This unannounced inspection took place on 15 October 2018. We had previously carried out an inspection on 18 and 22 February 2016 when we found the service had complied with all the regulations we reviewed.

Alfred House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Alfred House is located in Bury. Alfred House consists of two large adjoining terraced properties made into one. The property is close to Bury town centre. The home has good transport links into Bury and Manchester and there is a park, shops and other amenities close by.

Alfred House provides accommodation for up to ten people with mental health needs who require support with personal care. Ten people were living at Alfred House at the time of our inspection.

At our last inspection in February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a manager who was registered with us. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager of Alfred House was also the registered provider for the service.

People said staff treated them with kindness and compassion. Comments included, "The staff here are good to me, very supportive, and “I can rely on the staff to help me with everything that I need.”

Staff knew people's care needs, preferences, personal histories and backgrounds. People said staff protected their privacy and their dignity was respected. People were supported to be independent.

People received care from staff who were appropriately trained to effectively carry out their job roles. People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005). People's nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance. There were sufficient staff to care for people. Risks to people's safety were assessed and medicines were administered safely.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

We found that records were written in a positive and respectful way and provided guidance on how to support people.

Alfred House had arrangements in place to receive feedback from people that used the service, their relatives, external stakeholders and staff members about the services provided.

We found that records were sufficiently maintained and effective systems were in place to monitor the quality of the service.

This was an unannounced inspection, which took place on 18 and 22 February 2016. We had previously carried out an inspection on June 2014 when we found the service had complied with all the regulations we reviewed.

Alfred House provides accommodation for up to ten people with mental health needs who require support with personal care. Ten people were living at Alfred House at the time of our inspection.

Alfred House is two large adjoining terraced properties made into one. The property is close to Bury town centre. The home has good transport links into Bury and Manchester and there is a park, shops and other amenities close by.

The service had a manager who was registered with us. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager of Alfred House was also the registered provider for the service.

People we spoke with either told us they felt safe at the service. Staff knew what action they must take if they suspected or witnessed abuse or poor practice taking place.

Recruitment processes in the service were sufficiently robust to help ensure the protection of vulnerable people from the risks of unsuitable applicants being recruited.

We found staffing levels were appropriate to meet the needs of people who used the service. Additional staff were provided to support people to attend events such as health appointments and activities outside the home.

No outside agency staff were used by the home. This meant that people who used the service received consistent support from a staff team who knew them well.

There were systems in place to ensure the safe administration of medicines and effective control of infection practices. Staff had received the training they needed to support people safely and effectively.

People told us that they liked the food that was offered. One person told us, “It’s lovely.” Mealtimes were seen as a social occasion and people were encouraged to eat as a group for meals. People also enjoyed eating out at restaurants, pubs and at ‘The Welly’ a mental health café in the park nearby.

People had the access they needed to health and social care professionals.

The atmosphere in the service was relaxed and friendly and there was a good rapport between people who used the service and the staff supporting them.

People gave us examples of how staff had gone the ‘extra mile’ to support them to attend family events some distance away from the home.

We saw that most people were able to come and go from the home as they pleased. People enjoyed taking part in activities such as going to the theatre. Contact with family and friends was encouraged.

There had been no complaints made about the home. All the people we spoke with told us the registered manager and all the staff were approachable and would always listen and respond if they raised any concerns.

We saw that a quality assurance survey had been carried out in October 2015. Questionnaires had been sent out to a people who lived at the home, their relatives and health and social care professionals. All the respondents were happy with the care and support people received at Alfred House. A relative commented, “I am extremely satisfied with [person’s] care.”

Prior to our visit we contacted the local authority safeguarding and commissioning teams and also the local clinical commissioning group (CCG). They raised no concerns about the care and support people received from Alfred House.

People were supported in promoting their independence and community involvement. Most people were able to tell us what they were doing in their day to day lives. Seven people had recently been on holiday to a villa in Spain supported by three support workers. It was clear that everyone had a good time.

We saw a copy of the menu that showed the main meal of each day for the week. People told us that they could ask for an alternative if they did not like what was being offered. One person, with the encouragement of staff, had managed to put on weight to help promote better health. This person told us that the food was “very good”.

We looked around shared parts of the home and found all the areas that we saw to be clean and tidy. We saw that there were infection control measures in place. For example there was a separate sink for people to wash their hands in the kitchen as well as liquid soap and paper towels, which were also in the bathrooms.

We saw that the house was comfortable and homely and maintained to a good standard. One person said that they thought the house was “beautiful, especially the conservatory and the rear garden area”.

We saw that there were frequent and friendly interactions with the deputy managers on duty and the atmosphere was calm and relaxed. People said that “The staff here are very good” and “I can talk to them about how I am feeling.”

People we spoke with told us that they made their own decisions. They said that they could do what they wanted to when they wanted to as long as they let staff know where they were going and what time they would be back. Outside the home some people needed support from a member of staff to ensure that they were kept safe and also to help them achieve their personal goals.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Appropriate checks were undertaken before staff began work. Interactions between people living at the home and staff were seen to be relaxed and friendly.

People we spoke with told us that they could speak to the manager or a staff member if they had any problems or concerns. They said that they were confident that they would be taken seriously and they would do their best to sort the problem out.

Prior to our visit we contacted the local safeguarding and commissioning teams about the service. They informed us that they had no concerns about Alfred House.

We visited the home unannounced on 17 January 2012 at 1pm. When we arrived four people living at the home were watching the TV and chatting in the lounge and two people were in their rooms. Another person arrived home later. One staff member was on duty. They all made us feel very welcome.

We spoke with seven people of the people living at the home. Some people said that they had lived at the home for a long time. People told us that they would speak to a staff member or the registered manager if they had a problem, worry or a complaint about the home. A person said “it’s a safe place.” People said that they “got on well with the staff and knew them very well.”

People told us that they could do what they wanted when they wanted. They told us that they were involved in community based activities, decided what food went on the weekly menu and they kept in contact with their families and friends. A person told us that they had a dentist and an optician, situated nearby and that they had visited them recently. Another person said that staff were “good about my illness I’ve been really ill.” ”I am a lot better and am getting even better.”

We also asked the local adult care commissioning and safeguarding teams whether they had any concerns about Alfred House. They confirmed that at this time they had not.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service caring? Is the service effective? Is the service responsive to people’s needs? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with seven people who used the service, speaking with the owner and four staff members who supported them, observation and looking at records.

Is the service safe?

People who lived at the home we spoke with told us they felt safe at the home. They said they could approach the owner or any staff member at if they had any worries or concerns. They were confident they would be listened to and that the problem would be sorted out.

Some people had fluctuating capacity due to their mental health needs. We saw examples of best interest meetings being held where there had been a change in a person’s needs. This helped protect their rights.

We saw that where there were legal restrictions in place that these were kept under review by the relevant health care professionals

Is the service effective?

People told us that their individual needs, choices and preferences were acted upon and were respected by the staff supporting them.

The staff supporting people told us about what action had been taken when a person’s mental health needs had changed. Records we saw showed that urgent action had been taken to contact the appropriate health care professionals and this had led to an improvement in their health.

Is the service caring?

People we spoke with told us they were very happy living at the home and were complimentary about the care and support they received from the owner and the staff team who supported them.

The majority of the people who lived at the home had done so for a long time. The people we spoke with told us that the group got on well together most of the time.

Interactions between people and the staff supporting them were seen to be frequent, friendly and the atmosphere was calm and relaxed.

Is the service responsive to people’s needs?

Some people told us they maintained contact with their families and friends who were regular visitors to the home.

Everyone had the opportunity to go on holiday every year. People told us about the holiday they were preparing for, which included shopping for new clothes. Everyone we spoke with was looking forward to the holiday.

Is the service well-led?

The owner was also the manager of the home and was registered with us. The owner was a registered mental health nurse with thirty years’ experience of supporting people with mental health needs.

All the people we spoke with during our visit told us that the owner was very supportive and approachable and they were encouraged to speak with her about any concerns or worries they had.

Prior to our visit we contacted the local safeguarding, commissioning and quality assurance teams. They informed us they had no concerns about Alfred House.