About the service: S E L F Limited - 14 Park View is a care home and provides accommodation and support for up to nine people living with a learning disability. There were eight people living at the service when we visited.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

People’s experience of using this service: People told us they were happy at the service. One person said, “I like it here and the staff are great.” The service had made improvements and had effective systems in place to ensure medicines were managed safely. People told us they felt safe. Staff were knowledgeable about safeguarding and were confident any concerns would be dealt with appropriately. A robust recruitment process was in place. Health and safety checks were regularly conducted to make sure people lived in a safe environment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received personalised care. We observed many positive interactions between people and staff. Staff clearly knew people well and were knowledgeable about people’s life histories, preferences and care and support needs.

Staffing levels were sufficient to meet people’s needs. The registered manager regularly reviewed staffing levels to ensure enough staff were available to support people in the community.

People were involved in developing care plans and setting goals. Staff supported people in daily decision making.

The service ensured people had access to health professionals when required and supported with any ongoing care and support needs.

Incidents and accidents and safeguarding matters were recorded and reviewed.

Staff morale was high. Staff were supported well by the management team. Training was designed around the needs of the people living at the service.

Information throughout the service was available in an appropriate format for people to understand the care and support they received.

People were supported to take part in activities and interests they enjoyed. The service also supported people to develop life skills, literacy and numeracy.

People, relatives, healthcare professionals and staff had opportunities to give feedback.

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

Rating at last inspection: Requires improvement with breaches in regulation 12 and regulation 17 (the last report was published on 22 May 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule for services rated good.

The inspection took place on 8 February 2018 and was unannounced. This meant the provider and staff did not know we would be coming. The inspection was planned partly in response to concerns raised with the Care Quality Commission (CQC) about the management of a recent safeguarding concern.

We previously inspected SELF Limited - 14 Park View (‘14 Park View’) in September and October 2015, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

14 Park View 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. 14 Park View provides care and support for up to nine people who have a learning disability. Nursing care is not provided. There were nine people using the service at the time of our inspection. The registered provider operates three separate services at Park View (numbers 14, 15 and 16). During this inspection we inspected all three services. Although the services are registered with the CQC individually we found that there were areas that were common to all three services. For example, training programme and delivery, joint staff meetings and one set of policies and procedures across all three services. For this reason some of the evidence we viewed was relevant to all three services.

The service had a registered manager in place. 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.

The management of a recent safeguarding concern was not robust in terms of establishing clear outcomes, nor was the investigation process sufficiently accountable.

Risk assessments did not always set out clearly enough how to protect people who may be at risk of absconding, or at risk of harm from others.

Medicines administration practices were not always in line with good practice and opportunities had been missed to improve these practices.

Auditing processes had not identified some of the areas identified on inspection and the provider needed to review how they managed the auditing of the service in the longer term, both in terms of the efficiency of individual audits and who these responsibilities may in time be delegated to.

Staff did not always ensure confidential information was appropriately locked away, or that keys to the medicines storage units were securely stored.

The majority of risk assessments were sufficiently detailed with clear strategies in place for staff to help protect people in a way that also did not unnecessarily restrict them.

People who used the service interacted well with staff and told us they felt safe. No relatives or external professionals we spoke with raised concerns about safety.

There were sufficient numbers of staff on duty to meet people’s needs and staff were aware of their safeguarding responsibilities.

All areas of the building were clean and processes were in place to reduce the risks of acquired infections. The registered manager agreed their response to a flood in a bathroom could have had more regard to people’s individual hygiene. The premises were generally well maintained, with external servicing of equipment in place.

Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks. These checks were refreshed after three years after external advice.

The ordering, storage, administration and disposal of medicines was generally safe, although we identified areas of poor practice with regard to creams and the administration of ‘when required’ medicines.

People

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? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

The service was safe. Where staff had identified a potential risk, either during the initial assessment or after admission, a risk assessment had been completed to ensure people remained safe.

The provider had systems in place to ensure people received their medication from trained staff and in a timely manner. Where people had been prescribed ‘as and when required’ medication, the provider had developed protocols for staff to refer to so that it was administered appropriately.

People did not raise any concerns with us about the staff. People’s comments included: “Staff 100%”; “Staff give you respect”; and, “Staff are really nice to me.” We observed during our inspection that staff appeared to have the time to give people the attention they wanted and needed.

Is the service effective?

The service was effective. Information gathered during the initial assessment was used to develop detailed support plans. These were focussed on self-development tasks and activities to promote independence, such as having a bath and making the bed. The tasks were personalised to the needs of each individual.

Is the service caring?

The service was caring. The staff were very supportive towards the people they cared for and were kind and caring. We saw that staff supported people sensitively and offered re-assurance when required. We saw that people responded positively towards staff and appeared calm and relaxed around them. People told us they were happy with the support they received from staff. They commented: “Top notch”; “I really like living here”; “Staff give you respect”; and, “The manager always says goodbye before she goes home.”

Is the service responsive?

The service was responsive. People had access to a range of specialists and health professionals to ensure they received appropriate care. For example, this included their GP, psychiatrist, Community Mental Health Nurse, social worker and other health professionals.

People we spoke with told us they were happy with the service. They told us that they knew who to talk to if they had any concerns or worries. People commented, “I have no concerns for anything”; “The staff help me”; and, “The staff sit down and talk to you if you are upset.”

Is the service well-led?

The service was well-led. People had opportunities to give their views about the service. The provider held regular ‘service user’ meetings, which were usually well attended. We saw from meeting minutes that people’s views were listened to and actions from the meeting had been recorded. People also had regular key worker meetings with staff. This gave people the opportunity to have one to one time with staff to talk about their care and the things they would like to do.

The provider had a system of monthly quality audits in place. These included health and safety checks, checks of staff files, medication and care records. We saw that the audits had been successful in identifying changes required to people’s care plans.

The provider had systems to log and investigate incidents, accidents and restraint. We viewed the accident records and found these were monitored by the manager. Information from a range of sources including incidents and accidents was analysed and used to improve the care people received.

There were eight people living in 14 Park View when we visited. Although not all could tell us their views in detail some gave us very clear information about the experience of living in the service. Three people showed us around the building or thier bedrooms. We observed positive interactions between the staff and people who were using the service. They told us they were very happy with the support they received. Two of the people living in the service told us they were happy with the way they had been decorated and furnished to their taste.

We saw people looking to the staff for reassurance when we spoke with them, and the staff provided this support without it being intrusive or inappropriate. People said they felt safe and knew who they would go to if they were worried. We observed staff assisting in a professional and pleasant way and the atmosphere in the service was quiet and calm and the staff were focusing on the people they were supporting.

Staff were recruited and selected using a robust process which made sure they were fit to work with vulnerable people and had the skills and knowledge to deliver the service. People living in 14 Park View told us "The staff are lovely, especially the manager who is great".

There were systems in place to make sure the proprietor could assess the quality of the service they provide and make improvements if necessary. These included obtaining peoples views and audits, and were appropriate to the service they deliver.

There were seven people living in 14 Park View when we visited and one person who was planning to move in and was being gradually introduced to the service.

We met with the people living there and although not all could tell us their views or experiences owing to their speech and language impairments, others gave us very clear information. Some spent time with us and we observed positive interactions between the staff and the people who were using the service. They were very happy with the support they received.

The people living in the service were being supported by staff on a one to one basis for some of the time and they were responding very positively to the staff who were with them when we were there. Two of the people living in the service gave us permission to see their bedrooms and they told us that they were happy with the way they had been decorated and had been personalised to their taste.

During our visit we saw the people using the service looking repeatedly to the staff for reassurance when we spoke with them, and the staff provided this support without it being intrusive or inappropriate. We observed staff assisting the people living in the service with their usual daily activities; including helping with domestic tasks watching television or going out to the farm. Staff responded to their needs in a professional and pleasant way and the atmosphere in the service was quiet and calm and the staff were focusing on the people they were supporting.

People living at 14 Park View told us they received good care and that staff involved them in deciding how their care should be given. We spoke with two people who told us that they thought the service was the best place they had lived. One person said, “they look after us well here.” Another person told us they go out in the community, which they preferred. They said, “it’s gorgeous, I’ve never known anything like it.”

One person told us that staff helped with their laundry, cooking and arranging activities. They explained that staff helped them with areas they could not do for themselves. They said, “I like to keep my own room clean and tidy.”

People living in the home told us they had the opportunity to visit the home before they were admitted. Also, that they felt they had some choice in whether they came to the home. They told us that they felt staff had provided them with appropriate support. Through our observations, we saw that people seemed confident in their surroundings and in their interactions with staff.

Everyone that we spoke with said that the service was meeting their needs.

This unannounced inspection took place on 21 September 2015, 25 September 2015 and 2 October 2015. The service was last inspected on 18 June 2014 and was meeting the legal requirements we looked at during the inspection.

14 Park View provides care and support for up to nine people who have a learning disability. At the time of our inspection nine people were living in the home. Nursing care was not provided. The registered provider operates three separate services at Park View (numbers 14, 15 and 16). During this inspection we inspected all three services. Although the services are registered with the Care Quality Commission (CQC) individually we found that there were areas that were common to all three services. For example, a single training programme, joint staff meetings and one set of policies and procedures across all three services. For this reason some of the evidence we viewed was relevant to all three services.

The home had a registered manager. 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 described to us the excellent care they received from kind, caring and respectful staff. One person said, “I have been well looked after here.” Another person said, “I am happy.” One person told us, “We are all treated nice.” We observed positive relationships had developed between people and staff. People regularly sought staff out to show them arts and crafts they had completed. Staff in turn were encouraging and supportive.

People were actively in control of the care and support they received. People told us they were supported to make choices. The home had a strong focus on personal development and promoting independence. People were occupied with structured activities within the home based around developing and improving life and literacy skills. People had the opportunity to attend college and work at the registered provider’s stables to further develop their skills. People and family members told us the home was safe.

Staff had a good understanding of safeguarding adults and whistle blowing. Staff knew how to report concerns and told us they would not hesitate to do so if they were concerned about a person’s safety. Staff had completed safeguarding training.

The registered provider had risk assessments in place which detailed the controls needed to help keep people safe.

Medicines were handled appropriately with accurate records kept. Medicines were stored securely.

There were enough staff to meet people’s needs in a timely manner. Recruitment checks were carried out before new staff started their employment.

The registered provider carried out regular checks to help ensure the premises were safe for people. Incidents and accidents were logged and investigated.

Staff were well supported in their role including the opportunity to have individual development sessions if required. Staff received regular one to one supervision and appraisals with their line manager. Staff received on-going training to help them provide the care and support people needed. Some training was personalised to the needs of individual people. Other training completed included risk management, moving and assisting, food hygiene, first aid and fire awareness.

The registered provider was following the requirements of the Mental Capacity Act MCA. Deprivation of Liberty Safeguards (DoLS) authorisations were in place for people who needed them. People were asked to give their permission before receiving care or support.

Personalised guidance had been written to help staff support people appropriately when they were displaying behaviours that challenge. This included identifying individualised strategies such as, distraction or diversion techniques and physical intervention only as a last resort. Where physical intervention was required a detailed record of the incident was kept.

People receive the support they needed to meet their nutritional needs. Records confirmed people had regular input from arrange of external health and social care professionals.

People had their care and support needs assessed. The assessment included identifying people’s care preferences. For example, some people liked arts and crafts, puzzles, numeracy, gardening, the farm and sports. People’s abilities to complete daily living tasks were also assessed. Tasks considered included eating, drinking, personal hygiene, cooking, cleaning and travelling independently. Following the assessment detailed, person-centred care plans had been written.

People told us about their care plans. In particular they said they were particularly working on three areas related to their daily living skills. We viewed key worker records which showed people and key workers jointly discussed progress people had made.

There were opportunities to take part in activities both inside and outside of the home. These included outings and planned activities such as games, arts and crafts.

People told us they knew how to raise concerns. Although the people we spoke with said they had no concerns. There was a complaints procedure in place. No complaints had been received at the time of our inspection. People had opportunities to meet to share their views.

People and staff gave us positive feedback about the approachability of the registered manager. One person said, “Ashley [Registered manager’s name] is the best manager.” A family member commented, “Simply put [director’s manager’s name] leads by example.”

People said there was a good atmosphere in the home. One person said, “We are like one big happy family. I like the people here. There are no arguments.” Another person said, “We have a bit of fun.” One staff member said, “Most days the atmosphere is fine. It is a lovely place to work.” Another staff member said, “Everyone gets along.”

There were regular opportunities for staff to give their views, such as team meetings. Meetings were used to as an opportunity to discuss topics to improve people’s care. Ad hoc discussions took place with staff to deal with specific situations. Consultation took place with staff and external professionals. Positive feedback was received during the most recent consultation.

The registered provider undertook a regular quality audit to check people received appropriate care. For example, the audit included checks of fire safety, housekeeping, infection control, accidents and maintenance. There was also a system of medicines audits in place. The registered provider had plans for developing the service in the future.