This unannounced inspection took place on 21 April 2017. Deepdene House is a care home that provides care and support up to 20 people with mental health needs. At the time of the inspection there were 20 people using the service.

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.

We last carried out an unannounced focused inspection on 4 November 2014 and made a recommendation in relation to safe medicines management. We also found one breach in regulation relating to cleanliness and infection control.

At this inspection we found the service had made improvements around the safe management of medicines. People received their medicines in line with good practice and as prescribed. Records relating to the administration, recording and storage of medicines were up to date.

At this inspection we found the service had taken action to improve the cleanliness of communal bathrooms. The service had ensured hallways, stairs and landings were adequately cleaned to minimise the risk of infection.

People were protected against the risk of harm and abuse because staff were aware of the signs of abuse and how to report their concerns. Staff received safeguarding and whistleblowing training and told us they felt confident in raising their concerns and that these would be acted on. The service had devised risk assessments that gave staff clear guidance on how to manage and mitigate the risks safely.

The service employed sufficient numbers of suitable staff that had undergone criminal checks and other vetting procedures. The registered manager and staff confirmed that the rotas were flexible to ensure people could attend activities and health care appointments. Staff received training to ensure they met people’s needs. Staff reflected on their working practices through supervisions and appraisals.

People did not have their liberty restricted unlawfully. The registered manager and staff were aware of their responsibilities of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS authorisation requests were submitted by the service to the local authority when they required to place restrictions on people’s liberty.

People confirmed they were supported to access health care appointments when required. People’s health was monitored and maintained. The service ensured people had access to sufficient amounts of food and drink to meet their dietary requirements and preferences. The service encouraged people to maintain a healthy lifestyle. People spoke positively about the food provided.

Care plans were person centred and detailed people’s health, social and medical needs. Staff were aware of the importance of following the guidance set out in care plans and deliver care in a way people wanted. Care plans were reviewed regularly to reflect people’s changing needs.

People confirmed they were encouraged to make decisions about their care and told us staff respected their decisions. Staff treated people with dignity and respect and encouraged people to maintain their dignity. Staff were aware of the importance of confidentiality and the impact breaching confidentiality can have on people. The service maintained people’s records securely, with only those with authorisation having access to them.

People accessed both in-house and community based activities, that met their preferences and choices. Staff encouraged people to participate in activities and could identify how people may present if socially isolated. People knew how to raise concerns and complaints. People told us they would speak with staff, the registered manager or their relatives if they were dissatisfied with

Deepdene House provides personal care and accommodation for up to 20 people with mental health needs. At the time of our visit there were 17 people living in the home.

At our last inspection on 28 June 2013 the service was meeting the requirements inspected.

There is registered manager at the home. 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 living at the home told us they felt safe. Staff were knowledgeable in recognising signs of potential abuse and knew the action to take to keep people safe and follow reporting procedures.

We have recommended that the manager and staff explore guidance about the recording of giving medicines to people as we noted some omissions in relation to medicines given ‘as required’, but in other respect medicines were managed well.

Some areas of the building, specifically bathrooms and toilets, were not adequately clean and could have presented a risk of infection to people who lived and worked there. This meant there was a breach of the regulation relating to cleanliness and infection control. You can see what action we told the provider to take at the back of the full version of the report.

Staff were trained in topics which helped them to understand the needs of people living at Deepdene House and provide appropriate care. People received a co-ordinated service and staff liaised with health and social care professionals. Staff understood people’s needs relating to their mental health and physical health conditions such as diabetes and ensured that care addressed the range of people’s needs.

People told us the staff were caring and helpful and helped them with a range of things like shopping, applying for benefits and planning outings. Activities were available to people both in and out of the home. Cinema trips were arranged and those who wished to attend places of worship did so.

Specialist equipment was provided when appropriate, and adaptations were made to meet particular needs such as fitting handrails to steps in the garden, to make access safer for some people. Advice was sought to ensure individual needs were appropriately catered for.

The manager was open to suggestions for improvements to the service from people, staff and visiting professionals who found her approachable. For example people made suggestions to change the menu which were made. Appropriate action was taken in response to incidents with a view to preventing recurrence.

We found the provider involved people who used the services in the development of their individualised care plans and supported them to consent to care, as able. One person said that, "my keyworker helps me out during the day".

The provider protected people and their staff. There was evidence of individual risk assessments and safeguarding policies in place to protect people who use the services. People were supported to make complaints if required and staff provided people with feedback following an investigation into their complaint.

Records were managed appropriately and securely stored.

One person praised a member of staff. They told us "She's a great help to me. I can always talk to her when I'm feeling low. She helps me fill in forms and sorts out problems with my mobile phone".

Another person was preparing their own breakfast in the kitchen. They told us "The staff are pretty good here. They're helpful. They help me with my problems. Sometimes I just can't get myself together and motivate myself. I feel safe enough here though".

People engaged in activities of their choice. One person told us "I like making jam and I can do that here. I'm growing vegetables and flowers in the garden and at my allotment. I really enjoy that".

Another person said "I need the staff. They help me keep my room tidy. I like the television and I like the chicken dinners the best." And when we asked if they felt safe at Deepdene House they said "Yes".

Another person said "Everything's OK here. There are no problems. The meals are good and the staff are alright".

Visiting health professionals spoke positively about the support provided by staff. One told us "The staff communicate well with me. And they were well prepared when I visited Deepdene House to review the care of three people using the service. Keyworkers understand the needs of the people they are supporting".

People living in the home told us that they felt safe and that they were generally satisfied with life in the home.

Most people enjoy the meals but some think that their cultural needs could be better catered for.

People were concerned that there has been a frequent change of home managers and this has led to poor communication about concerns at times.

A health professional was concerned that the mental health team could be kept better informed.