Park View is a purpose built complex comprising of three individual bungalows located to the west of Hull city centre. The purpose built establishment consists of three bungalows, each of which have five single ground floor bedrooms, a lounge/dining room, one bathroom and two separate toilets. The three bungalows share a large garden but each has its own patio area.

The service is registered to provide care and accommodation for up to fifteen adults who have a learning disability, and who may also have physical needs. The home is owned and managed by Kingston Upon Hull City Council. At the time of our inspection there were 13 people using the service.

This unannounced inspection took place on 15 December 2016. The last inspection of the service took place on 5 and 13 May 2015 and we found the registered provider was non-compliant with the regulation relating to consent.

During this inspection we saw that the registered provider had taken action to ensure where people who were unable to give consent because they lacked the capacity to do so, the service was working within the principles of the Mental Capacity Act 2005 (MCA), which meant they had achieved compliance with the regulation.

The service 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.

Not all of the people who used the service were able to discuss their experiences of the service with us. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who were unable to speak with us.

It was clear from our observations that the people who used the service trusted the staff that supported them and positive relationships had been developed. Staff looked for visual cues from people’s body language, as well as listening to the tone and pitch of people’s verbalisation to understand what they were trying to communicate.

People who used the service were supported by caring and attentive staff who understood their individual needs and knew their preferences for how care and support should be delivered. Staff explained things in a way that people could understand. They made eye contact and treated people with dignity and respect.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns.

People were supported by staff who had completed relevant training and who were supported effectively to enable them to meet the assessed needs of people who used the service.

Staff understood how to gain consent from people who used the service. The principles of the Mental Capacity Act 2005 were followed when people were unable to make specific decisions themselves. People were supported to eat a healthy diet and drink sufficiently to meet their needs and were supported by a range of healthcare professionals to ensure their needs were met effectively.

The staff and registered manager were responsive to people’s changing needs. Reviews of people’s care took place on a regular basis. People and their appointed representative were involved in the initial and on-going planning of their care. Care plans had been developed which focused on supporting people to maintain and develop daily living skills whilst remaining safe. People took part in a range of activities and went to social events. The registered provider had a complaints policy in place that had been created in a format that made it accessible to the people who used th

We used a number of different methods to help us understand the experiences of people who used the service, because the majority of people who used the service had complex needs which meant they were not able to tell us their experiences.

We spoke with two people who used the service and they told us they liked living in the home and commented; "I like it", "Mam and dad come to see me", "I go out" and "Holidays to Butlins."

We also spoke with visiting relatives who could not speak highly enough about the care their family member received. They said, "We cannot fault it and the care is second to none", "I wouldn't want my daughter to be anywhere else" and "The manager and staff are fantastic."

We saw choice was offered to people and staff had developed communication methods to aid understanding. We also saw there was a varied menu and this was discussed where possible with the person or their advocate and any likes, dislikes and preferences where recorded within individual care files.

Throughout the inspection we observed staff interacting and engaging with people who used the service and this was carried out in a caring and inclusive way. Staff offered choices and spoke with people at their pace giving them time to respond. However, we noticed that the staffing levels required re-assessing to ensure people were not left alone without staff presence. Following the inspection we were told the staffing levels had been increased with immediate effect.

We used a number of different methods to help us understand the experiences of people who used the service, because the majority of people who used the service had complex needs which meant they were not able to tell us their experiences.

We saw that choice was offered to people by the use of pictorial information and this included the service user guide which gave clear information about what the person could expect when living in the home. We spoke with two people who lived in the home and they commented, “I like living at Park View”, “I go out and I go to the shops” and “I go to my brothers and I like that.”

We also saw there was a varied menu and this was discussed where possible with the person or their advocate and any likes, dislikes and preferences where recorded within individual care files. This ensured that people using the service made their own choices of what to eat.

We saw that care plans were designed in an easy read format, they were individualised and included activity planning. This showed the person themselves had been involved in their development.

We observed staff interacting and engaging with people who used the service and it was evident that positive relationships had been developed. Staff interacted in a caring and empathic way.

We spoke with two relatives of people who used the service and they told us they were very happy with the care and support received by their family member. The relatives commented, “I cannot fault it, it’s absolutely great”, “The staff are fantastic and we know our daughter is well cared for.”

When we spoke with relatives they confirmed that the home was always clean and fresh smelling.

Relatives also told us that the manager and staff were approachable, kind and very supportive.

Prior to our visit we spoke with the local authority contracting and commissioning department, who told us they had carried out a monitoring visit to the home and had no current concerns. We also spoke with the local safeguarding team who confirmed that there had been two recent referrals and these were being investigated.

Park View is a purpose built complex comprising of three individual bungalows located to the west of Hull city centre. The purpose built establishment; consists of three bungalows each of which have five single ground floor bedrooms, a lounge/dining room, one bathroom and two separate toilets. The three bungalows share a large garden but each has its own patio area. Each of the bungalows has recently undergone extensive refurbishment, including the provision of new kitchens and redecoration throughout. The service is registered to provide care and accommodation for up to fifteen adults who have a learning disability, and who may also have physical needs. The home is owned and managed by Kingston Upon Hull City Council.

The service was last inspected on 13 September 2014 and was meeting all the regulations assessed during the inspection. We undertook this inspection on 5 and 13 May 2015 and the inspection was unannounced which meant the registered provider did not know we would be visiting the service.

The people who used the service had complex needs and were not all able to tell us fully about their experiences. We used a Short Observational Framework for Inspection [SOFI] to help us understand the experiences of the people who used the service. SOFI is a way of observing care to help us understand the experiences of people who were unable to speak with us. We observed people being treated with dignity and respect and enjoying the interaction with staff. Staff knew how to communicate with people and involve them in how they were supported and cared for.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission [CQC]; they had been registered since October 2010. 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.

The registered manager completed quality checks on areas such as care plans and records. We found some of these had been effective in identifying gaps in information, but not in ensuring follow up action was completed in a timely manner. For example, in two records maintained for people who used the service, we found information was not current, risk assessments had not been reviewed within agreed timescales and checks on lifting equipment had not always been recorded. This meant that staff may not have had up to date guidance about how to meet these people’s needs and there was a risk of important care being missed.

Staffing levels had been increased since the last inspection and were structured to meet people’s individual needs. There was sufficient staff on duty. Staff received training, but there was not a formal supervision process in place which led to some staff not receiving supervision or support on a regular basis.

Recruitment practices were safe and relevant checks had been completed before staff commenced work.

People were able to access their GP, attend routine health checks and access other health care professionals as required.

The registered provider had policies and systems in place to manage risks, safeguard vulnerable people from abuse and for the safe handling of medicines. Medicines were ordered, stored administered and disposed of safely. People received their medicines as prescribed. Only staff who had received training were involved in the administration of medicine.

We found people’s health and nutritional needs were met and people were supported to plan their own preferred menus. They accessed professional advice and treatment from community services when required. We found people received care in a person-centred way with care plans describing people’s preferences for care and staff followed this guidance.

We observed positive staff interactions with the people they cared for. Privacy and dignity was respected and staff supported people to be independent and to make their own choices. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest. The recording of the assessments to check people’s capacity could be improved as there had been no mental capacity assessments completed for any of the people who used the service at the time of our inspection.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 deprivation of liberties Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding about these and when they should be applied. However, there had been no DoLS applications made on behalf of the people who used the service, even though they required constant supervision and were unable to leave the service independently.

These issues meant that the registered provider was not meeting the requirements of the law regarding the need to obtain lawful consent for the people who used the service. You can see what action we told the registered provider to take at the back of the full version of this report.

There was a complaints procedure and relatives told us they would feel able to make complaints on their relative’s behalf and these would be acted on.

People were supported to engage in a range of social activities in the home and within the local community.