Our unannounced inspection commenced on 27 March 2018, and we returned for a second day on 3 April 2018. We told the provider we would be coming back for this day to complete the inspection. At our last inspection in November 2016 we rated the service as ‘requires improvement’ overall and identified two breaches of regulations related to safe care and treatment and good governance. We asked the provider to send an action plan to show how they intended to make improvements to address the issues we found. At this inspection we found they had followed their action plan and were now meeting the requirements of all regulations.

Sunnyview 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. Sunnyview is situated in Ferrybridge, with easy access to local facilities. The home provides services for up to seven individuals with learning disabilities and associated mental health needs. The home is on two floors, and each person has their own room. There is an enclosed garden, which people in the home can access. At the time of our inspection there were six people using the service.

The care service has 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 with learning disabilities and autism using the service can live as ordinary a life as any citizen

There was a registered manager in post, who had been recruited since our last inspection. 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 told us they were safe at Sunnyview, and we saw the registered manager checked this was the case at regular service user meetings. Staff training and the provider’s processes meant people were well safeguarded, and we saw the registered manager investigated and reported any incidents appropriately. There were enough staff on duty to enable people to receive support when they needed it, and we saw records which showed staff had been recruited safely. We saw evidence of a good approach to equality of opportunity in recruitment practices.

People lived in a clean and well-maintained home, and we saw the registered manager ensured regular servicing of safety equipment.

Medicines were well managed. Stocks and records were up to date, and we saw documentation in place which supported good practice in this area. Staff responsible for administering medicines had regular training and observation of their practice.

Staff were well supported to be effective in their roles. They had access to appropriate training which was regularly updated, and attended supervision meetings to discuss their performance. People were supported to have good access to health and social care professionals, and there was accessible documentation in place to help people with appointments.

Care plans showed how people made decisions and how and when they may need support. Appropriate safeguards were in place where people could not make decisions, for example about where they lived. Independent advocates were involved in supporting people with their decision making.

We saw people could make choices about how they spent their time, and were able to have regular access to the community. People’s diet was tailored to their preferences and needs, and we saw healthier eating was promoted.

People told us they got on well with staff, and we observed this was the case. Care and support were provided in caring ways, and people were able to contribute t

We inspected Sunnyview on 14, 17 and 24 November 2016. The first and last days of the inspection were unannounced. This meant on those days the service did not know we were coming.

Sunnyview was last inspected in December 2015 and was rated as ‘good’ overall, with ‘outstanding’ in the responsive domain. This inspection was prompted in part by notification of an incident following which a person who used the service sustained a serious injury. This incident may be subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

The information received by the Care Quality Commission (CQC) about the incident indicated potential concerns about the way the service managed risk to people. This inspection included an examination of those risks.

At the time of our inspection, six people were being supported at the home; one person was in hospital.

The home did not have a registered manager. The last registered manager left in December 2015. A new home manager had been appointed and was about to apply to be registered at the time of this inspection. 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.

Most risks to people had been managed properly, however, we noted the risk assessments and care and support plans of some people with identified risks did not include the information staff needed to manage these risks. Most checks on the building and utilities were up to date; however, we found electrical hazards identified in December 2015 had not been addressed for over 11 months.

We observed medicines administration was person-centred. Documentation relating to medicines management was not always correct and there had been persistent issues in 2016 with medicine stock-checking and reconciliation.

Support workers and one relative told us there had been issues with low staffing levels, particularly at weekends. The home manager acknowledged this but said the registered provider was making efforts to recruit more staff. People we spoke with at Sunnyview said there were enough staff.

Most aspects of recruitment were done correctly, although records showed one support worker had not provided a full employment history, as is required by the regulations.

Staff could describe the different forms of abuse people living at Sunnyview might be at risk of. They said they would report any concerns to managers or the local authority safeguarding team.

Incidents and accidents which had occurred at the service since the last inspection had been managed, investigated and documented correctly. We saw evidence they had been followed up by the home manager.

We found the home was clean and tidy.

Most staff had received the training they needed to meet people’s needs, although identified some gaps. Support workers had access to supervision, however, this had not been according to the registered provider’s policy of six per year in 2016. The registered provider was reviewing their appraisal policy at the time of the inspection.

The service was compliant with most aspects of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although we noted people’s families had not been involved in best interest decision-making on their relatives’ behalf.

People were happy with the meals they were provided with at Sunnyview and told us they could choose foods they liked. Support workers encouraged people to eat a healthy diet.

Records showed and people told us they were supported by the service to maintain their general health.

Detailed records were kept when support workers used physical restraint to help people experiencing behaviours which may challenge others. Staff had received the training they needed to

The inspection took place on 17 December 2015. The inspection was announced. The provider was given 24 hours’ notice because the location was a small home for younger adults who may be out during the day; we needed to be sure that someone would be in.

Sunnyview provides accommodation and personal care for up to 7 younger adults with a learning disability, autistic spectrum disorder and associated complex needs. All the people who use the service require bespoke and flexible support packages. There were five people living at the service on the day of our inspection.

Sunnyview is a large house in a quiet residential area which offers accommodation over two floors. There is a quiet ‘bungalow’ at one end of the service with a dedicated summer house in the garden which was built to meet the specific needs of one person who uses the service. The other people who use the service live together in the main house, where they have their own rooms which are highly personalised with décor and personal effects of their choice.

The service has a registered manager. 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. There was a manager registered with the Care Quality Commission (CQC); they had been registered since December 2010. At the last inspection on 4 November 2013, the registered provider was compliant with all the regulations we assessed.

The registered manager and staff team demonstrated an in-depth understanding of managing risk and supporting people that had historically displayed behaviour that challenged others to live as independently and safely as possible. The staff team utilised risk management strategies effectively and were able to support people to try new things and make positive changes to their lives.

Within the main house, there were quiet spaces. These allowed people to be around each other without having to be in the same room. This encouraged one person in particular to spend time in the main part of the home. They would not have been able to do this without their own space being available to them. There is a kitchen, two lounges, two dining areas, a bathroom and toilets all of which are shared.

There is open access to the garden area. This has a summer house so people living in the main house who smoke can do so without having to endure poor weather conditions and is an additional quiet area. People who use the service have access to groups and social events which are arranged by the provider within the group of services they have in the area. This allows people who use services to expand their circle of friends, to access educational classes which allow them to explore and develop new skills and to attend social events with people from other homes within the local area.

There was very clear evidence of the time and effort which was spent developing and continuously improving the service. The provider and their senior management team came up with innovative and flexible ways to support people to move forward. The staff team looked at the barriers which were stopping people achieving their goals and found ways to remove those barriers without increasing the risk to the person who used the service or other people.

The registered provider was constantly reviewing, improving and where needed adapting the environment to meet people’s needs and to ensure that any new people who were admitted to the service had a suitable environment from the moment they arrived, adaptations were also made for the changing needs of people who were already using the service.

We found that each person had a personalised programme of activities which were designed in partnership with the people who used the service, focussing on their particula

We spoke with three people who used the service. They all told us they liked living at the home. One person told us they “like my holidays, they take me on” and another person told us they “like the staff.”

We spoke with four members of staff. They all told us they enjoyed working at the home. One staff member felt it was a ‘lovely place to work, we get treated well.”

The staff we spoke with had a good understanding of the need to treat people with dignity and respect, for example they told us they would ensure bathroom doors are closed when people are using them and they would not enter a bedroom without the consent of the person.

We saw that staff had training in safeguarding and were able to tell us what they would do if they had any concerns about the people who used the service. The people who used the service told us they would talk to the manager if they had any worries about the way they were being treated.

We looked at the care plans of three of the people who used the service. We saw that they were centered around the needs of the individual and were reviewed and updated on a regular basis.

The staff we spoke with told us they had regular supervision. We looked at the supervision notes of two staff members and an annual review of one staff member. We saw that they were up to date and had been signed by all parties.

The home had an up to date medicines policy and we saw evidence that medications were administered safely.

Sunnyview, owned by the Millennium Care Services, is registered to accommodate six individuals with learning disabilities and associated mental health needs, on the day we visited the service five people were living there. We used a number of different methods to help us understand the experiences of people who used the service, including talking to people, reviewing documentation and observing the care being delivered. During our visit we spoke with the registered manager, two members of staff, three people who used the service and a Community Learning Disability Team (CLDT) lead nurse who commented that there were no concerns about Sunnyview. Staff we spoke with gave good examples of how people were treated with dignity and respect. We looked at care plans for people who used the service and found that they were up to date and provided good information about how people's care and support needs were met. We saw that people were at ease and relaxed with staff and their surroundings, staff treated people with consideration and in a manner which protected their safety and comfort. Staff told us access to training was good and they were encouraged and supported to obtain further relevant qualifications. The registered manager told us there had not been a complaint recently but in the event of this happening any complaint would be logged and investigated, we were also told that the staff were in the process of completing the annual staff survey.

At the time of our visit most of the people who live at the home were out enjoying their daily activity programmes. Some people did return to the home before the inspection was completed but declined the opportunity to speak to us. Because of communication difficulties we were unable to speak with one person who remained in the home throughout the duration of our visit. However, we were able to observe interactions between the person and the staff team.