This unannounced inspection took place on 12 June 2018. At our last inspection in May 2016 the service was rated Good. At this inspection we found the service remained Good.

Clandon House provides accommodation and personal care for up to three people. At the time of our inspection there were three people living at the service.

The service has a registered manager. 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 and associated Regulations about how the service is run.

At this inspection, we found robust processes were not in place to ensure people's personal allowances were managed appropriately. The recording of people's personal expenses and the overall management of personal allowances were not secure and open to abuse.

People received care and support based on their assessed needs, care plans and risk assessments.

Staff knew about safeguarding and protecting people from harm. The premises were clean and infection control practices were evident throughout the service.

People received their medicines as prescribed by their doctors. Staff were trained and experienced in the management and administration of medicines. They were well supported, supervised and had access to training related to their roles.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and people’s capacity to make decisions was assessed when required.

The staff recruitment process enabled the service to ensure there were suitable and enough staff to support people.

People's diversity and preferences were met by staff. The service provided meals that reflected people’s preferences. People were also supported to access healthcare and community facilities.

The management was open to new ideas and was willing to work with people, families, and health and social care professionals.

This unannounced inspection took place on 20 May 2016. The service was last inspected in September 2014 and at that time was meeting the regulations we looked at.

Clandon House is a three bed service providing support and accommodation to people who need support to maintain their mental health. It is a large house in a residential area close to public transport and other services. The house does not have any special adaptations but the ground floor is accessible for people with mobility difficulties. People lived in a safe environment which was suitable for their needs.

The service has a registered manager. 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 and associated Regulations about how the service is run.

People were safe at the service. They were supported by caring staff who treated them with respect. Systems were in place to minimise risk and to ensure that people were supported as safely as possible.

People received their prescribed medicines safely and appropriately. Medicines were administered by staff who were trained and assessed as being competent to do this.

People were supported by staff who had the necessary skills, knowledge and training to meet their assessed needs, preferences and choices and to provide an effective and responsive service.

The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed both in terms of their physical and mental health needs. A health and social care practitioner told us that this was an excellent service and that staff managed people’s very complex needs well.

People were protected by the provider’s recruitment process which ensured that staff were suitable to work with people who need support.

People were happy with the food provided and this met their cultural needs. They were encouraged to eat a healthy diet.

People were involved in developing their care plans and in agreeing how they should be supported. They were supported to make choices about their care. Systems were in place to ensure that their human rights were protected and that they were not unlawfully deprived of their liberty.

The registered manager and the provider monitored the quality of service provided to ensure that people received a safe and effective service that met their needs. A health and social care practitioner told us that the service “wants to do things properly.”

A single inspector carried out this inspection. We considered all the evidence we had 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 effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

We spent time with people who used the service and observed how they were supported by the staff. We saw that staff treated people with respect and dignity. A person who used the service told us, “Staff are respectful. If I had a concern the manager would listen and do something about it.”

Systems for the administration of medicines had improved and staff had received medicines administration training. People were now protected from the risks associated with medicines.

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). When there were concerns about a person’s ability to make a decision affecting their safety and welfare a mental capacity assessment had been carried out and a DoLS put in place. This kept people safe and protected their rights.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Their care needs were assessed and plans of care developed from these. Staff told us about people's individual and assessed needs and of the strategies that were in place to meet these effectively. A consultant psychiatrist told us that the service had managed complex and challenging difficulties effectively.

Is the service caring?

We saw that staff supported people in a respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do. One person who used the service said, “They [staff] help and are supportive. They give good moral support.” A consultant psychiatrist told us, “They provide a high level of support to patients and appear compassionate and caring in their attitude.”

Is the service responsive?

Care staff were able to tell us about people’s needs and how they supported and cared for them. The service was responsive to people’s changing needs. For example staff were able to tell us about how they recognised that a person’s mental health was deteriorating and the actions that they took when this occurred. A member of staff said, “We are making progress with X. We had a big meeting and changed how we worked with them.”

Is the service well led?

The service had a registered manager in place. Staff we spoke with felt that they received the support and guidance needed to carry out their duties and to meet people’s needs. A consultant psychiatrist told us that the home was well managed and that in his team’s opinion they were outstanding.

When we last inspected this service in October 2013 we identified areas of concern regarding record keeping, medication and care planning. We carried out this inspection to check if improvements had been made. We found that overall improvements had been made to the service, although there were still some issues that needed to be addressed.

We found that care plans and risk assessments had been improved and that they now set out how to meet people's needs. However, not all risks were covered by risk assessments. The service had implemented a policy for the recruitment of staff since the previous inspection to help ensure that staff were suitably skilled and experienced to carry out their roles. Records were stored securely, although not all records were accurate and up to date.

We fund that since the previous inspection the service had implemented systems to check the quantities of medication held in stock. However, we found that the amounts of medication recorded as being in stock did not always match the amounts that were actually held. We also found that staff had not undertaken any recent training about the administration of medication.

People we spoke with told us the service was meeting their needs. Comments included "they help me with getting up. They are efficient" and "the one to one communication with me is excellent. I can talk about my problems." We found that care plans and risk assessments were in place for people. However, risk assessments only identified risks, they did not provide any guidance on how to manage or reduce the risks.

We found medications were stored securely. However, the service did not have clear and comprehensive records relating to medications. We found the service had not carried out robust recruitment and selection procedures when recruiting care staff. The service had a complaints procedure in place and people told us they were aware of whom they could complain to. One person said "I would tell the staff." We found that records were stored securely but that the service did not have all up to date records required.

We spoke to the two people living at this home. They both said they ‘’Like living here’’ and can choose how they wish to spend their days. There are a number of opportunities available to access events and activities in the local community which they sometimes attend.

We reviewed each care plan and found them to be individualised person centred. These care plans were developed with the person and their families.

The home is staffed by three registered nurses two of which are owner/managers. Staff subscribe to continued educational opportunities in order that the care remains safe, supportive and effective.

The relative we spoke to say ‘’The staff are excellent’’ and ‘’We are very happy with the care provided’’.

There are appropriate safeguarding and whistle blowing policies in place. Relatives said they never had cause to complain but knew what the process was if they needed to.

We spoke to people who use the service and found that in general they were happy with the care provided by the home. People who use the service made positive comments about the service which included “I am alright here.”