Clevedon House 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.

Clevedon House accommodates up to 11 people in two adjoined buildings. Some people had a learning disability and autism. Some also had physical or sensory impairment. There were 10 people using the service at the time of this inspection.

At the last inspection in September 2015 the service was rated Good.

At this inspection we found the service remained Good but we have made a recommendation that the service review their policy and practice in line with the NICE guidance and guidelines for managing medicines in care homes because medicine management was not robust.

Why the service is rated Good:

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety. People said they felt safe at Clevedon House.

Staff were recruited in a safe way and available in sufficient numbers to meet people’s needs.

The premises was well maintained and there were measures in place to ensure a pleasant and hygienic environment for people.

The induction and on-going training of staff ensured they were effective in their role. Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them in any way. People’s legal rights were understood and upheld.

The service had ‘gone back to basics’ with regard to ensuring people had good food and a varied and balanced diet. This had improved some people’s health. People said they liked the food.

People’s health care needs were well met through staff knowledge of the person and appropriate contact with specialist health care professionals.

People were treated with kindness and respect because their views were sought and responded to and their needs were understood and met. One person said, “It’s our home. The staff are just here to support us.” Staff interaction with people using the service was of a high standard.

People’s care and support was planned with them. Where information was important, pictorial communication was used. This included ‘happy, sad’ faces as a starting point for making a complaint or raising an issue. Complaints were welcomed as a way to make improvement.

People were able to follow their varied interests, with or without staff support. These included sports, gardening, voluntary work, outings and holidays. People came and went at the home as was their choice.

The service was well-led and the registered manager was praised for the improvements they had made to people’s lives. People’s views were sought and every opportunity taken to improve the service. Audits and checks were carried out in-house, by managers from sister homes and by the provider.

We spoke with four people who use services. They told us that “we choose what we do each day”. One person said “today I am going to a “fun day at the Hornets Club”, another person said, “I am going to the shops to buy something for my room”.

We observed people being respectfully asked by staff how they wished to be supported and in making decisions about how they spent their time during the day.

We spoke with four people who used the service at Clevedon House. They told us that they knew what was in their care plan and had been involved in preparing it. One person told us “today is my life skills day; I am helping with some cleaning”.

The manager told us that care plans are reviewed annually with a facilitator. We saw examples of the work undertaken which showed us that people’s views were recorded about issues such as “things important to me”, my dreams and goals”, and “who is going to support me in my actions”. We saw that these were placed in the care plan review. This means that the care plans are centred on the individual using the service.

People who used the service told us that they met with their key worker every month to review their care plan goals and make any changes needed. This means that plans of care are regularly reviewed and kept up to date in view of the changing needs of the person using the service.

We spoke to four people who showed us their bedrooms. All the bedrooms we saw had personal furniture, pictures and ornaments chosen by the people who lived there. Some of the bedrooms were locked which showed us that people’s privacy is maintained.

We saw that some case records were not accurate because there some signatures missing.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who had personal experience of using or caring for someone who used this type of service.

During our inspection we spoke with seven of the people who lived in the home. They were able to tell us their views of the service although some of the people were limited with their verbal communication skills. People told us that they were happy living in the home and that the staff encouraged and supported them to be as independent as possible. We were told “I am independent here” and “The staff are nice here. This is the best place I have ever lived”. People told us that they decided when to have their meals and what they wanted to eat. They said “We can eat anytime, the kitchen is never closed”; “There is a menu meeting every week so we can choose what we want” and “We get to choose what we like and can eat where we want to”.

People told us that they were involved in various social or work activities in the community. We were told “I go to church on Sundays”; “I work at a local resource centre” and “I go to the gym”.

We were told that staff treated people well and helped them with any concerns. People said “Staff are very good at helping people who have problems” and “I would tell staff if I felt unhappy about the way I was treated”. One person who was unhappy about the behaviour of another person who lived in the home said “I always tell staff and they listen to me. They talk to the other person and tell me I can make a complaint if I want to”.

People told us that staff were available to support them when needed. One person said “I don’t complain to staff because I never need to, it is good here”. Another person told us that staff went with them when they had to attend medical appointments and said “They always explain what the doctor has said afterwards”.

This inspection was unannounced and took place on 24 and 25 September 2015

Clevedon House provides personal care and support for up to 11 adults who have a range of needs including learning difficulties. There were 9 people using the service at the time of our inspection.

There was not a registered manager in post. 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. However the new manager was going through the process of registration.

Staff were well supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people. Staffing levels met the present care needs of the people that lived at the service.

Accidents and incidents were recorded appropriately and there had not been any recent safeguarding incidents. Comprehensive medicine audits were carried out regularly.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed MCA with the manager and looked at records. We found the provider was following the requirements in the MCA.

People were treated with kindness, compassion and respect. Staff demonstrated they had an excellent knowledge of the people they supported and were able to appropriately support people without limiting their independence. Staff consistently spent time speaking with the people they supported.

People had a choice of meals, snacks and drinks chosen by themselves, which we saw they enjoyed. People had been included in planning their own menus and their feedback about the meals in the service had been listened to and acted on. Most people were actively involved in meal preparation.

We saw that the home supported people to access a full range of activities, in the home, at the providers’ headquarters and in the community.

Care records showed that people’s needs were assessed; care plans were personalised and regularly reviewed.

The provider had a complaints policy and procedure in place. There had not been any recent complaints however people knew how to make a complaint.

We saw evidence that comprehensive quality assurance processes were regularly undertaken to ensure the service was aware of people’s views of the service. This ensured an open culture that is open to challenge and is learning from any issues affecting the quality of the service as they arise.

We walked around the service and saw it was comfortable and personalised to reflect people’s individual tastes.

We have made a recommendation about the provider making sure the laundry facilities are accessible to all people living in the service.