This unannounced inspection took place on 6 December 2016. At the last inspection on 15 July 2014 the service was meeting the regulations we checked.

Medihands Clifton provides accommodation and personal care for up to 13 people who have mental health needs, acquired brain injury or who may be living with dementia. The home is owned and managed by a private individual who has two other care homes in the local area. There were 11 people living at the home on the day we visited, one person was in hospital.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. We saw that people could speak to the registered manager or provider at any time.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place. We saw that regular checks of maintenance and service records were conducted to ensure these were up to date.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received appropriate medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff were supported through one to one supervision and through staff meetings.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others.

Detailed records of the care and support people received were kept. People were supported to eat and drink sufficient amounts to meet their needs. People had access to healthcare professionals when they needed them, so their healthcare needs were met.

People were supported by caring staff and we observed people were relaxed with staff who knew them and cared for them. People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to do and to choose the activities or events they wanted to attend.

The registered manager had arrangements in place to respond appropriately to people’s concerns and complaints. From our discussions with the registered manager, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? The summary describes what people using the service and the staff told us, what we observed and the records we looked at. On the day of our inspection there were 11 people using the service. We looked at the care records of four people; spoke with seven people using the service, three members of staff and the manager.

Below is a summary of what we found.

Is the service safe?

Care plans had details of people's needs and how these were to be met. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely.

We saw that risk assessments of the environment were regularly carried out and action plans written if required. The temperature of cooked foods was monitored at each meal; this helped to ensure food was correctly cooked.

Staff had received training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and understood how this could impact on the people they cared for.

Is the service effective?

People received effective care from staff that were trained and supported by the manager. We saw that people were happy, well cared for and treated with respect. Care plans were regularly reviewed with the person using the service.

Staff received a range of training. We evidenced that staff were being supported to study for further National Vocational Qualifications (NVQ). Staff received one to one supervision and yearly appraisals.

Is the service caring?

The service was caring. This was confirmed by our observations of staff and people using the service. Staff respected people's privacy, dignity and their right to be involved in decisions and make choices about their care and treatment.

People we spoke with said “I like the garden”, “this is a good place” and “I’m near my family here”. People also commented in the annual survey, ‘happy to live here’ and ‘I don’t want to go from here’.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. We saw from the daily notes that most people enjoyed the activities on offer and the home catered for their individual preferences. Some people did comment that there ‘weren’t enough activities’.

On the day of our visit which was unannounced, we saw that a few activities were taking place and people were joining in if they wanted to.

Is the service well-led?

The home employed a manager who knew their staff and people well. The manager told us about the audits that they conducted and showed us the recorded evidence to support them.

People were asked for their views about the service and we reviewed the returned questionnaires.

Staff we spoke with commented "it’s good here, you learn a lot and gain experience", “other staff and the manager are very supportive” and “best place I’ve worked”.

At a recent meeting people using the service were asked to comment of the home strengthens and weaknesses. The strengths were cooking, cleanliness and personal care. A weakness was communication.

We spoke with five people who use the service, three members of staff and the manager during our unannounced inspection of Medihands Clifton.

One person said "I visited and chose to come here" while another person said "my relatives visited and chose the place for me, they made the right choice". "The staff are lovely" and "they're good here" were some of the comments people made about staff. People said "I've got all I need in my room" and "they keep the place nice and clean". "I do what I want", "I go out to the day centre", "I see my family", "I watch television", "I listen to the radio", "I talk with the others" and "not much to do here" were comments people made about what they did.

Staff said they had the training and support they needed to do their job. One member of staff said one of the things they did well was the cleanliness of the home. Another member of staff said they knew the people who use the service well and how to meet their needs.

We saw improvements had been made to the environment. A bathroom on the ground floor had been refurbished, the garden had been developed to provide a covered smoking area with new flower beds and grass and the curtains had been replaced in the lounge. People made positive comments about the new shower and were happy with the improvements to the garden. We saw some good interactions between staff and people who use the service. Staff clearly knew what people liked and how to meet their needs.

Our inspection of 21st November 2012 found that the premises were not being maintained to a good standard and that people who use the service had little to occupy their time. The provider wrote to us and told us that they had made the required repairs to the home and put systems in place for staff to check the environment on a daily basis to ensure it was kept at a good standard. They told us that they were purchasing activity materials including board games in consultation with people who use the service.

During this unannounced visit we saw improvements had been made to the environment and the type of social activities available and provided to people who use the service. We spoke with six people who use the service and two members of staff.

People said they had been watching television, reading the paper, talking amongst themselves and with staff and said they had enough to do during the day. Staff told us they had some jigsaw puzzles and board games that they got out during the day and said that they had time to sit with people who use the service.

We spoke with eight people who use the service, one visitor, two members of staff and the manager.

"I'm happy living here", "I chose to come", "I'm feeling settled", "I have all I need in my room", "I was able to bring some items of furniture and belongings with me" and "I have the things that are important to me" were some of the comments we received from people about how they experienced living at Medihands Clifton. We saw some bedrooms had been personalised with individuals belongings and photographs, while other rooms were quite bare.

People told us they liked the food saying "I enjoyed lunch", "the food is usually good", "I had enough to eat", "they asked me if I wanted shepherds pie for lunch" and "we have porridge, toast and a cup of tea for breakfast".

"I watch television", "I go out to the day centre" and "we don't do much" were comments people made about what they did each day. Daily records indicated many people spent much of their time in the lounge watching television. We saw people sat in the lounge watching television, two people made a cake with staff and one person had a visitor.

People told us staff provided the care and support they needed saying "they listen", "they give me the help I need", "some are better than others", "they call me by my name" and "they respect my privacy". We saw some good interactions between staff and people who use the service with staff demonstrating good knowledge of people's needs and how to meet them.

Comments from people who use the service included ‘I like it here’, ‘It’s quite restful – it seems to be alright’, ‘I take it as read – I neither like it nor dislike it’ and ‘it’s been alright so far’.

People who use the service told us that they were treated respectfully by the staff who work at the home.

Feedback about the staff employed at the service included ‘very understanding’, ‘they seem alright’, ‘quite alright – they are nice to me’ and ‘some are good, some are not so good’.

We asked people what they did each day. Responses included ‘I do nothing really – just watch some TV’, ‘nothing much’ and ‘I don’t do activities’. Other feedback included ‘there are things to do here’ and ‘I go out downtown every day’. Two people said they that they would like to get out more with staff.