What life is like for people using this service:

• The service provided exceptionally person-centred support to people and enabled them to live as full a life as possible through understanding, encouragement, positive behaviour support, and working effectively with guidelines from healthcare professionals. Changes in people’s needs were responded to immediately and staff went beyond the call of duty to ensure people had additional support. People were made to feel cared for and treated as valued individuals.

• The service supported people coming from different areas, for example from acute hospital services, to work through and manage their symptoms, become more independent and in some cases, go on to live independently. This was supported by a thorough pre-assessment process. The service worked closely with involved healthcare professionals to ensure people received holistic care which took into account all areas of their lives. This enhanced people’s health and wellbeing.

• Staff had access to a wide range of training which in turn supported them to meet people’s needs effectively. They sought advice from a wide range of healthcare professionals, and took initiative to support people according to their needs at the time. This included working with people to manage their symptoms with minimal negative impact wherever possible. Staff knew people extremely well, and what approaches were effective with them, which added to the effectiveness of the service.

• People were supported by a positive, proactive staff team who were accountable for their actions and knew what was expected of them. The ethos and values of the service was evident throughout the home. Staff supported people with a wide range of activities, hobbies and interests, and were there to listen to people when they needed. People had privacy and their own space, which staff respected.

• There was exceptionally good leadership in place, and the registered manager worked closely with staff and was always visible, regularly talking with people living in the home and participating in supporting people. There were highly effective systems in place to gain feedback and ensure the service was running well. The registered manager sought and shared knowledge and ideas, which contributed to improving the service and ensuring up do date best practice was followed. People and staff feel respected, valued, highly supported and listened to.

• People were truly placed at the centre of the service and were consulted on every level. Respect for privacy and dignity, and supporting people to feel truly, ‘at home’, was at the heart of the provider's culture and values.

Rating at last inspection: Good (published 11 May 2016)

About the service:

Callum House is registered to accommodate ten people with a learning disability/mental health condition and this includes five self-contained units, in addition to five en-suite bedrooms in the main house. These units are intended as ‘transitional’ accommodation for people preparing to move on into independent living in the community. At the time of our inspection Callum House was fully occupied.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service has maintained it's rating of Good overall.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with people who used the service, looked at care records of four people in detail. We also spoke with three staff and the registered manager.

This is a summary of what we found:

Is the service safe?

When we arrived at the service the staff member asked to see our identification and asked us to sign in the visitor’s book. This meant that appropriate actions were taken to ensure that people who used the service were protected from others who did not have the right to access the home.

People told us that they felt safe and did not have any concerns. The staff we spoke with adequately explained the procedure they would follow if they suspected any form of abuse. The provider had safeguarding and whistle-blowing policies in place. These clearly explained the manger's and staff's responsibility in relation to safeguarding people and poor practice.

Before people went to live in Callum House, the manager undertook a detailed assessment with them that ensured they would be safe in the environment. The assessment also considered whether the provider's staffing arrangement was adequate enough to meet their needs. Care and support was planned and delivered in a way that intended to ensure people’s safety and welfare. This included effective risk assessments for people who left the home to pursue their own activities.

The manager and senior support worker had been trained and understood their obligation to apply the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions. No person living in Callum House had been assessed as needing this safeguard in place.

We saw that staff had been provided with training in safeguarding vulnerable adults, Mental Capacity Act (MCA) 2005 and Deprivations of Liberty Safeguards (DoLS). This meant that staff had been provided with the information they needed to ensure that people were safeguarded.

Care had been taken to make sure people were kept safe by only employing people who had the necessary pre-employment checks. This included a clear Criminal Records Bureau (CRB) check.

On the day of our inspection there were enough appropriately skilled and experienced staff on duty, and we saw that it was sufficient to meet people’s needs. Care staff were seen to be available when help was needed.

Systems were in place to ensure the manager and staff learnt from events such as accidents and incidents. We saw evidence that root cause analysis was undertaken on each event and actions put in place to help avoid a repeat occurrence. This reduced the risks to people.

There were effective procedures in place to manage and mitigate foreseeable emergencies. These included loss of premises due to fire or flood. We saw evidence that the provider's audit schedule was effective. This included regular auditing of the suitability and safety of the premises.

Is the service effective?

The people we spoke with told us that the care and support they received reflected their needs. People said that they could choose what they did during the day and that many of the activities were aimed at increasing their independence. We noted that there were five units as well as individual rooms at Callum House. The units were designed for people to stay in prior to moving into the community. There was clear evidence that the care and support given to people effectively achieved this. One person we spoke with told us that they had participated in workshops relating to food hygiene, health and safety and medicines management. They said that this helped them to prepare for their future.

People's needs were reviewed on a regular basis to determine if there were any changes in the way they needed to be cared for and supported. One of the support staff we spoke with said, “The care plans are tailored to people’s needs and change as people’s needs change”. The people we spoke with told us that they were involved in the process. They said that staff worked with them to increase their independence, and helped them to achieve their goals. This meant that care planning was effective as it took into account the changes in people's needs.

Is service caring?

We spoke with two people who used the service. Both of them told us that they were very happy living in Callum House. One person said, “It’s like living in a family here. The staff are kind and polite. I am very lucky to be living here”. Another person said, “It’s fantastic here. I had the opportunity to come here two years ago but didn’t. I should have done. It’s the best thing I have ever done. I get looked after really well”.

We saw that support staff interacted with people living in Callum House in a caring, respectful and professional manner. It was clear when observing the staff that people were treated with respect and encouraged to be involved in decisions about their care.

People's care and support plans were person centred and had been written with the person involved. The plans clearly documented how people's needs should be met and were reviewed and updated on a regular basis. People's daily records showed staff had effectively responded to people's individual needs in a caring and compassionate manner.

People who lived in Callum House were regularly asked their views about their care and support. We noted that all of their responses were positive. One person had written, “I am pleased with my room. The home looks lovely. (Member of staff) helps me tidy my room on a Thursday. We do a good job”.

It was evident that the staff knew the needs of the people they were caring for. Their interaction with people was positive. We observed staff sitting in the lounge speaking with people. There was a lot of laughter and people were seen to be enjoying the conversations that took place.

Is the service responsive?

We saw evidence that the care and support given to people responded to their individual needs. People were provided with opportunities to participate in activities that interested them. This included going to the gym, going shopping and gardening.

The people we spoke with told us that they were aiming to be able to live an independent life. We noted that people attended workshops relating to food hygiene, health and safety and medicines management. They said that this helped them to prepare for their future. This meant that the service was responding to the needs of people to help them have the necessary skills to be independent.

There was information around the home that explained how to make a complaint. Although there had not been any written complaints for four years, the manager told us that verbal complaints were appropriately logged and investigated as necessary. The people we spoke with who used the service knew how to raise a complaint but told us that they had nothing to complain about.

Is the service well-led?

The service had a registered manager responsible for the day to day management of it. People who used the service told us that the management was very good, and 'always about' to talk with. It was evident throughout our inspection that the manager was knowledgeable about each person living in the home. We observed positive interaction between the manager and the staff, and between the manager and people who used the service.

Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns. They told us that they felt well supported. There was an effective on-call system in place. This ensured that staff could contact someone more senior, at all times, if they had any concerns.

The service had quality assurance systems in place and records seen by us showed that any identified shortfalls had been addressed promptly.

The purpose of this inspection was to follow up on concerns identified during our previous inspection carried out in July 2013.

Following an action plan submitted by the provider, we returned to Callum House to check that improvements in relation to the accuracy of care planning had been made.

We found that they had.

We observed staff interacting with the people they were caring for and saw that staff knew the people they were caring for well. For example, they talked with the people about the individual activities they had planned for the day. Staff and people living at the service got on well together and we noted a happy, relaxed atmosphere.

We spoke with two members of staff about the service and they both told us that they felt everyone was cared for appropriately. They told us they had never had any concerns about the people and that they enjoyed their job. The staff members spoke with knowledge and understanding of people’s needs.

We reviewed the medication practices within the home and found these were managed in line with best practice.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

During our reviews of people's care records, we found concerns in relation to the appropriateness and accuracy of the information which was held about people.

We spoke with three people living at Callum House and they all expressed satisfaction with the service. One person told us “I am very happy here and am living my life how I want to” they further commented that “It’s ideal for me and there is nothing whatsoever to improve”. Another person told us that they “Couldn’t be happier”. The third person commented “There is nothing I want to see improved I am supported to live my life how I wish”.

We observed staff interacting with the people they were caring for and saw that staff knew the people they were caring for well. For example, they talked with the people about the activities they had been undertaking and their individual hobbies and plans for the rest of the day. Staff and people living at the service laughed and joked together and we noted a happy, relaxed atmosphere.

People told us that they knew who to contact if they had a compliant and that they felt the support provided met their needs.

We found that Callum House had in place effective procedures to ensure the home remained clean and that staff received appropriate support in order to carry out their roles.

People we spoke with told us that they liked living in Callum House. One person said they liked to call round and see their friends when they wanted to but that they could also shut their door if they didn't want to see or talk to anyone.

Another person told us that they had just been into the city shopping, which was something they often liked to do.

The Director told us that one person had officially retired but still liked to 'go to work' each day to help out on the local market.

One person told us that they liked doing their own cooking and showed us some cookery books, which they said they were learning from.

People told us that they were looked after well in Callum House and that they liked the staff.

People we spoke with told us that they knew what to do and who to talk to if they weren't happy or had a problem.

People also told us they felt safe and happy living in Callum House.

One person told us that they liked their room and that they tried to keep it tidy but the staff needed to help them sometimes.

People we spoke with told us that they liked the staff and got on well with them.

This inspection was carried out on 13 and 14 October 2015 and was unannounced.

Klair House Limited owns two adjacent locations (Klair House and Callum House) that provide care, support and accommodation for people with mental health conditions and/or learning difficulties. Callum House is registered to accommodate ten people and provides accommodation for five people in the main house and a further five people in self-contained units. These units are intended as “transitional” accommodation for people preparing to move on into independent living in the community. At the time of our inspection Callum House was fully occupied.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

People were safe and lived in a safe environment because the premises were well maintained and any safety issues were rectified promptly. The management and staff ensured that identified risks to people’s safety were recorded on an individual basis and all supporting staff had very good knowledge of how to support people safely and effectively.

Staff were supported by way of training that was specific and relevant for meeting people’s needs appropriately. Staff also received regular supervisions and appraisals to deliver care effectively. On occasions, people using the service also attended certain training sessions at the same time as the staff. There were consistently enough staff to support people and ensure their needs were met and appropriate recruitment checks were carried out before staff began working in the home. New members of staff completed a comprehensive induction and all staff were very well supported by the manager and the organisation as a whole.

Medication was managed and administered safely in the home and people received their medication as prescribed. Some people administered their own medication and there were effective systems in place to ensure people were able to do this safely.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Nobody living in Klair House was currently subject to DoLS.

All the staff in the service were very caring and frequently went above and beyond the call of duty to provide outstanding care. People using the service decided what meals they wanted on the menus and people living in the self-catering apartments were encouraged and supported to do their own food shopping, as well as prepare and cook their own meals. Friends and relatives visited regularly, were always welcome and sometimes joined their family members for meals. People were consistently treated with dignity and respect and were able to be as independent as possible. People lived very full and active lives and undertook pastimes, hobbies, education or employment of their choice.

The staff and management worked very closely with a wide network of healthcare professionals and prompt guidance was sought, with timely referrals made when any needs or concerns were identified. Staff always followed the instructions and guidance provided by these professionals, to ensure people’s ongoing health and wellbeing.

Comprehensive assessments were completed with people prior to their admission, to ensure their placement at the service would be appropriate for them and would meet their needs. People were fully involved in planning all aspects of their care and received care and support that was individual to their needs. Assessments of risk detailed what action was required or had been carried out to remove or minimise these risks for people.

People were able to voice their concerns or make a complaint if needed and had been made aware of the service’s complaints procedure. People were listened to, received appropriate responses and action was taken, as needed.

People were genuinely at the heart of this well run service and people’s needs were being met consistently and appropriately. The manager was very approachable and always open to discussion. Communication between the manager, other directors of the service and staff was also frequent and effective.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored and maintained. Audits were also carried out regularly by the manager, directors, staff and people using the service, in order to identify and address any areas that needed improvement.