About the service:

• 141 Vicarage Farm Road is part of Instant Care Solutions Limited. The service offers personal care for up to ten people with mental health needs. At the time of the inspection 10 people were using the service.

People’s experience of using this service:

• The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. There were also systems in place to identify and mitigate risks.

• Safe recruitment procedures were in place and there were enough staff to meet people’s needs.

• Medicines were managed and administered safely.

• People’s needs were assessed prior to moving to the home. Care and support were delivered and monitored in line with current guidance.

• Staff had up to date training, supervision and annual appraisals to develop the necessary skills to support people using the service.

• People were supported to maintain healthier lives and access healthcare services appropriately.

• The provider acted in accordance with the Mental Capacity Act 2005 (MCA).

• People told us staff were kind and respectful of their wishes and provided support in a respectful manner.

• People were involved in planning their care. Care plans contained details of how to meet people’s individual needs.

• There was a complaints procedure in place and the provider responded to complaints appropriately.

• The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.

• People using the service and staff reported the registered manager and team leader were available, listened and actively promoted an open and transparent work environment.

Rating at last inspection:

• The last comprehensive inspection was 26 June 2016. We rated the service ‘good’ overall.

Why we inspected:

• This was a planned inspection based on the previous rating.

Follow up:

• We will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly. If any concerning information is received, we may inspect sooner.

The inspection took place on 28 June 2016 and was unannounced. The last inspection took place on 15 May 2014 at which time the service was compliant with the regulations we checked.

141 Vicarage Farm Road is a care home registered to provide accommodation and care for up to eight adults with mental health needs. At the time of our inspection there were seven men living at the service.

The service had a registered manager who had been in post since 2011. 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 had safeguarding and whistleblowing procedures in place and staff had undertaken the appropriate training to safeguard people from abuse.

Risks to people had been assessed and identified. Plans were in place to minimise risk and keep people safe.

There were enough staff to meet people’s needs and the service followed safe recruitment procedures to ensure staff were suitable to work with people who used the service.

People’s medicines were managed in a safe way.

The staff had the training and support they needed to meet people’s needs effectively.

The service followed the principles of the Mental Capacity Act (2005) including that people should consent to their care and treatment.

People’s nutritional and dietary requirements were assessed and met.

People’s health care needs were met.

The staff were kind and caring.

People were treated with dignity and respect.

People had comprehensive care plans that reflected their choices and risk assessments that were regularly reviewed.

The service provided activities relevant to the people who used the service.

People felt able to make a complaint and these were investigated and responded to appropriately by the registered manager.

The service had systems to monitor the quality of the service delivered and ensure peoples’ needs were being met, which led to improvement of the service.

We spoke with three people using the service and two staff and the registered manager. At the time of the inspection there were seven people using the service.

The inspection was carried out by a single inspector during one day. The focus of the inspection was to answer five key questions;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed with the person using the service. Risk assessments related to the care and support being provided and were regularly reviewed to ensure people's needs were being met safely.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). If DoLS decisions needed to be made the staff were aware of the appropriate procedures to be followed. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards.

During our inspection the manager showed us a copy of the protection from abuse, bullying and harassment policy and procedure used at the service. Staff we spoke with were aware of the principles of safeguarding and how to report any concerns.

Is the service effective?

People's individual health and care needs were assessed and they were involved in the development of their care plans. The care plans identified specific support needs including personal hygiene, physical and mental health, cultural and religious beliefs and resettlement needs. The care plans and risk assessments were regularly reviewed and were up to date to ensure people received appropriate care and support.

People received effective support from staff who were trained and supported by the manager. We saw that staff completed a range of courses each year to meet the support needs of the people using the service.

Is the service caring?

People we spoke with said that they felt safe, cared for and were treated with respect by the staff. People said, "The staff are very nice and I get on really well with them all", "I like the way things are run here" and "The staff here are my friends".

Is the service responsive?

The manager told us that people received a copy of the complaints procedure as part of their welcome pack and the service user guide. They were also given a copy of the form used to report complaints as part of the guide. People we spoke with were aware of how to make a complaint and told us that if they were unhappy with anything they would speak to the manager.

People we spoke with told us they took part in a wide range of activities. One person we spoke with said "I like listening to the radio, going to the exercise class at the leisure centre and I am thinking about going to the drop in centre. The staff really help me do things I want". Participation in activities was recorded and this enabled staff to ensure that the activities being offered met the individual needs and wishes of the people using the service.

Is the service well led?

There were regular audits of the care plans and risk assessments carried out by the key workers and manager. Any actions identified were recorded on a check list and staff confirmed when they had been completed.

The service had a quality assurance system in place. We saw records that showed us that any identified issues were addressed promptly. As a result there was ongoing improvement in the quality of the service.

We visited the service because we had received information that the service might not be complying with essential standards of quality and safety. In particular concerns were raised about staff shouting at people who use the service and not allowing them to make their own decisions about what they did on a day to day basis.

At the time of our visit there were seven people using the service, one of whom was in hospital. We spoke with four people who were using the service, the manager and two other members of staff. People told us that staff treated them respectfully. One person said, "staff talk to me nicely" and another told us, "there's quite a bit of respect here." When asked about how they were supported to make decisions people told us, "I get to choose what to do, staff prompt me to do things like cooking and playing games but they don't tell me." Another person said, "I get to choose what I want to do."

We spoke with two members of staff. Both of them were able to demonstrate how they communicated with people in a way that was respectful and supported people to make decisions for themselves. For example, staff told us they tried to be approachable, listened to people and acted on any concerns that they mentioned. They said they spoke with people in a reassuring manner and supported them to make choices.

The manager told us that house meetings took place at regular intervals, and that people met with their key workers on an individual basis, so that they could express their views and share their experiences of the home. People were also given the opportunity to complete satisfaction surveys at regular intervals.

At the previous inspection we found areas of non compliance around care and welfare, the management of medicines and quality assessment and monitoring in the home. At this inspection we found that action had been taken and compliance achieved.

We spoke with the provider, the acting manager of the service, one other member of staff and three people who were using the service. People told us that they were involved in decision making about the care they received and the records we saw confirmed this.

People's needs were assessed and care plans developed so that staff knew what action to take to meet these. Identified risks had also been assessed to ensure that people were kept safe whilst balancing their right to make choices and maintain their independence.

We observed positive interactions between staff and the people using the service. One person said, "it's pretty good here" and another said, "I like cooking and the staff help me to make chicken and rice". Staff told us that they enabled people to engage in activities of their choice and we saw some people being supported to go to the cinema.

Systems were in place to ensure that medicines were stored, administered and disposed of safely and people were supported to self administer their medicines if it had been assessed that it was safe for them to do so.

Quality assurance monitoring systems had been introduced to ensure that people's needs were being met and to inform improvements to the service.

We spoke to the provider, three members of staff and five people who use the service. People told us staff treated them respectfully and that their privacy was respected. People also told us that they were given choices and involved in their care and people’s cultural and religious needs were respected.

There were appropriate numbers of experienced and skilled members of staff on duty to meet the needs of the people who used the service.

Medication was appropriately stored in the home. However, the records were not always fully completed and risk assessments had not been completed for those people self administering their medication.

People’s needs were not always adequately assessed recorded and reviewed and as a result people were at risk of not receiving appropriate and safe care.

There were not any systems in place to review and monitor the quality of the service. Therefore the provider could not be assured that safe and appropriate care was being provided.

People who use the service told us that staff treated them with respect and were available when they needed them. They said that they could have privacy when they wanted it and that they were able to make choices about how they spent their time.

People told us that they liked living at the home and gave positive feedback about their experiences since moving in. Relatives also gave good feedback about the home and the support their family members received.

People said that the home’s manager or a member of staff were approachable if they wanted to speak to someone about any aspect of the service. They said that their concerns had been addressed if they had ever been unhappy about something at the home.