We carried out an unannounced inspection of Campania on 12 January 2017.

Campania is a large Victorian building over four floors in Weston-super-Mare, a short walk from the seafront, town and parks and is one of the provider’s, N.Notaro Homes Limited, 11 services. The home is registered for up to 41 people who are living with alcohol related problems such as Korsakoff's syndrome. This meant that people required support with mental health challenges, memory loss, behaviours which could be challenging for staff and other physical effects of long term alcohol abuse. The service does not provide accommodation for people who are continuing to abuse alcohol and people sign an alcohol /illegal substance agreement before moving into the home. Therefore they knew when support could be withdrawn by the service, for example following persistent alcohol use, aggressive behaviour or engaging in illegal activities. At the time of the inspection 38 people were living at Campania with one person in hospital. People knew they were subject to random breathalyser tests and drug tests before admission. Staff, with the person’s involvement aimed to provide a package of care and support that would enable people to be as independent as possible. Staff encouraged links with peoples’ families, often lost when lives are disrupted by alcohol abuse, to be re-established. Few people at the home were in contact with relatives. Campania staff tried to go beyond just providing a safe home and put rehabilitation at the forefront of what they tried to achieve by celebrating those who were able to move forward into independent community living. For example, in 2016 eight people were enabled to move out to their own flats in the community with support. Staff encouraged former skills and interests to be regained and provided opportunities for new experiences to enrich the lives of people living at the home.

At the last inspection in July 2014 we found the service to be compliant with the standards we looked at. At this inspection we found the service was still meeting all regulatory requirements and did not identify any concerns with the care provided to people living at the home.

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. At the time of this inspection the registered manager was on leave and the home was being managed by a knowledgeable and competent deputy manager.

People told us they felt safe. People expressed no concerns about their safety and were complementary about the level of support and care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had good knowledge of how to identify and report any safeguarding or whistleblowing concerns. Due to the nature of the service the home worked closely with local police and a community justice partnership to safely manage conflict, or anti-social behaviour, resolve issues between people living at the home and agree future actions. They also worked closely with homeless and addiction charities, community housing support, further education and voluntary work organisations and independent advocates promoting rehabilitation and facilitated a weekly professionals ‘sharing’ group.

There were systems in place for the safe storage, administration and recording of medicines. Each person kept their medication in a locked cabinet in their bedroom and only staff authorised to administer medicines were allowed access. Some people were able to administer their own medication, especially if they were moving towards

This service was inspected by a single adult social care inspector. In order to answer the questions below we spoke with five members of staff and fifteen people who used the service. We also reviewed six people’s care records and three staff records.

If you wish to look at our findings in detail please see the full report.

Is the service safe?

The environment was clean. People told us they felt safe. Staff personnel records contained all information required. This meant the provider could demonstrate that the staff employed had the skills and experience needed to support people who used the service. Staff were confident to raise concerns to the manager and able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Is the service effective?

People can be reassured their needs will be met. Each person had a care plan that detailed their care needs. Staff had a good understanding of people’s care and support needs and they knew people in the service well. Care records were accurate and complete. All risks had been assessed, and safeguards put in place where necessary.

Is the service caring?

People were supported by patient and respectful staff. People told us they were treated with respect and were involved in decisions about the care they received. One person told us, "Oh yes, the staff are all very good." Throughout our visit, we saw that people were not rushed. One person told us, “They don’t hurry you here.”

Is the service responsive?

There were systems in place to monitor and audit the quality of the service. For example, people's views were sought in surveys. People’s support needs were assessed before they came to the service. Care records reflected people’s needs and ensured that care and support was provided in accordance with people’s wishes. People had access to activities that were important to them, and were supported to maintain relationships with friends and relatives where possible.

Is the service well-led?

Clear quality assurance processes were in place, including regular audits, monitoring of complaints and surveys. All care records we viewed were accurate, current and complete. The service had a robust system in place to respond to complaints and concerns. Staff had a good understanding of the ethos of the service and there were quality assurance processes in place. Staff were regularly supervised by senior staff.

People told us they were treated with respect and were involved in decisions about the care they received. One person told us "the staff are all very helpful and good". We noted inconsistencies about involvement of people in their care arrangements. We noted the staff practice of going into people's own accommodation when they were not present and how this was an infringement of people's privacy.

Comprehensive assessments were completed so the service could meet people's needs effectively. People, where able, were supported to move to independent accommodation. The service provided meaningful activities suited to people's needs. People were not given opportunities to discuss issues associated with living in the service and moving to independent accommodation.

We saw there were appropriate arrangements for the management and administration of medicines. People were enabled to self- administer and manage their medicines as part of achieving maximum independence.

There were appropriate systems in place for the recruitment and selection of staff. The required legal checks had been made to establish the suitability of people who applied to work in the service.

There were systems in place to monitor and audit the quality and safety of the service. Improvements had been made where shortfalls in practice had been identified. People's views were sought about the service they received.

There were fortyone residents living in Campania at the time of our inspection. We met and spoke with fifteen residents, met a visiting professional and made our own observations whilst walking round the home. We asked residents about their experience of living in the home, one said” my needs are met in a timely way.”

Residents were involved in planning the support they need from the service. The records showed that residents were involved in arranging their care. Although a few residents said they could not remember planning their care, the care records showed they had written and signed some of the care documentation. One resident said” I can’t remember planning my care, but I’ve a bad memory." Whilst another resident said “staff and I did it together.”

Residents had a mixed view of the service. There were a variety of views about the food which varied between "not good" to “food is good” onto “The food is very good.” Residents we spoke with told us that they had good relationships with staff and their views ranged from “they are alright” to "staff are pretty good.”

Residents told us that they felt safe in the home and were able to talk to staff if they had concerns. One resident said "If I wanted to complain, I would talk to the manager and get a written response.”

Residents told us they felt involved in the decision making in the home. Residents told us they participated in the home's community meetings and the minutes were available in public areas.