This unannounced inspection of 161 High View Care Service took place on 23 May 2018. 161 High View Care Service is a ‘care home’ for adults with substance misuse and mental health needs. People in care homes receive accommodation and nursing or personal care as a 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 accommodates five people in one adapted building and five people were using the service when we visited.

This was the first rating inspection of 161 High View Care Service since they registered. We have rated the service Good overall.

There were two registered managers 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.

Risks to people were managed in a way that promoted their safety. Risk assessments were in place and detailed measures to reduce harm to people. Staff were trained in safeguarding people from abuse and demonstrated that they understood the signs of abuse and how to report any concerns in line with the provider’s procedures. There were enough staff to provide safe and effective support to people. Staff employed at the service had undergone thorough recruitment checks to ensure they were fit to work with people. Medicines were administered and managed safely and in accordance with the provider’s procedures. Incidents and accidents were reviewed and lessons were learnt from them. Health and safety systems were in place and up to date. The service was clean and well maintained. Staff followed food hygiene and infection control procedures.

Staff were trained, supervised and had the skills and knowledge to meet people’s needs. People’s needs were assessed with involvement of relevant professionals where required to ensure their needs were met. Staff understood how to support people with their needs. People were supported to have a balanced diet. Staff worked effectively with health and social care professionals to attain positive outcomes for people. People received the support they needed to access healthcare services to maintain good health. People’s care and support were well coordinated. There were suitable facilities available for people to use.

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. Staff understood their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff understood people’s needs and treated them with respect, kindness and dignity. Staff supported people to express their views and people were involved in planning their care and support. Care plans noted people’s Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) status and staff knew about them.

The service tailored the care and support they delivered to people to achieve positive outcomes for them. Each person had a support plan which set out how their needs would be met. People were supported to improve their daily living skills and to become independent as much as possible. People were encouraged to participate in activities they enjoyed. People were supported to maintain relationships they chose. Regular reviews took place to ensure the support delivered to people continued to meet their needs. People knew how to make a complaint if they were unhappy with the service. The provider investigated complaints in line with their procedure.

The registered managers understood their responsibilities and complied with the requirements of their registrations. Staff received the support, direction and leadership they needed to perform their

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The service had enough staff to care for the number of clients and their level of need. Vacancy rates, turnover and sickness absence were all low. Clients did not have any activities or appointments cancelled because of lack of staff.
• The service assessed and managed risk to clients and staff. Staff developed full risk assessments for each client. The service encouraged staff to be vigilant and prevent incidents before they happened.
• The service reported and learned from incidents when they happened. Incidents resulted in an action plan, where necessary, and clients’ care plans were updated with these action plans.
• The service arranged a medical, psychological and social assessment for every new client, which were kept in client folders.
• Staff developed client care plans which showed evidence of the client’s point of view. The care plans included evidence of ongoing physical care, informed consent and ongoing capacity assessments where needed.
• The service supported staff to gain training and qualifications in nationally recognised certificates. Staff had specialised training in response to the specific needs of the clients.
• Staff treated clients with respect and compassion. Clients felt safe and comfortable and told us that staff were always available.
• Clients discussed their care and treatment with staff and therapists, and their consent was recorded. Clients were asked their level of satisfaction with the service, which was documented in their care plans.
• The registered manager provided regular supervision, appraisal, induction and training to all the staff.
• The provider used this service to pilot innovation in therapy techniques and care delivery. The service introduced therapeutic support in April 2016 to provide rehabilitation support to clients and monitor outcomes.

However, we also found the following issues that the service provider needs to improve:

• Care plans were not available in easy read.
• There was nowhere for clients to receive visitors in private.

The home was registered with the Care Quality Commission in March 2014 and started providing a care service when three people moved in at the beginning of April 2014.

We gathered evidence against the outcomes we inspected to help answer our five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and whistleblowing. This reduced the risk to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Two people said that their care plans reflected their current needs.

The provider also employed behavioural support advisors and councillors to provided advice to staff on how to support people using the service with their individual needs.

Is the service caring?

We observed positive interactions between staff and people using the service during the course of our visit.

We spoke with three people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; “the staff treat me well, they are lovely people, they help me with my medication and take me out” and “I find the staff here are very helpful”.

Is the service responsive?

People using the service told us they knew how to make a complaint if they needed to and they were confident the provider would do something about their complaint. We saw the homes procedures for dealing with complaints. The registered manager told us the home had not received any complaints however people using the service could be assured that their complaints would be fully investigated and action taken if necessary.

We found that people using the service were involved in the recruitment of staff.

Is the service well-led?

We found there were effective systems in place to regularly assess and monitor the quality of service that people received.

Staff told us they enjoyed working at the home, there was good teamwork and they were well supported by other staff and the registered manager. They told us they had completed an induction, they had received lots of training and they had received regular supervision from the manager.