We carried out an unannounced inspection on Coxley House on 2, 6 and 7 February 2017. Our last comprehensive inspection took place on 28 October 2015 where we found a breach of the regulation in relation to the safe management of medicines. The provider submitted an action plan telling us how they were going to make improvements to the service. During this inspection, we found that the provider had made improvements however, we identified a further concern in relation to the safe management of medicines and have made a recommendation in relation to this.

Coxley House provides accommodation and support for up to 13 people with mental health needs. The home comprises of 13 self-contained flats, and is situated in the London borough of Tower Hamlets close to community facilities. At the time of our inspection there were 10 people living in the home.

The service had 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 2008 and associated Regulations about how the service is run.

Safeguards were in place to protect people from abuse. Risks to people’s safety and welfare were identified and actions put in place to minimise these risks.

The provider checked the suitability of staff employed by adhering to their recruitment procedures. There was enough staff employed to ensure people received safe care. Staff received training that met the needs of the people they cared for in the home.

Safe medicines practices were not always followed in relation to recording medicines that were administered. All the staff had received medicines training with the exception of one member of staff.

People were involved in planning their menus and enjoyed the meals that were provided. They had the appropriate facilities to prepare and store their own foods. Staff supported people to attend their medical appointments.

The provider ensured lessons were learnt to improve the standards of the services provided. Prevention measures had been put in place to minimise future re-occurrences of incidents. The service was quality assured to meet the specific requirements of people’s care.

People’s rights were protected in accordance with the Mental Capacity Act 2005 (MCA) and staff were knowledgeable about the requirements of the Act and the Deprivation of Liberty Safeguards (DoLS).

Staff interacted with people in caring way and the importance of ensuring people’s dignity and privacy was a priority on the provider’s agenda. People’s relationships with their families and friends were valued.

People’s care plans captured their experiences and were reviewed when their needs changed. The provider sought different ways to engage people that took into account their diverse needs.

We have made one recommendation in relation to safe care and treatment.

This inspection took place on 28 October 2015 and was unannounced. The last inspection to this service was a follow up inspection on 29 August 2014 which looked at breaches from the previous inspection of 11 September 2013. We found that the provider was meeting the requirements of the regulations we inspected at the follow up inspection.

Coxley House is a registered care home for adults who have mental health needs run by the East Thames Housing Group. It comprises of 13 flats for people who use the service. There were six people using the service at the time of inspection.

There was a registered manager in place. 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.

Staff did not consistently follow safe practice when recording the medicines people were taking. We found gaps in one person’s chart where signatures were required. The registered manager acknowledged that staff had not followed their own good practice in this instance and said he would address the issue with the relevant staff and with the staff team as a whole. The medicines policy and procedure was not specific to this service and needed to be updated.

People who used the service said they felt safe and had no concerns about their safety. Staff completed training and knew how to keep people safe from abuse. Staff took appropriate action in response to incidents and clearly recorded these and the actions they took.

People who used the service had been settled over a long period of time. No-one who used the service had been admitted to hospital for treatment as a result of a relapse in their mental health. Risks to people were assessed and reviewed at least every three to six months. Staff took action in response to known risks to ensure people were safe. Staff carried out daily health and safety checks to ensure the safety of the premises.

There was a stable staff group who knew people well, the majority of whom had worked in the home over a long period, and were sufficient in skill-mix and numbers to meet people’s needs.

People who used the service said they liked the staff who supported them with their identified needs. Staff said they enjoyed working in the service.

Staff were supported by the provider and received training to ensure they were effectively able to carry out their roles and responsibilities. Staff had received training about the Mental Capacity Act 2005 (MCA) and demonstrated their knowledge about MCA issues.

The nutritional needs of people using the service were met according to their known needs and people said they were happy with the food. People were able to have their preferred ethnic foods.

People were supported to maintain good health, and had access to healthcare services and ongoing healthcare support.

People who used the service gave positive feedback about the staff and said they were kind, caring and treated them well. We observed good interactions between staff and people using the service. Relatives gave complimentary feedback about the staff and the service their family members received.

Staff helped to promote and encourage independent living skills and enable people to make their own decisions in relation to their own personal and domestic care, their daily leisure and social activities. Support plans included people’s likes and dislikes, which enabled staff to provide a more personalised service.

People received care that was tailored to and responsive to their needs. Personalised support plans identified each person’s needs and how these would be met. Needs were assessed prior to admission. Staff monitored changes and took action to maintain people’s health and welfare needs on an ongoing basis, reporting any issues or concerns to professionals, such as consultants and care-coordinators for specialist advice and support. People’s needs were regularly reviewed by multi-agency health and social care professionals.

A complaints procedure was in place, however people said they had no complaints. We saw that several compliments had been made by relatives and people who used the service.

People benefitted from using a service that was well managed and organised to ensure their needs were met. The registered manager understood their responsibilities and promoted a positive, open culture. Staff said they were happy with how the service was managed and how they were supported. There were systems in place for the service to check and deliver quality care on a daily basis. Management were committed to addressing areas where staff performance fell short of expected standards in order to maintain the safety and quality of the service. People’s views were sought about the quality of the service and records showed that people and their relatives were overall satisfied with the service.

We identified one breach of regulation in relation to the safe management of medicines.You can see what action we have told the provider to take at the back of this report.

During this inspection we spoke with three people who use the service and one relative, as well as the manager and two support workers. People told us they enjoyed living in their home and described the staff as "very caring" and "reliable and nice." One person said they were looking forward to a holiday abroad with their key worker and had chosen to return to the same destination as last year. On the morning of this inspection they had been out to a shopping centre with their key worker for holiday clothes. Another person said they liked having a studio flat as it made them feel independent but also safe in the knowledge that staff were always available. They told us, "I like it because I can have privacy and see my visitors in my flat. I go downstairs for my meals and sometimes for activities or a chat."

The service was non-compliant in two outcome areas at the previous inspection visit in September 2013. Outcome 10, Safety and suitability of premises, was non-compliant as the internal doors restricted the independence of people using zimmer frames. Outcome 14, Supporting workers, was non-compliant as not all staff had received current training for supporting people with behaviours that challenge and some staff had told us they did not feel appropriately supported to carry out their roles and responsibilities. Following the receipt of our inspection report the provider sent us an action plan, which informed us of how they would address the areas of non-compliance within an agreed timescale.

During this inspection we found that the service had made suitable alterations to the internal doors, which were now being safely used by the one person living at the service assessed to require a walking frame. Staff told us they felt well supported by the registered manager and pleased with the quality of their training. Records showed that all of the staff team had received recent training in how to support people with behaviours that challenge.

During our visit we spoke with three people living at Coxley House, the manager and four staff members. People spoke positively about the home and the care they received. There were a number of ways people living in the home were involved in decisions about the way that services were delivered.

People told us they were happy living in the home and liked the way they were involved in making choices about meals and activities. One person said, “I help to plan the menus once a week and I get to choose what I want to do.”

Staff told us about concerns they had about working with people with behaviour that challenges. Some staff said they felt unsupported by the management team when they had raised their concerns.

The premises had not been adapted to allow people living in the home to move around and be as independent as possible in activities of daily living.

The provider responded appropriately to any allegation of abuse. During our visit people did not raise any concerns about their safety.

We spoke with three people living at Coxley House. People spoke positively about the home and the care they received. There were a number of ways people living in the home were involved in decisions about the way that services were delivered.

People told us they felt safe living at the home and felt that staff were well trained and knowledgeable about mental health. One person said “they know what they are doing. It would be terrible here if they didn’t know how to do their jobs.”

Staff we spoke with received appropriate training and told us they were supported to carry out their role.

One person made comments about the level of support and assistance that they need each day. This person said that they are very independent but also know that staff are there if they need them. Another person told us about the number of years that they had lived at the home and that they could not recall ever having been worried about whether they are being supported. All of the people who spoke with us said that they feel safe with the people who care for them. No one reported having any concerns and two people said specifically that they would be able to talk to the manager if anything happened.