This comprehensive inspection took place on 21 and 26 February 2018 and was unannounced.

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

St Andrews accommodates up to eight people with a mental health condition, in one large house over three floor house, in the London Borough of Lambeth.

The service had 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.

The service continued to develop and regularly review risk management plans to keep people safe. Risk management plans gave staff clear guidance on managing identified risks and minimising the risk of a breakdown in their mental health.

People continued to be protected against the risk of harm and avoidable abuse. Staff were aware of the providers safeguarding policy, how to escalate concerns and where appropriate whistleblow.

People received support from familiar staff that underwent rigorous checks to ensure their suitability for the role. Staffing levels were monitored to reflect people’s level of needs. Staff underwent training to effectively meet people’s needs, and received regular supervisions and annual appraisals to reflect and improve their working practices and the delivery of care.

Medicines were managed appropriately and regular audits carried out to quickly identify issues, so that the impact to people was minimal. Medicines were administered in line with the prescribing G.P.

The service had an embedded culture of ensuring people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff had sufficient knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People continued to receive care and support from staff that respected and embraced their differences. People were encouraged to recognise and celebrate their culture and beliefs as and when they desired.

People were provided with foods that met their dietary needs and requirements, in line with guidance from a dietician and other healthcare professionals. People who required specific dietary requirements were provided with this and encouraged to make healthy choices.

The service had devised in collaboration with people, their relatives and healthcare professionals, care plans that identified their needs and gave staff guidance on how to meet their needs. Care plans were reviewed regularly to reflect people’s changing needs.

The service supported people to engage in activities of their choice and that met their social needs. People were encouraged to attend day centres and other community based activities as well as in-house activities organised by the activities coordinators.

The service had an embedded culture of undertaking audits to drive improvements within the service. Audits that identified issues were actioned swiftly. The provider continued to seek people's views through regular meetings, quality assurance questions and consultations

This unannounced inspection took place 27 November 2015. The service provides care and accommodation for up to eight adults with mental health conditions. At the time of the inspection there were six people living at the home.

There was a registered manager responsible for the home and has been in post for 5 years. 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.

At the last inspection of the service took place on 3 April 2014 where we found the service met all the regulations we looked at.

People told us they felt safe in the service. Staff had been trained in safeguarding people from abuse and they demonstrated they understood how to safeguard the people they supported in line with their organisation procedure. Staff also knew how to whistle-blow if necessary.

There were sufficient numbers of staff on duty to meet people’s needs safely. Risks to people were assessed and managed appropriately to ensure that people’s health and well-being were protected. People received their medicines safely and medicines were managed in line with procedure.

Staff told us they were supported to do their jobs effectively. Staff received regular supervisions and feedback about their performance. The service worked effectively with other health and social care professionals including the community mental health team (CMHT). People were supported to attend their health appointments and to maintain good health.

People’s choices and decisions were respected. People agreed to their care and support before it was delivered. The service understood their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure people were not restricted of their freedom without following the law.

People had access to food and drink throughout the day and staff supported them to prepare food to meet their nutritional requirements.

Care records confirmed that people had been given the support and care they required to meet their needs. People’s individual care needs had been assessed and their support planned and delivered in accordance to their wishes. People’s needs and progress were reviewed regularly with the person and a professional to ensure it continues to meet their needs.

People were encouraged to follow interests and develop daily living skills. There were a range of activities which took place within and outside the home. People were encouraged to be as independent as possible. People told us that staff treated them with respect, kindness and dignity.

The service held regular meetings with people and staff to gather their views about the service provided and to consult with them about various matters. People knew how to make a complaint if they were unhappy with the service. The registered manager and provider regularly monitored and assessed the quality of service provided. There were no recommendations or actions from audit reports we looked at.

Our inspection team was made up of one inspector. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures are robust and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people will be safeguarded as required.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly.

A member of the management team was available on call in case of emergencies. Staff had received training to meet the needs of the people living at the home.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Areas of the support required for each person had been identified in care plans where required and records and our observations confirmed that this support was provided.

Is the service caring?

People were supported by kind and attentive staff. Our discussions with staff on duty and our observations of the care and support provided confirmed this. We saw that care workers showed patience and gave encouragement when supporting people.

Is the service responsive?

The staff responded quickly when people needed extra support from their health professionals. People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were unhappy and had been frequently surveyed for their views of the service. We saw that the provider used this feedback to improve the service. People can therefore be assured that their views are taken into consideration in regards to the running of the service.

Is the service well-led?

The service was well- led. The manager was registered and had been in post for many years. The provider visited the service often and followed up on any quality issues identified. The service worked well with other agencies and services to make sure people received their care in a joined up way.

People using the service were satisfied with their care. We spoke with three of the six people using the service. Their comments about the service at St Andrews were positive.

One person told us " I am very happy here. I enjoy having a cigarette in the garden. I like the staff. They are polite and not at all abusive. There are lots of meetings and activities to do. I enjoyed the recent day trip to the seaside".

Another person told us " The staff are nice. They help me wash my hair and have a bath".

We asked another person if they were happy at St Andrews and the person smiled broadly and gave us a 'thumbs up' sign that things were good. They told us they were very happy at St Andrews and enjoyed a good joke with the staff.

We found that staff responded to people’s requests for help and their changing needs. Staff were seen to be encouraging and supportive with a good understanding of people's preferences and routines.

People were being supported to maintain their physical and mental health and encouraged and supported to take part in activities in the community and at home. Staff encouraged people to be independent where possible.

We spoke with three of the seven people living at St Andrews when we visited. They told us that they were happy with the service and felt safe there.

We heard that staff were polite and provided people with the support they needed.

We heard of the regular opportunities for people to be involved in making decisions about their care and the running of the home.