The inspection took place on 1 October 2018 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected Falmouth House in August 2017, at which time the service was rated requires improvement. At this inspection, the service was rated good.

Falmouth House 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.

Falmouth House accommodates a maximum of 10 people with a range of mental health needs. The service is split across three floors. Nursing care is not provided. There were eight people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was also responsible for the management of the provider’s other small service nearby and was supported by a deputy manager.

At the previous inspection we found care plans were not always person-centred and people’s aspirations and goals and achieving them were not always well planned. At this inspection we found improvements had been made in both regards.

There had been improvements in the fabric of the building since our last inspection, including some new flooring and redecoration to people’s rooms. The provider showed us the plans for further refurbishment of the premises on an ongoing basis. The service was generally clean although at the time of inspection the provider was awaiting the new cleaner to start, meaning care staff were currently covering cleaning duties.

The care service had been registered for a number of years, in a converted terraced house, and had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. We found however, despite the building not being in line with current best practice guidance, that people with learning disabilities using the service could live as ordinary a life as any citizen and were supported by staff to do so.

Medicines administration practices were safe, with staff trained appropriately and their competence assessed annually by the deputy manager. Staff demonstrated a good knowledge of people’s medicinal needs.

Risk assessments were in place and were specific to people’s individual needs and circumstances. Staff demonstrated a good working knowledge of these risks and described what factors to look out for that may indicate people becoming more at risk.

Staffing levels were appropriate to the needs of people who used the service and rotas were planned in advance.

All staff understood their safeguarding responsibilities and were committed to making sure people were safely cared for. People who used the service felt safe and secure.

Training and support was effective, with the induction giving new staff introductions to each person’s needs. Training ensured staff had the core skills required. Staff told us they were well supported.

People had a choice of meal options and had been encouraged to try healthy alternatives such as salad.

People were supported to have maximum choice and control of their lives in the least restrictive way possible. The policies and procedures in place supported this practice. Staff had received training in the Mental Capacity Act (2005) and consent was evident in care planning and through day to day interactions.

Care plans contained sufficient guidance for staff to ensure people’s needs were met and that visiting he

This inspection took place on 15 and 16 August 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Falmouth House provides care and accommodation for up to 10 people with enduring mental health needs. On the days of our inspection there were six 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 (CQC) 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 inspected the service in July 2015 and rated the service as good. At this inspection we rated the service as requires improvement.

We found, whilst the provider had made some improvements with regard to the maintenance of the building since the last inspection, areas of the home still required refurbishment to ensure they were easy to clean. The registered manager began the additional necessary refurbishments during our inspection and we saw they had a long-term refurbishment plan in place.

Some fire doors had been left open on the first day of the inspection and the registered manager agreed to remind staff and people who used the service of the importance of adhering to fire safety procedures.

The premises were otherwise maintained safely, with checks of emergency and firefighting systems in place. Contingency plans were in place for unexpected disruptions to the service, for example gas/electric supply failures.

People who used the service, relatives and external professionals told us they had no concerns about people’s safety.

No one using the service at the time of inspection was subject to a Deprivation of Liberty Safeguard (DoLS). The deputy manager displayed a good understanding of the Mental Capacity Act 2005 and best interest decision making, should people be unable to make decisions themselves in the future. People were supported to have levels of 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.

Individual choice and goal-planning was an area the service needed to improve. Some people achieved good health and wellbeing outcomes with the support of staff but these were not coherently planned. The registered manager agreed to review and implement the use of a recognised tool to help plan goals for people who used the service.

People who used the service were generally independent and accessed the community regularly, although we found the service could do more to motivate, encourage and support people to pursue activities meaningful to them.

Individual care plans contained risk assessments which were reviewed regularly. These contained specific strategies for staff to help people avoid risks.

Staff had received a range of training, including mandatory courses such as safeguarding, fire safety, infection control and food hygiene as well as specific training to meet people’s needs.

Staff supervisions and appraisals were in place, as well as regular staff meetings.

There was a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that the staff, deputy manager or registered manager and provider would respond and take action to support them. We saw complaints were treated seriously and responded to appropriately by the deputy manager.

We saw people were encouraged to choose healthy food options and some people helped in the kitchen regularly. People confirmed they had a choice of meals and were involved in menu planning.

Care plans had regard to people’s medical and personal needs, life histories, preferences and risks. Staff demonstrated a good knowledge of people’s needs.

We found t

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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 –

Is the service caring?

We saw that people’s needs were assessed and care delivered in line with their assessed needs. We saw that people had access to outside professionals such as doctors, dentists and opticians. This meant there were systems in place to help maintain their health and wellbeing. One person who used the service told us, "This place is very comfortable. We are well cared for, well fed, loved; I am very happy here.” Another person we spoke with said," I like living here. I have been here four years and I am very happy.”

We observed that staff responded in a caring and compassionate way to people’s needs and had a good understanding of people’s individual likes and dislikes. We saw care staff interacted well with people, were warm, supportive and spent individual time with them. We observed staff supported people to be as independent as possible. One person we spoke with told us, “The staff are OK; they should get a gold medal.”

Is the service responsive?

People’s needs were assessed and their care plans reviewed and revised in line with their changing needs. People had access to a range of outside services to ensure their health and wellbeing was maintained, including doctors, dentists and opticians.

We saw that people’s dietary needs were catered for. People were offered choices about meals and any special dietary requirements, such as for diabetes were provided. People we spoke with told us that the food was good and that they got a choice of meals. One person told us, “The food is A-OK; it’s really good food.” Another person told us, “The food is OK, you get what you want.”

We found that staff had a good understanding of people’s individual needs, likes and dislikes. We saw that people’s choices were noted. For example, people had indicated what food they did or did not like. Another person had been helped to register as an organ donor. We saw that one person did not have English as their first language. We saw from records that interpreters had been used to try and improve communications with the person.

Is the service safe?

People were cared for in an environment that was safe and well maintained. Audits of safety systems were in place. People had individual personal emergency evacuation plans which detailed the help they would need if there was a fire or similar event.

The building was clean and tidy and people had access to soap and towels. The kitchen and bathroom areas were regularly cleaned. Fridge and freezer temperatures were monitored to ensure food was kept in good condition.

However, we found that checks on the safety of equipment within the home were not formally undertaken meaning there was no system to ensure that electrical items in use had been assessed as being safe to use. We have asked the provider to tell us what they are going to do to ensure that proper checks are undertaken and recorded.

We spoke to the staff member on duty at the time of our inspection. She told us that having one staff member and the support of the deputy manager and manager during the day was sufficient. The manager told us, and records confirmed that a lone working policy was in place for the service.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that no applications have needed to be submitted and people’s care plans reflected that the issue of capacity had been assessed and considered. All people using the service were assessed as having the capacity to make decisions about their life. Staff within the home had received training on DoLS and the Mental Capacity Act 2005.

Is the service effective?

People told us they were happy with the care that had been delivered and their needs had been met. People who used the service told us there were enough staff and they were supportive. One person told us, “All the staff are really good.” Another person said, “I think the staff are alright.”

People’s nutritional needs were assessed and food and drink was supplied, taking into account individual needs and preferences. People’s weight was regularly monitored and where there was concern about weight additional advice was sought.

We noted there was a system in place for a rolling programme of regular audits and reviews of people’s care records and to update risk assessments.

We saw that any training undertaken was logged and a date highlighted when this training needed to be updated. This meant that there were systems in place, to ensure that staff had up to date knowledge and information in order to carry out their roles.

Is the service well led?

The home had a range of quality assurance systems in place to monitor the quality and consistency of care. We saw copies of documents regarding checks on medication, care records and nutrition.

We saw that accidents, complaints and safeguarding incidents were investigated and, where necessary, action taken to change or improve care delivery.

People who used the service confirmed that there were regular residents’ meetings and we saw copies of notes from these meetings.

Staff confirmed that there were regular staff meetings and we saw minutes from this meeting. Staff told us, and records confirmed that they had regular supervision with a senior member of staff and yearly appraisals.

We spoke with seven of the eight people living at the home to find out their opinions of the service. They all made positive comments about the care they received. One person said, “It’s wonderful here. I’ve never had as many friends.”

We found that before people received any care or treatment, they were asked for their consent and the provider acted in accordance with their wishes.

After speaking with people who used the service, as well as other health and social care professionals involved in people's care, we concluded people’s care and treatment was planned and delivered in line with their individual care plans.

People who used the service were satisfied with the standard of the accommodation. Their comments included, “I like it. I have a television to watch films on” and “It’s kept clean.” The provider ensured the premises were kept in a good state of repair and essential systems, such as electric and gas, were checked and maintained.

People were complimentary about the staff. Comments included, "The staff are wonderful." We concluded appropriate checks were undertaken before staff began work and effective recruitment and selection processes were in place.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We visited the home unannounced on 24 April 2012 to carry out a routine inspection. Nine people were living at the home at the time of our inspection. We meet six of them, as well as the manager and two care workers. We talked in private with three of the people who live here. They all made positive comments about living here. For instance, one person said, “it’s paradise here”. Another said the staff “treated him with respect” and were “very kind”.

This inspection took place on 21 and 23 July 2015 and was unannounced. A previous inspection undertaken in June 2014 found there were breaches of legal requirements in relation to premises and equipment. A review of evidence undertaken in September 2014 found the provider was compliant with legal requirements.

Falmouth House is one of two locations owned and run by Albany Care Homes Limited and is situated in Whitley Bay. It provides accommodation for up to ten people with enduring mental health issues, who require assistance with personal care and support. At the time of the inspection there were nine people living at the home.

The home had a registered manager who had been registered since March 2011. 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 told us they felt safe living at the home and said staff treated them well. Staff had a good understanding of safeguarding issues and said they would report any concerns to the registered manager or deputy manager. We found some issues with the premises. Some fire doors did not fully fit into the door recesses, meaning an effective seal was not made to prevent smoke and heat passing between fire compartments. Three fire doors had been propped open. We also found three windows where the appropriateness of window restrictors needed assessing, as they did not meet current health and safety guidance. Some areas of the home were in need of additional cleaning and the paint in one shower room was badly peeling from the wall. The home utilised material towels rather than paper towels and people told us these were not always clean. Where paper towels were available waste bins were not always available.

The registered manager said staffing levels were maintained to support the individual needs of people living at the home. Additional staff were rostered to support activities or individual appointments, such as general practitioner visits. Appropriate recruitment procedures and checks were in place to ensure staff employed at the home had the correct skills and experience. People living at the home were able to input into the recruitment of new staff. Medicines were stored safely and records were up to date. Two people were prescribed “as required” medicines, but did not have a care plan in place to detail the specific use of these medicines.

Staff told us they were able to access a range of training, although one person said the recent change to booklet based training was not always the best form of learning. Staff employed recently confirmed they had undertaken an induction process and shadowed experienced staff before fully taking on care duties. Staff told us they had access to regular supervision sessions and had an annual appraisal.

People told us they enjoyed the food provided at the home and were able to request items to be included on the menus. Some people actively participated in compiling the shopping list. We observed people had access to food and drink throughout the day.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager told us no one at the home was subject to any restriction under the DoLS guidelines. Staff understood how to support people to make choices. The registered manager told us there had been no recent best interests decision meetings.

We noted the decoration of the home was in need of refreshing in some areas. The registered manager confirmed refurbishment of the home and replacement of furniture was an ongoing process. Some hall/ landing areas and the main lounge area had recently been decorated. The outside of the property had recently been repainted.

People told us they were happy with the care provided. We observed staff treated people well and there were good relationships between staff and people living at the home. Staff had an understanding of people’s individual needs, likes and dislikes. People had access to general practitioners, dentists and a range of other health professionals to help maintain their wellbeing. People said they were treated with dignity and staff respected their individual preferences and decisions. They said they could spend time at the home as they wished.

People had individualised care plans that were detailed and addressed their identified needs. Staff told us people preferred to manage their own time rather than participate in organised activities, although some activities did take place in the evening. People told us about individual time out accompanied by staff members, which they had enjoyed. They said they would tell the staff or the registered manager if they had a complaint, but were happy with the care at the home. There had been no formal complaints in the last 12 months and informal complaints or concerns were dealt with appropriately

The registered manager showed us records confirming regular checks were carried out at the home. Questionnaires completed by people living at the home indicated a high level of satisfaction. Staff were positive about the management of the home and felt supported in their roles. Regular staff meetings took place to discuss the running of the service. People told us meetings took place and they could make suggestions about activities and menu choices. Records were broadly up to date and complete.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment.