About the service: S E L F Limited - 15 Park View is a care home and provides accommodation and support for up to eight people living with a learning disability. There were seven 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 and felt safe living at 15 Park View. The service had made improvements around the way it dealt with safeguarding concerns. Risks to people's well-being were recorded and updated when their circumstances changed. Changes had also been made to the provider’s auditing systems. Whilst audits were basic, we found them to be effective.

People received support to take their medicines safely. Sufficient staff were deployed to enable people to go out and access the community when they chose to. The provider ensured staff employed were suitable with the right skills and experience to support people living at the service. Training was designed around people’s needs.

Health and safety checks were regularly conducted to make sure people lived in a safe environment.

Staff were supported by a well established management team who had a clear vision for the service which placed the needs of people first. Staff told us they were proud to work at the service.

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 were complimentary about their staff and the positive relationships they had with them. We observed many positive interactions between people and staff. Staff clearly knew people well and were knowledgeable about people’s life histories, family structures, preferences and, care and support needs. We observed staff seek permission before supporting people.

Care plans provided guidance for staff to follow to support people in accordance with their preferences and wishes. Healthcare professionals were regularly involved in supporting people to develop care plans and setting goals. People had access to health care professionals when required and supported with any ongoing care and support needs.

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.

The service actively sought feedback from people, relatives, healthcare professionals and staff.

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 (report 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 - 15 Park View (‘15 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.

15 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. 15 Park View provides care and support for up to eight people who have a learning disability. Nursing care is not provided. There were eight 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, which had the potential to impact on people who used the service and staff, 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, and who presented particular risks to themselves

Medicines administration practices were safe and in line with good practice although staff did not always ensure confidential information was appropriately locked away, or that keys to the medicines storage units were securely stored.

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.

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 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.

People had accessed external healthcare professionals such as GPs, dentists and nurses to get the support they needed. Staff liaised well with these professionals.

Staff received a range

We met with the eight people living in 15 Park View, and although not all could tell us their views in detail some gave us clear verbal information. Throughout the day we observed positive interactions between the staff and the people who were using the service. People told us they were happy with the support they received. We saw some were being supported by staff on a one to one basis for some of the time while others were actively engaged in group activities such as fire training which was being led by the staff.

People told us they felt safe and knew who they would go to if they were worried. We observed staff assisting the people living in the service with their usual daily activities; including helping with domestic tasks. Staff were sensitive to people’s individual needs and were discreet when making suggestions about them needing personal care such as going to the toilet. 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.

Records such as care records and staff records were detailed, up to date and kept securely. They records contained enough detail to make sure the care and welfare needs of the people living in the service were met and that the staff had the skills, knowledge and experience to safely meet those needs.

We met, and spent time with, the people living in 15 Park View during the visit. Not all could give us a verbal account of their views and experiences due to their speech and language impairments, others gave us very specific verbal information. We saw positive, friendly and respectful contact between the staff and the people who were using the service.

We spent time with the people in the communal areas and we observed them being supported by staff on an individual basis and in group activities. People engaged in a positive way with the staff including gentle teasing of a member of staff which they initiated and enjoyed. All interactions were maintained in a professional and respectful way which ensured their needs were met. Two people spent time showing us their bedrooms telling us that they were happy with the decoration and that they had been supported to make it personalised to their tastes. The activity session we observed gave people the opportunity for them to be positively engaged and spend time together in a meaningful way.

We saw the people looking to the staff for reassurance when we spoke with them. Staff provided this support without it being intrusive or inappropriate. Staff were assisting the people with their usual daily activities and responding to their needs in a professional and pleasant way and this was recorded in their care records. The atmosphere in the service was lively but settled and the staff focused on the people they were supporting.

People living at 15 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 was carried out on 21 September 2015, 25 September 2015 and 2 October 2014. The service was last inspected on 18 June 2014 and was meeting the legal requirements we checked during the inspection.

15 Park View provides care and support for up to eight people who have a learning disability. At the time of our inspection eight people were living in the home. Nursing care is not provided. The registered provider operates three separately registered 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 individually we found some information was applicable 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 and family members consistently told us the care was excellent. People said kind, considerate and committed staff provided their care. One person said, “It is perfect here” and “Staff are fantastic. They help you, come in on their days off to take you out. Come in on their own time to help you.” One family member said, “It’s like home from home. I can’t speak highly enough.”

Throughout our observations we saw people had developed positive relationships with their staff team. People actively engaged with staff, for example when they wanted to show them arts and crafts they were working on. Likewise staff responded with encouragement and praise. Staff were quick to respond to maintain people’s wellbeing.

People were supported to be as independent as possible. People took part in structured activities based around improving their life skills and their literacy skills. We observed staff reinforcing these skills during activities. Some people attended college courses or worked at the stables to develop their life experiences and skills. Other people were accessing the local community independently. People, family members and staff said the home was a safe place to live.

Staff demonstrated a good understanding of safeguarding adults and whistle blowing. For example, they knew how to report concerns. All of the staff we spoke with said they would have no hesitation to report concerns to keep people safe. Safeguarding training was up to date.

Risk assessments were developed where required. These identified the controls required to help keep people safe. Accurate medicines records supported the safe handling of medicines. Medicines were stored safely.

There were enough staff to support and care for people. We observed people had their needs met quickly. The registered provider undertook recruitment checks to ensure new staff were suitable to work with vulnerable people.

Regular health and safety related checks were done to help keep the premises safe. Records showed incidents and accidents were logged and investigated.

Staff received good support from their line managers. They could have individual development sessions if they needed additional help. Records confirmed staff had regular one to one supervision and appraisals. On-going training was provided so staff had the knowledge they needed to care for people. Practical workshop sessions were provided based around the specific needs of individual people. Staff had completed a range of training courses, such as risk management, moving and assisting, food hygiene, first aid and fire awareness.

The registered provider followed the requirements of the Mental Capacity Act (MCA) including the deprivation of liberty safeguards (DoLS). DoLS authorisations were in place for people who needed them. People were asked for consent before receiving care and support.

Staff had access to personalised information to help them support people when they displayed behaviours that challenge. Staff used various strategies to help people including distraction techniques and physical intervention as a last resort. Detailed records were kept of any incidences of physical intervention used.

People received the support they needed to have enough to eat and drink. They also had regular access to healthcare professionals when required.

People’s needs had been assessed to identify their support needs. Part of the assessment included identifying jointly with people their care preferences. Some people liked arts and crafts, puzzles, numeracy, gardening, the farm and sports. The assessment also considered people’s abilities to complete daily living tasks such as eating, drinking, personal hygiene, cooking, cleaning and travelling independently. This assessment and other background information was used to develop detailed, person-centred care plans.

People told us about how they were focusing on developing daily living skills in three main areas. People discussed their progress with these skills during regular key worker sessions.

People had lots of opportunities to take part in activities both inside and outside of the home. This included outings and planned activities such as games, arts and crafts.

People only gave us positive feedback about their care. They knew how to raise concerns. The registered provider had a complaints procedure. There were no complaints on-going at the time of our inspection. There were regular opportunities for people to meet together and give their views about their care.

We received positive feedback about the registered manager. People, family members and staff told us the registered manager was approachable. One person said, “The manager looks after me very well.” One family member said, “I have no problem with the manager.” One staff member said, “I can go to the manager at any time.”

The home had a good atmosphere. One person said, “I get on with everybody.” Another person said, “[Staff] have a laugh with you.” One family member described the atmosphere as “fantastic, really good.” They added they “never feel unwelcome.” Another family member said, “We are made very welcome.” One staff member said, “Most of the time really good. We have a laugh.”

There were regular team meetings so that staff could meet to give their views. These were used to discuss ideas to improve people’s care and support. One-off discussions took place with individual staff members when required in response to specific situations. The registered provider consulted with staff and external care professionals. We found positive feedback had been received during the most recent consultation.

Regular quality audits were carried out to check on the quality of people’s care. These included checks of fire safety, housekeeping, infection control, accidents and maintenance. Regular medicines audits also took place. The registered provider had plans in place to develop the service.