This inspection took place on 31 January 2017 and was unannounced. At the last inspection on 18 May 2016 we asked the provider to take action to make improvements to the way they monitored the quality of the service, and this action has been partially completed.

35 Hill Top View is registered to provide accommodation and personal care for up to four people with learning disabilities. The services are divided between two houses. This includes 33 Hill Top View. There were four people living at the home when we inspected.

There was 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.

The provider needed to improve the way they monitored the quality of the service they were providing. Action was still required to ensure audits identified where improvements could be made.

People were kept safe from harm because staff understood their responsibility to protect them from abuse and poor care. People’s risks were assessed and staff were provided with management plans to support people in the least restrictive manner. Staff maintained a consistent approach to support people when they became anxious or presented with behaviours that challenged their safety. There were processes in place to ensure staff were suitable to work with people in a caring environment.

Staff had access to training to improve their knowledge of care and enhance their skills. Staff sought people’s consent before providing care and supported people when they needed help with their decision making. People received their medicines when needed and staff recorded them accurately. People were provided with meals that met their individual needs. The advice of specialist healthcare professionals was sought whenever necessary to maintain people’s health and wellbeing.

People received kind and compassionate care. Staff supported people to maintain their dignity, independence and privacy. Staff gained information about what was important to people so that they could provide care which met their preferences. People were encouraged to try new activities and staff recorded what they did or did not enjoy to ensure what they did met their preferences.

Relatives and visiting healthcare professionals were given the opportunity to share their views of the service. There was a complaints procedure in place. Staff felt supported and were provided with updates through a regular meeting schedule.

We inspected this service on 18 May 2016. The inspection was unannounced and undertaken by one inspector. At our last inspection on 9 July 2014 the provider was meeting the legal requirements we inspected.

35 Hill Top View is registered to provide personal care for up to four people who present with varying levels of learning disabilities. There were four people living in the home when we inspected.

There was 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.

The provider did not have an audit programme in place to monitor the quality of care they provided to bring about improvements when necessary. Accidents and incidents were recorded but the information was not analysed to identify trends and patterns.

Staff knew how to recognise abuse and the actions they should take to report their concerns. People risks had been assessed and there were plans in place to ensure risks were managed. Medicines were stored and managed safely and people were supported to take their prescribed treatments.

Staff understood and respected people’s needs and provided kind and supportive care in their home environment. Staff reflected people’s wishes and preferences in the way they delivered care. Staff understood how to support people who did not have the capacity to make their own decisions. People were offered a varied and nutritious diet.

People were encouraged and supported to engage in activities and outings that gave them an opportunity to socialise. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health and wellbeing whenever necessary. People were supported to maintain the relationships which were important to them.

There were recruitment practices in place to ensure that the staff employed were suitable to work with people. Staff received training and support to deliver a good quality of care to people and a training programme was in place to address identified training needs.

Relatives and healthcare professionals were given opportunities to share their views of the service. Staff felt well supported.

You can see what action we told the provider to take at the back of the full version of the report.

This visit to 35 Hill Top View was an unannounced inspection. This location consisted of two houses, number 33 and number 35 Hill Top View. At the time of our visit two people lived at number 33 and two people lived at number 35. All of the people using the service were provided with one to one support throughout the day. None of the people using the service were able to tell us about their experiences of care.

Below is a summary of our finding based on our observations, speaking to care staff and from looking at records. We considered our inspection findings to answer the questions we always ask:-

Is the service safe?

Risk assessments were in place where risks had been identified, with plans of action that informed staff how risks could be minimised.

Sufficient numbers of qualified staff were available to meet people’s needs.

Is the service effective?

Behaviour management protocols were in place, which provided staff with detailed information on how to support people effectively when they presented a risk to themselves or others.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection. People appeared comfortable with the staff that supported them.

Comments received by the service from people’s relatives stated that the staff were very caring.

Is the service responsive?

People's health and care needs were addressed promptly and referrals made to relevant health professionals as required.

People’s preferred routines were followed to promote personalised care and support.

Is the service well-led?

The home has been without a registered manager since January 2014. The acting manager advised us that she was in the process of applying for registration.

Staff told us that they received the support needed to undertake their job and told us that the acting manager was approachable and available to them when needed.

We inspected 35 Hill Top View on a planned unannounced inspection which meant the service did not know we were coming. 33 Hill Top View is also registered within 35 Hill Top View. We spoke with people who used the service, their relatives, staff and the provider and new manager during the inspection. There were four people using the service at the time of our inspection, two people were residing in 33 Hill Top View and two at 35 Hill Top View.

In this report the name of a registered manager appears. They were not in post and not managing the regulatory activities at this service at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The provider told us that recruitment to the manager post was underway.

We found that people who used the service were supported to consent to their care, treatment and support.

We saw that people’s care and welfare needs were being met. A relative told us: “I’ve got a good relationship with the home, I’m happy with the care the girls give”.

We saw that the service had systems in place to manage people’s medication safely.

Staff told us and we saw that they were supported to fulfil their role effectively.

We saw that the service had a complaints procedure and representatives of people who used the service knew how to make a complaint.

When we visited 33 and 35 Hill Top View we found that there were two people living in each house. There were two men living at number 33 and two women lived at number 35. Due to the complex needs of the people that lived in both houses we were unable to get their verbal opinions about their day to day lives. To help us understand if people were happy, comfortable and relaxed in their environment we observed their care and looked at the interaction between them and care staff.

We were able to read the diaries belonging to two people. The daily entries in the diaries were written with the support of the person’s care worker. The information in the diaries provided us with details of how people spent their day to day lives. For example we read about the activities people had taken part in.

We found that staff understood people’s individual and personal needs. Staff showed that they knew how people communicated their needs. We saw that care staff treated people kindly and respectfully.

We read documents that showed that the provider regularly audited the service. These included questionnaires sent out annually to the families or representatives of people who used the service. We saw that family members made positive comments about the service. One person commented, “The care ‘X’ is getting is very good”. Another person said “’Y’ seems happy and settled with life at 35 Hill Top View”.