The inspection visit took place on 17 October 2016 and was unannounced.

Clough House is registered to provide personal care and accommodation for 14 people. It is a small home situated in a conservation area in Leyland. Accommodation is provided in single bedrooms and one double room. There are sufficient bathrooms and toilets, and various aids provided to support people living in the home to maintain their independence. The upper floor can be accessed by two stair, lifts sited at each end of the building. There are outdoor seating areas for residents use.

A registered manager was 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.

At the last inspection in 30 January 2014, we found the provider was meeting the requirements of the regulations inspected.

At this inspection we found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding adults training and understood their responsibilities to report any unsafe care.

We found recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

Staff received training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support or where appropriate their relatives were involved in decisions and consented to their care. The registered manager and staff told us about important details regarding people's care and support that weren't always recorded in care plans. We have made a recommendation about this.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at the times they needed them.

During the inspection visit we observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. We observed the lunch time meal which was relaxed and organised. People who required support to eat their meals were supported by staff who were caring and patient. This was confirmed by talking with people who lived at the home. The cook had information about people’s dietary needs and these were met.

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at the home knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns. No one we spoke with had raised a concern, but they were confident the registered manager would take appropriate action to resolve any issues.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, spot checks, meetings and care reviews. We found people were satisfied with the service they received.

The registered manager and staff

People’s care and treatment was planned and delivered in a way that helped to ensure their health, welfare and safety. People were cared for as they wished by well trained staff. People described staff as being “very kind and helpful and they are like good friends to us, always there and interested in you”. “The staff are friendly and polite, well you’ve seen them yourself this morning. I don’t have any family, the staff sees to all my needs”. Activities provided for people were very good and the service promoted good links with the local community. People were provided with a good diet that catered for their needs. “The food is good, I have no complaints, and there is always plenty to eat”. “I can’t grumble it’s usually homemade. We get different things. I like most things on offer and if I don’t like something the staff will make me something else”.

People told us they lived in a clean environment. “It’s kept lovely, not too posh but very homely. It’s nice though because when you share facilities with people, hygiene is very important”. “One thing even my family comment on is that there is never any unpleasant smells. It’s kept very clean”.

People were given good opportunities to give their views as to whether the service and accommodation provided met with their needs and expectations. High standards of quality monitoring were carried out to ensure people’s health welfare and safety.

People had a good assessment of their needs. They were supported to understand what they could expect in principle from the service. They were consulted about their care and support and had signed their consent acknowledging this. One person said “Yes I have a key worker and I usually tell her what I want. I get about and I like to do most things for myself. They (staff) don’t take over”. People told us they were treated with kindness and respect and carers understood their needs. “I’m looked after well. The staff are very nice and helpful”. “I think it’s lovely here. They can’t do enough for you and they always try to get people involved. I used to play tennis when I was younger. I used to knit and crochet and have always kept busy. There’s plenty to do here, no time to get bored”. “They are always about to help you in anyway they can”. “We have a bit of fun here. I know them all and everyone gets on fine. The food is very good too, homemade and plenty of it”. People had an excellent personal profile written that placed them at the centre of their daily care. We found medication was managed correctly. People described their accommodation as homely. They were provided with everything they needed including warmth and comfort. People were cared for by staff of good character and who were trained. People said staff were “the best”, “very helpful”, and “good at their job”. “I couldn’t put one above the other they are all extremely nice people, the best”.

People living in the home told us they were very happy and cared for very well by the staff. They were getting all the help they needed and staff were very good. They told us that they can express their views and are involved in making decisions about their care and support. If they need anything, staff are more than willing to get it for them

They said the help they got was what they needed. Comments were made such as “It’s my second home. We’re like family. It’s lovely here and staff are so helpful, even when they are busy.” “They look after me well, “The staff are very good. I like to watch television, I have my own. I go out and have visitors. Sometimes an activity person comes. I enjoy playing dominoes and cards. It’s good here.” They also told us they were supported to access other health and social care services they needed. If they are not well the doctor will visit them.

We were told there were no rules to follow and no rigid routines. They usually pleased themselves what they wanted to do. Staff took into account their views and respected their right to privacy and independence. They could have visitors when they wanted and staff made them very welcome.

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People told us they were confident to raise issues of concern with the manager if ever the need arose.

People told us “I’m very comfortable,” “It’s good, the food is nice, no complaints. We are asked what we would like to do. Staff are always around to help us.” And, “It’s really good here. I can always speak up if I don’t like anything, I’m sure the manager would deal with it.