We carried out an unannounced comprehensive inspection on 10 February 2018.

Clearview provides care and accommodation for up to seven people with learning disabilities. On the days of our inspection there were seven people living at the care home. In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

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.

The service did not currently have a registered manager in post. 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. However, a new manager had started work this week who had plans to apply for registration with the CQC.

The Provider Information Return (PIR), where we ask providers to tell us what they do well and what they would so better, said; “Our Director (provider) has owned the business for nearly 20 years and has always promoted a positive culture that is open and person centred.”

At the last inspection on the 5 December 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

People were not able to verbalise their views and staff used other methods of communication, for example pictures or sign language. We met and spoke to all the people during our visit and observed the interaction between them and the staff.

People remained safe at the service. People were protected by safe recruitment process which helped to ensure only staff suitable to work with vulnerable people where employed. Staff said there were sufficient staff employed to meet the needs of people and support them with any activities or trips out. One staff said people were safe because; “We all work together to keep people safe.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to enable people to retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. All staff had completed a range of training such as safeguarding training and new staff completed the Care Certificate (a nationally recognised training course for staff new to care). The new manager confirmed that the Care Certificate training included a section on the Equality and Diversity needs of people.

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’s end of life wishes were not currently documented, however the new manager had plans to discuss this issue with relatives, advocates and involve people as much as possible. People's health was monitored by the staff and they had access to a variety of healthcare professionals. This helped ensure people’s healthcare needs were met.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes. Information re

The inspection took place on 5 December 2015 and was unannounced. Clearview provides care and accommodation for up to seven people with learning disabilities. On the day of our inspection seven people were living in the service.

The service had a registered manager in post. 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.

We met and spoke with all seven people during our visit. People were not able to fully verbalise their views and used other methods of communication, for example pictures and symbols. We therefore spent time observing people. A relative commented; “Fantastic place!”

People’s mental capacity was assessed which meant care being provided by staff was in line with people’s wishes. Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. Staff had undertaken safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff were trained and understood what people’s medicines were for. They understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapists.

People had access to healthcare professionals to make sure they received appropriate treatment to meet their health care needs such as occupational therapists. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

People looked relaxed and were observed to be happy with the staff supporting them. Care records were detailed and personalised to meet each person’s needs. People and / or their relatives were involved as much as possible with their care records to say how they liked to be supported. People were offered choice and their preferences were respected.

People’s risks were well managed and documented. People were monitored when required to help ensure they remained safe. People lived active lives and were supported to try a range of activities, for example swimming and bowling.

People enjoyed the meals offered and they had access to snacks and drinks at any time. People were involved in planning menus, food shopping and preparing meals, and were encouraged to say if meals were not to their liking.

Staff said the registered manager was very supportive and approachable and worked in the home regularly. Staff talked positively about their roles. Comments included; “I really love working here.”

People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities. Staff received an induction programme. Staff had completed training and had the right skills and knowledge to meet people’s needs.

There were effective quality assurance systems in place. Any significant events were appropriately recorded and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback was sought from relatives, professionals and staff to assess the quality of the service provided.

At our inspection on 29 August 2014 we found that improvements were needed to the way medicines were managed. This inspection was carried out by one inspector. The focus of this inspection was to answer the key question in relation to the home's management of medicines: is the service safe?

Below is a summary of what we found. The summary describes what 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?

We found that overall the service was safe. There were proper procedures in place to record what medicines people were prescribed and when they had taken them.

We noted that all medicine was kept under lock and key according to regulations and the home had systems in place to ensure that it would be difficult for the people who lived at the home to gain unauthorised access to the medicines. We saw that only staff who had been trained were allowed to administer medicines.

One adult social care inspector carried out this inspection. The focus of the inspection was to answer the key question - is the service safe?

Below is a summary of what we found. The summary describes 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.

We inspected this service because at a previous inspection we found that improvements were needed to the way medication was managed. A senior member of care staff assisted throughout the inspection.

Is the service safe?

We saw that medication was generally managed well and in a safe manner. For example, staff had received training in administering medication. We also saw that medication was stored securely.

However, we identified some improvements were needed. Not all policies had been recently reviewed, issues identified through audits had not always been followed up, and recordings on Medication Administration Record (MAR) charts were not always accurate. A compliance action has been set for this and the provider must tell us how they plan to improve.

During our inspection we were able to meet all of the people who used the service. Some of the people we met had limited verbal communication so we spent time in the communal parts of the home speaking to staff and observing the care being provided.

We saw that people were relaxed and happy in their home. One person was having a lie in. Staff said that they respected this person’s choice and would support them to get up when they were ready.

Care plans were detailed and included information about how people wanted and preferred to be supported.

We saw a folder containing photographs of one person and important aspects of their life. This ensured that the person was able to understand and be involved in issues concerning their care and lifestyle.

We saw that people had a well- balanced and varied diet. Any special dietary needs had been catered for and guidelines were in place when any risks had been identified.

A health professional we spoke to said that people’s health needs were well met. They said “ Staff are good at considering preventative care, and make appropriate, prompt referrals when they have any concerns”

Staff had been provided with updated, clear information about procedures to safeguard people who used the service.

We saw that the recording of incidents had been improved to include more detail. These changes ensured that the provider could have an overview of incidents and consider any lessons for future practice.

All of the people that live at the home have significant support needs. Because of these support needs most of the people we saw during our visit to the home on 22 July 2011 were unable to tell us about their experience of the care being delivered, or participate to any significant extent in the planning and development of their care. However we were able to observe the way in which staff members interacted with individuals and we spoke with a senior member of staff about peoples care needs and how these were met. We were able to speak with two of the people that use the service. One person expressed happiness through their speech and the other person told us that he was comfortable and happy with the staff. There was a relaxed atmosphere amongst the people that lived at the home during the course of our visit. We saw staff delivering support with patience and care.

We saw that there was adequate staffing to meet the needs of the four people that were living at the home on the day of our visit.

The home was generally clean. However we saw that some equipment was not being adequately cleaned. We noted incontinence odour in various places around the home which indicated that the service needed to manage this issue with more care. The home did not have appropriate laundry facilities to meet the needs of some of the people that used the service.

The service’s medication administration system was generally adequate to keep peoples’ medicines safe, properly administered, and adequately recorded. However, one person had not been receiving their pain relieving medication as it was prescribed. Some administration of prescribed medicines was not adequately recorded and the system for the management and administration of non prescribed medication was not appropriate which could lead to people being placed at risk.