus. People also had an annual holiday, this year it was to The Isle of Wight.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The service demonstrated good practice in a number of areas. There was a highly motivated team and the feedback from residents using the service was positive about the care they were receiving. The care was person centred and residents were involved in all aspects of their care

• The service has recently introduced a new model of care which combines psychological support and behavioural interventions to support the cognitive needs of residents with brain injury.

• The service showed commitment to improve the skills and knowledge of support workers to provide support for people with brain injury.

However we also found the following areas the service needs to improve:

• There were a few areas for improvement to ensure the service was safe and responsive. This included ensuring that any identified safeguarding concerns were referred and escalated to the local authority and that complaints were responded to promptly and effectively.