About the service: Highview Residential Unit is a care home that accommodates up to seven people that had primarily acquired brain injury related to substance misuse or alcohol and drug related problems. At the time of our inspection seven people were residing at the home.

People’s experience of using this service:

• At our last inspection we found that staff were not regularly supported through supervision, appraisal and regular training. Improvements had now been made in these areas with staff receiving regular support.

• At our last inspection quality assurance systems were not effective, areas for improvement were not promptly identified and care plans weren’t reviewed regularly. The registered manager had implemented quality assurance systems, ensuring that quality of care was continually reviewed.

• At this inspection some improvements were needed to ensure that medicines were always managed safely. Controlled drugs administration was not always recorded accurately, in line with best practice guidance. Following the inspection the provider had commenced implementation of the required improvements.

• We also found that staff files did not always evidence staff full employment history and appropriate references. Following the inspection the provider sent us records to show that they had obtained the documentation for the files we viewed, and assured us they would commence a full staff file audit.

• People and relatives felt that staff were caring and compassionate towards peoples needs. People’s care needs were regularly reviewed to ensure the home was meeting their needs.

• The home was continually reviewing the activities they offered people, to ensure they were appropriate to meet people’s individual needs.

• Comments about the management of the home were positive, with staff feeling well supported and the registered manager being proactive in making improvements across the service.

Rating at last inspection: At our last inspection of 11 and 12 April 2018 (published 29 May 2018) the service was rated ‘requires improvement’. We found one breach of the regulations in relation to good governance. There were also gaps in staff training and supervision, and medicines administration was not always accurately recorded.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 11 and 12 April 2018 and was unannounced.

Highview Residential Unit is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Highview Residential Unit accommodates up to 7 people in one adapted building. People using the home had primarily acquired brain injury related to substance misuse or alcohol and drug related problems. At the time of our inspection 6 people were residing at the home.

There was no registered manager in place at the time of our inspection as the manager was new in post. However, the service manager had applied for their registration and this process was in hand. 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 our previous inspection of 09 and 19 January 2017 the provider was inspected as a standalone substance misuse service. This focused inspection was conducted to assess and ensure that the provider had addressed the concerns raised in the warning notice and the requirement notices from the previous inspection of August 2016.

At the inspection of 09 and 19 January 2017 we found that improvements were required to ensure that people’s consent to audio equipment in their rooms was recorded, and that incidents were routinely discussed in team meetings.

This inspection will be the first time that the service is rated. At this inspection we found that the provider had made improvements in relation to the above areas. However, there were some areas identified that would benefit from some improvements. We found one breach of regulations in relation to good governance. You can see the action we asked the provider to take at the back of this report.

The manager did not complete regular audits of care plans, and did not identify that there were some gaps in people’s keyworker reviews. Medicines records did not always detail the reason for ‘other’ being recorded when someone did not take their medicine.

We also found some gaps in staff supervision records and training. Following inspection the manager promptly sent us records to show that people’s training needs had been booked.

We will check on the provider’s progress with the above at our next inspection.

People’s risk assessments were comprehensive and provided clear guidance on how best to support people. Staff were clear on how to manage any suspected allegations of safeguarding and knew how to use the provider whistle blow policy. There were enough staff to meet the needs of people and the safety of the premises was regularly checked. Medicines were safely stored and administered to people.

People’s needs were holistically assessed and people’s consent to aspects of their treatment was sought where necessary. People were supported to access support from a range of healthcare professionals where required. People were encouraged to maintain a healthy and balanced diet.

Staff were clear on how to respect people’s privacy and dignity, whilst promoting people to be as independent as possible. Staff treated people with kindness and compassion and knew people’s needs well.

People’s care was personalised to meet their needs and the provider was developing the implementation of individual activity schedules. A clear complaints policy was in place should the need arise, and people were supported to express their end of life choices should they wish to do so.

The manager was new in post and was keen to develop a transparent and supportive relationship with staff to ensure clear communication in the delivery of people’s care. They understood their responsibi

People told us they were satisfied with the service. Their comments to us included "The staff are as good as gold" and "I cook the meals that I want to eat and enjoy the things I am doing here. I bake cakes to take to church. I enjoy going to hobby craft club. I go swimming and to the cinema. It's great".

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Care and treatment was personalised and delivered in a way that was intended to ensure people's safety and welfare.

People were protected from the risks of inadequate nutrition and dehydration and they told us they enjoyed their meals.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises because they were well maintained by the provider.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff told us their training was effective and they had good support from managers.

There was an effective complaints system available and people told us they felt comfortable about making a complaint but did not have any to make.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The provider had made improvements to their day-to-day practice since the last inspection in August 2016. The improvements ensured safe care and treatment was being delivered to clients. The issues identified in the requirement notice and warning notice from August 2016 had been addressed.

• Staff completed risk assessments and risk management plans for all clients. Risk assessments were regularly reviewed and updated after an incident.

• Medicines were being managed safely. Staff completed medicine administration records (MARs) appropriately and there were no gaps in the charts. Six out of 14 members of staff had completed the new in-house medicine administration training. The medicine cupboard keys were stored in a lockable cabinet in the administration office.

• Staff had received up to date training in how to administer medicines to clients who were diagnosed with epilepsy and had seizures.

• The service had put appropriate systems and processes in place to ensure that the quality and safety of the care and treatment provided was monitored and improved upon. The service had put a clinical risk register in place to address areas of risk.

• Care plans were personalised and tailored to individual client’s needs.

• The service had ensured they had obtained the correct information from staff prior to employment.

We found the following issues that the service provider needs to improve:

• The service had introduced audio monitors for clients who had epilepsy. However, staff had not recorded that client’s consented to the audio equipment that had been installed in their bedrooms.

• We did not always see evidence that staff routinely discussed incidents in the team. The lack of discussion meant staff may not receive full feedback and learning from incidents.