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Inspection carried out on 6 September 2019

During a routine inspection

About the service

Cathedral View is a care home that provides respite and short break stays for up to eight people who have a learning disability. At the time of our inspection two people were staying at the service. The ground floor single storey service is divided into two separate spaces, each that accommodates up to four people

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People told us they felt safe whilst staying at the service. People were protected from the risks of harm, abuse and discrimination. Staff knew what their responsibilities were in relation to keeping people safe. We observed people to be relaxed around staff.

Staff were recruited following safe processes and received appropriate support and an induction into the service. Staff also received supervisions and attended regular team meetings.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were supported to maintain a healthy diet and had access to healthcare professionals should they need them.

There were quality assurance systems in place to monitor the running of the service and the quality of the service being delivered.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was Good (published 24 October 2018). At this inspection we found the provider had sustained this rating.

Why we inspected: This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cathedral View on our website at www.cqc.org.uk.

Follow up: We will continue to monitor information we receive about the service until we retu

Inspection carried out on 1 February 2017

During a routine inspection

The inspection took place on 1 February 2016 and was unannounced. At our last inspection on 6 February 2015, the service was found to be meeting the required standards in the areas we looked at. Cathedral View provides respite (short stays) accommodation for up to eight people. At the time of our inspection four people were staying at the home. The home is divided into two separate accommodations that accommodates up to four people.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

People and relatives were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

Complaints were recorded and responded to in line with the service policy.

People, relatives and staff were complimentary about the registered manager and how the home was run and operated.

Inspection carried out on 24 November 2014

During a routine inspection

This was an unannounced inspection carried out on the 24 November 2014. At the last inspection in June 2014 we found a breach of legal requirements as staff were not properly supported with training and competency assessed in the administration of insulin and percutaneous feeding (feeding via a tube inserted into the stomach). An action plan was received from the provider which stated they would meet the legal requirements by 20 August 2014. At this inspection we found that improvements had been made.

Cathedral View is a purpose built residential service which provides short stay, respite services for up to 8 people with a learning disability. There were 7 people staying at the service when we visited. Accommodation is provided across two houses with shared communal lounges and single bedrooms with en-suite bathrooms.

The service has 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.

The people we were able to speak with and their relatives told us they felt safe, that the staff were caring and respectful and that they met their needs. Our observations confirmed this. We saw that staff treated people with respect and were kind and compassionate towards them.

Relatives and staff told us they found the staff and management approachable and could speak to them if they were concerned about anything.

Medication was stored safely and administered correctly. The provider had systems in place to detect medication errors and took action promptly to rectify these.

People told us that staff knew them well and were aware of their individual needs, likes and dislikes. They were treated with dignity. They also told us that they were supported to express their choice, wishes and preferences.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. They understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

People had access to healthcare professionals when they became unwell. Relatives told us that the service kept them informed of any incidents or changes in their relative’s healthcare needs during their short stay for respite.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access leisure pursuits according to their expressed choice and with access to the local community.

The provider had a system in place for responding to people’s concerns and complaints. People told us they were confident that the manager and staff would respond and take action to support them.

There were systems in place to assess the quality and safety of the service provided. However, the provider should consider strengthening systems for evidencing their planning for improvement of the service.

Inspection carried out on 5 June 2014

During a routine inspection

This was a scheduled inspection. As part of this inspection we spoke with four people who used the service, four staff, and the registered manager. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

Staff received training in safeguarding vulnerable adults from abuse and the Mental Capacity Act (MCA) 2005. This included understanding their roles and responsibilities in relation to Deprivation of Liberty Safeguards (DoLS). The service had appropriate policies and procedures in place in relation to the MCA and DoLS. The manager told us that at the time of our inspection no applications had been submitted.

People�s health and care needs were assessed in consultation with either the person themselves, relatives or their advocate. People had a plan of care in place that reflected their healthcare needs in conjunction with support from health professionals, where required.

We were not assured that staff had been assessed as safe and competent to support people with the administration of their insulin and for people who required support with enteral feeding.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People's preferences, interests and choices had been recorded within person centred support plans. Care and support provided was in accordance with people's wishes ad their consent was obtained.

Is the service caring?

The interactions we observed by staff were kind, professional and caring. They responded appropriately and patiently to people�s requests and needs.

Is it responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action which ensured people were provided with the support they needed. This included seeking support and guidance from health care professionals such as dieticians, falls prevention specialists, doctor and community nurse.

People, who used the service, told us that they staff were always available when they needed them.

People were involved in participating in a range of activities both within the service and supported to access community based activities according to their individual need, wishes and choices.

Is the service well led?

The service had a registered manager responsible for the day to day management of the service. Staff told us they were well supported by the management and confident that any concerns would be addressed appropriately.

There was no formal process or management audit tool in place to support staff with the internal monitoring, assessing and reporting on the different aspects of the service. However, we saw that senior management had recognised this as a shortfall and plans were in place to rectify this.

Inspection carried out on 15 November 2013

During a routine inspection

We visited the service on 15 November 2013 to follow up on an outstanding compliance action made during an earlier inspection to the service on the 9 May 2013. Following the inspection the service supplied us with an action plan telling us what actions they were taking to become compliant and the date they would become compliant by.

During this inspection we did not speak with people using the service or staff providing the care. We examined medication records, care plans and looked for evidence of staff training and medication audits. We found the provider was meeting this standard but could not see evidence of how the provider was regularly monitoring medicines to ensure it was being stored, administered and recorded correctly.

Inspection carried out on 8, 9 May 2013

During a routine inspection

We spoke with the relatives of three people who were using the respite service. They all confirmed to us that they were satisfied with the level of care provided and that staff communicated well and were responsive to their relative's needs. One relative told us, "My relative is happy to use the service. It gives me peace of mind knowing that they are well looked after and safe." We used the Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help inspectors understand the experience of service users who could not talk with us. We saw that people using the service appeared to be relaxed and comfortable in the presence of staff. People were offered food choices and were encouraged to assist in the preparation of their meal where appropriate. Two people confirmed to us that staff were kind and helpful. Staff knew people's preferred communication methods and were able to understand what people wanted to tell them.

We found that the service was assessing and meeting people's care needs. Where people had specific medical or dietary needs, staff had been trained to the appropriate level. People's independence was supported and staff asked people about their preferences. There were potential risks identified with medication and there was scope to ensure that person specific medication care plans were in place for all people using the service. The provider had systems in place to monitor the safety and quality of its service.