Our inspection of North View took place on 4 January 2017 and was unannounced. At the previous inspection in February 2016 we had found the service to be in breach of Regulation 17, Health and Social Care Act 2008 (Regulated Activities) regarding good governance, as the service had not maintained complete records in respect of people living at the service or other records relating to staff. However, at this inspection we saw improvements had been made in these areas and the service was now meeting the relevant requirements.

North View is a converted house situated in the centre of Todmorden which provides accommodation and support for up to five people. At the time of our inspection there were five people living at the service.

The previous registered manager had recently left the company and a new manager was in place who had commenced the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 told us they felt safe living at the service. Staff understood how to keep people safe and safeguarding procedures were in place. Risks to people's health and safety were assessed with appropriate plans of care put in place to mitigate these risks. Care records were highly detailed and person centred.

Medicines were safely managed and administered. Staff had received medicines training and competency assessments and people received their medicines as prescribed. Protocols for 'as required' medicines were in place.

There were sufficient staff deployed to ensure people's care and support needs were safely met. The manager recognised the need for extra female staff and plans were in place to implement this. Staff and people had developed strong relationships and good interactions were observed. Recruitment procedures were robust and ensured staff employed were suitable to work with vulnerable people.

Staff training was tailored to the needs of the people who used the service although the manager recognised the need for more face to face training in areas such as autism. Regular staff supervisions and appraisals were in place.

The premises were well maintained and people were encouraged to personalise their bedrooms according to their tastes and choice.

People had access to a variety of food and assisted in shopping, preparation and cooking activities in order to promote their independence. Healthy eating and lifestyle choices were encouraged by the service.

People's preferences were respected within the home and reflected in activities and goals tailored to individuals. People were encouraged to be as independent as possible and encouraged to achieve their personal goals through regular meetings and discussions with their key worker. People were involved in setting long and short term goals to develop life skills and personal development.

Healthcare professionals were involved in supporting people's care where appropriate.

There was a relaxed and homely atmosphere in the home and people were at ease with the staff who were supporting them.

The manager was respected and staff felt supported by the management team. Staff told us morale was good and all staff worked well together as a team.

A range of audits and checks were undertaken to monitor the quality of the service and identify any improvements needed.

We inspected on 9 and 18 February 2016. North View is a converted house which provides accommodation and support for up to five people with learning disabilities. There were four people living in the service at the time of our inspection.

A registered manager was 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.

People and relatives we spoke with said people were safe living in the home. Safeguarding procedures were in place which were understood by staff. Risks to people’s health and safety were assessed with appropriate protocols and plans of care put in place to help ensure people’s safety. These were detailed and well understood by staff.

Medicines were managed safely and people received their medicines as prescribed. The support people were offered with medicines was robustly documented. Regular checks took place to ensure people continued to receive their medicines safely.

Although there was a shortage of staff employed, there were sufficient staff deployed at all times to ensure people received their contracted hours of care and support. Arrangements were such that people were able to develop and maintain strong relationships with staff. Robust recruitment procedures were in place.

The premises was appropriately managed and people were supported to personalise their environment with possessions and décor chosen by them.

People received care from staff who had a good level of knowledge about the people they were caring for. Staff received a range of training which was tailored to the needs of the people that used the service.

People had access to a variety of food and were encouraged to be involved in the sourcing and cooking of food as part of initiatives to improve their skills and independence. Healthy living choices were promoted by the service.

The service worked with healthcare professionals to develop care plans and protocols to help ensure effective care and support was provided.

People received dignified and respectful care from staff who understood their individual needs, likes and preferences. Relatives we spoke with praised the staff team and said they treated people well.

People’s needs were assessed and appropriate plans of care put in place. These contained a high level of person centred information on how to care and support people. These were understood by the staff team.

The service used tailored communication techniques to help ensure effective communication with people. People’s independence was promoted through the setting of short and long term goals to help people develop life skills.

People were supported to achieve a range of goals, which were evaluated on a weekly basis. People were fully involved in the planning of these goals. Goals centred around life skill development and providing worthwhile activities to people. People had access to a good variety of activities on a daily basis.

People, relatives and staff praised the unit manager who they said created a good atmosphere within the home. A range of audits and checks were undertaken to assess and monitor the service.

The service had failed to report all statutory notifications to the Commission as it had not reported safeguarding referrals made to the local authority to us.

Documentation of staff supervisions and body map charts was not sufficiently robust to demonstrate that concerns or injuries had been fully investigated.

We found one breach of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we told the provider to take at the back of this report

We set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe in the home. We found systems were in place to investigate people’s concerns to ensure people were kept safe. Staff had received training in safeguarding and understood how to identify and raise concerns. Staffing levels were sufficient to ensure the safety of people who used the service. People's care plans identified risk with activities to reduce and remove risk where possible.

Is the service effective?

Care was effective as people had their current needs assessed. Care plans required updating to reflect people’s current needs and were reviewed at least every three months. People told us they had choices with regards to their daily lives and praised the activities in the home. We observed the lunchtime meal which showed people were given appropriate support and choice.

Is the service caring?

People told us staff were kind and caring. For example one person told us, “Yeah, I really like the staff here,” and another person nodded their head and said, "Yes" when asked if the staff are caring. We observed staff displayed warmth and compassion when caring for people and treated them with dignity and respect.

Is the service responsive?

The home reviewed care plans at least every three months or when someone's needs changed. On the day of inspection we saw one person completed a goal as part of their care plan. The staff said they would update the goal progress showing they responded to people’s needs. There was evidence that people were referred to healthcare professionals such as dentists and doctors to ensure the service responded to any health concerns.

We saw a range of activities were available and staff told us they looked for signs of enjoyment and asked the resident if they would like to do it again or try something new.

Is the service well led?

The manager had identified problems with finance and training at the home through robust quality assurance systems. They had three different audits completed by three different people each month. There was a clear sense of direction and commitment from the management team to ensure these improvements were achieved.

Incidents and complaints were fully investigated and there was evidence that lessons were learnt to ensure continuous improvement.

When we visited the home in October 2013 we found there were not appropriate arrangements were not in place in relation to the recording of medicine. We looked at the medication administration records (MAR) for two people who lived at the home and saw there were gaps on both of the records. This meant it was not clear if people had received the medication they were prescribed.

We said that improvements were needed. We returned on this visit to check whether improvements had been made.

We spoke with the manager who told us that all staff had an observation of their competencies carried out regarding administering medication. In addition to this they had all re-read and signed the homes policy on medication. We saw that regular checks were now being carried out to ensure that any gaps on MAR records or stock levels were picked up immediately.

During our inspection of the home we were able to speak with one person who lived there and they told us they liked living at North View and they liked the staff. We contacted the relatives of two other people who lived at the home following our inspection to get their views. One person's relative told us 'It's a good place. It's very clean and safe, we know our relative is well looked after. We've never had to complain as we've been able to have a friendly word which had led to things getting sorted. When our relative has spent time with us you can tell they're happy to return. We'd know if things weren't right'. Another person's relative told us they were happy with the care their relative received most of the time. However, they felt the staff who worked at the home needed to be more aware of changes in physical health needs of the people who lived at the home.

The home provides accommodation for up to five people. At the time of our visit three people were living in the home. We were able to speak with one person who used the services and they told us staff looked after them well. They felt comfortable and safe living at the home. They told us that they are able to spend their time doing activities they enjoy with the support of staff.