Cromwell House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Cromwell House is a care home with nursing, which can accommodate up to 14 people between two on-site buildings, one being an independent living service. At the time of our inspection 13 people were using the service. These included people with mental health difficulties.

At our last inspection in January 2016 we rated the service as 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 on-going 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 inspection visit took place on 10 December 2018 and was unannounced.

There was a registered manager in post who was there at the time of the inspection. 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 continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to and follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to people. People received medicines as required.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People could speak openly with staff and understood how to make a complaint.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the registered manager. We were provided with information about the service where required.

Camino (Cromwell House) is registered to provide accommodation for up to 14 adults with long term mental illness who require accommodation and personal care. At the time of our inspection 13 people were using the service between two on-site buildings. One of the buildings offered a more independent living service, where people were able to do more things for themselves. Our inspection was unannounced and took place on 21January 2016. The service was last inspected on the 30 August 2013 where it met all of the standards.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were given appropriately.

People told us that they were kept safe.

We observed there were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs.

People told us that they were able to raise any concerns they had and felt confident they would be acted upon.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner and used a variety of communication methods to establish their consent and/or understanding.

People were supported to take sufficient food and drinks and their health needs were met.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision allowing staff to understand their roles and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and the provider gave the registered manager a high level of support.

Notifications were sent to us as required.

There were 12 people living at the home on the day of our visit, no one knew we would be visiting. We spoke to four people who lived at the home, two relatives, three staff, one visiting professional, and the manager.

People told us and we saw that that people's views were sought and acted upon. Staff spoken to was able to tell us about people's needs so that they received care in a way that they preferred. Both relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. One relative said ‘’I have seen X’s care plan and attended care reviews’’

All staff spoken to were able to tell us about people's needs and records seen confirmed the that staff were knowledgeable about the people they cared for. We saw positive interactions between staff and people that lived at the home. One person said, “I talk a lot to my keyworker and we are planning for my future.’’

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm. One person told us, ‘’Staff are friendly and helpful.’’ Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

Medicines were prescribed and given appropriately to the people who used the services.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

There were seven people living at the home on the day of our visit, no one knew we would be visiting. We spoke to three people who lived at the home, three relatives, three staff, and the manager.

The people who lived at the home had mental health care needs. People told us about their experiences, we looked at records and observed staff caring for them. Staff was able to tell us about people's needs so that they received care in a way that they preferred. Relatives told us they were kept informed about their relative's health so they felt involved in their care. One relative said ‘It’s a nice clean place and they seem to have everything in order.’’

We saw that systems were in place to keep people safe from harm. A relative told us ‘’Staff are friendly and helpful.’’ Staff received a range of training to support the people who lived in the home. There were systems in place to monitor how the home was run, to ensure people received a quality service.