This inspection took place on 26 October 2017 and was unannounced. The service provides nursing care and accommodation for up to 16 people with mental health needs. There were 15 people living in the home at the time of this inspection.

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.

At our last inspection in October 2016 we rated the service overall Good. At that inspection we found one breach of Regulations 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found that notifications to the commission were not always made when required and in line with our legislation.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service remains with an overall rating of Good.

Why the service is rated Good.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, action plans were in place about how to manage these, monitor and review them. Medicines were managed safely and staff followed the services policy and procedures.

People were supported by the services recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

People moved into the service only when a full assessment had been completed and the registered manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty safeguards (DoLS) were understood by staff and, appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services and expert treatment or advice.

People were confident in their surroundings and with each other. The atmosphere was very pleasant and people were doing their own things to relax and pass the time of day. The home had a family atmosphere and homely feel. Staff were knowledgeable about everyone they supported and it was evident they had built up relationships based on trust and respect for each other. People experienced a lifestyle that met their individual expectations, capacity and preferences. There was an ethos of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People we

The inspection took place on 20 October 2016 and was unannounced. The previous inspection took place in June 2015 and no breaches of the regulations were found at this time. The service was rated as 'requires improvement' at the last inspection.

The service provides nursing care and accommodation for up to 16 people with mental health needs. At the time of our inspection, 15 people were living in the home although two were in hospital.

There was a registered manager in place at the home. 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.

People and their relatives told us they were happy with the care provided by the home. We received a number of positive comments about staff including "marvellous" and they "give very good care". Our observations showed that staff were kind and respectful.

Care was planned in a person centred manner that took account of people's individual preferences and wishes. For example, people's preferred daily routines were described and we saw from daily records that these preferences were supported by staff. People were able to take part in a range of activities if they wished to.

People in the home were safe. There were sufficient numbers of staff to ensure their needs were met. Staff vacancies were managed so that the impact on people was minimised through the use of regular bank and agency staff. Staff received training and supervision to support them in carrying out their roles effectively.

People's rights were protected in line with the Mental Capacity Act 2005 (MCA). Applications were made to the local authority in line with the Deprivation of Liberty Safeguards (DoLS) when a person needed to be deprived of their liberty in order to be cared for safely.

People were able to be independent and this was encouraged where it was safe for the individual. For example, people were supported to make meals. Some people were able to go out of the home independently. This had been assessed and measures were in place to ensure their safety when they did so.

There were systems in place to manage medicines. People's preferred ways of receiving their medicines were taken account of.

Staff reported they felt well supported by the registered manager and able to raise any issues or concerns. There were systems in place to monitor the quality of the service.

We found that notifications to the Commission weren't always made. We found example of DoLS authorisations that had been granted but that had not been notified to the Commission in line with legislation.

We found one breach of regulations during this inspection. You can see the action we took at the end of the full version of this report.

The inspection took place on 15 April 2015 and was unannounced. At our last inspection in January 2014, the service was meeting the regulations inspected.

8 Graeme Close is one of the services provided by Milestones Trust. The home provides accommodation and personal care for up to 16 people with mental health needs. At the time of our visit there were 15 people living there.

There was a registered manager for the service. 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.

People were not always treated with respect. We heard a member of staff referring to personal information about people in shared areas of the home. The comments made were repeated and compromised the dignity of people who lived at the home.

Supervision to support staff effectively perform their work was not up to date; it was not being carried out as frequently as the provider’s own supervision policy stated it should have been.

People could not be assured that their complaints would be handled properly. One complaint had been made over six months ago about the attitude of staff. This had not been fully investigated.

The registered manager’s system for auditing quality was not being used properly. This was evident because they had not identified and fully acted upon the shortfalls that we found on the day of our visit. There was a risk that the quality of care people received was not being properly checked to ensure it was safe and suitable for people.

People spoke positively about the staff and the way that they were supported by them with their particular mental health needs. People were treated in a kind and polite way by the staff in the home. Staff spent time to speak with people they were supporting and there were positive interactions between them. People were approached staff in a relaxed way when they wanted to talk with them.

People’s mental health needs were assessed and their care was planned and delivered in a way that properly met their needs.

People were supported to eat and drink enough to stay healthy. People were involved in planning menus and their views about meal choices were acted upon so that they were included in the options available.

There were systems in place to ensure that staff followed the Mental Capacity Act 2005 if people lacked capacity to make informed decisions in their daily lives. The provider had completed one application under the Deprivation of Liberty Safeguards (DoLS) for one person. This had been accepted and DoLS safeguards were in place for the person.

The staff on duty understood the complex mental health needs of the people who lived at the home. People were supported and encouraged to make choices about their care and in their lives.

People living at the home were treated with respect and dignity by staff. We saw that staff were relaxed and friendly with people. Some people were positive about living at the home but other people were not. People told us they could come and go as they chose and if they needed staff support to go out this was available.

There was a programme of activities available and people told us they could choose to attend or not. People’s care needs were assessed and care was delivered in line with their assessed needs.

People were protected from abuse and staff knew what action to take if abuse was suspected.

People were not always protected from the risk of infection due to poor infection control systems in the bathrooms.

There were sufficient numbers of staff at the home but on occasion the home could be short staffed.

The provider had an effective system in place to monitor the quality of the service.

We observed people being supported in a kind and gentle way. Staff were patient and spoke with people indicating an understanding of their needs when communication was limited. The four people we spoke with told us they felt “staff were kind”, “felt safe” and were given the food they liked. They spoke about their enjoyment of the activities and we observed people engaged in an art group and in music therapy. They were clearly enjoying the activity they were involved in. People said they would complain to staff if they were unhappy.

We met with one person, making their own lunch in the kitchen designated for people to use. They told us they found the home to be very friendly and liked living there. They described the staff as “very supportive and helpful” and said they were never pushed to do something they didn’t want to.

We spoke with six permanent staff and two bank staff. All of the staff were positive about working at the home. Some had only worked there for a short while but said they felt included. They told us they felt supported by senior staff and said they had good training opportunities.

We met with a visiting health professional who was complimentary about the way staff were receptive to advice given by them and cooperative, working for the benefit of the person they supported. They told us they saw staff being respectful towards the person.

A visitor said they were made to feel welcome and felt “staff do a good job”.

We found outcomes were met.

We spoke with three people about their experiences of living at the home. These individuals told us they could make decisions about their appearance, what to do each day and about what they ate each day.

People said they were accompanied on social and health care visits. They said there were activities that they could join in house and in the community.

We were told that specific members of staff were assigned to be more involved with the person and they were known as key workers. One person said that key workers did a “lot” but the others were not able to give examples of the role of their key workers. People said they had a care plan and signed them after they discussed their needs with the staff.

We were told by the people living at 8 Graeme Close that the staff were good and knew how to meet their needs. However, when we asked people if they felt safe, one person said no. We were told this was because there was a lot of agency staff working at the home. We were also told that the qualified nurses working at the home had left and this had made them anxious.

When we asked people about making complaints, we were told the name of the staff they would approach with complaints. One person said that when they told staff about a piece of broken furniture it was repaired.