This inspection took place on 6 and 7 February 2018 and was unannounced . The last inspection was a focused inspection on 23 December 2016. That inspection was to follow up if improvements had been made with the key questions of Safe and Effective from a comprehensive inspection conducted on 29 and 30 March 2016. We found during the focused inspection the service had made improvements and had an overall rating of Good.

Felstead Street 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.

Felstead Street provides accommodation and care for 24 people with mental health needs. At the time of our inspection 22 people were using the service. Look Ahead provided the support and an independent landlord owns the property.

The service did have a registered manager however the person had been temporarily transferred within the company. The team leader in the service was acting in the role as the 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.

Staff had a good understanding of the safeguarding procedures and followed protection plans to minimise the risk of harm to people. Staff had a good working relationship with the community policing team. Thorough recruitment checks were completed to assess the suitability of the staff employed. Medicines were stored and administered safely. The home environment was clean and the home was free of malodour.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people were able to choose what they ate and drank. People told us they enjoyed the food. The home was well decorated and adapted to meet the needs of the people.

People told us that they were well treated and the staff were caring. We found that support plans were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a wide variety of activities.

The provider had not explored people’s wishes for end of life care. We have made a recommendation about involving people in decisions about their end of life care.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the manager was approachable and open. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and house meetings.

We carried out an unannounced comprehensive inspection of this service on 29 and 30 March 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staffing and safe care and treatment. We undertook this focused inspection on the 23 December 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Felstead Street’ on our website at www.cqc.org.uk’

Felstead Street provides accommodation and care for 24 people with mental health needs. On the ground floor, the service provides long-term care for up to 15 people. The first floor provides rehabilitative support for up to nine people to help them prepare for independent living. The first floor is named the Felstead Street Independent Project (FSIP). This floor is overseen by Look Ahead and the community mental health team provide life skills workshops to help people learn independent living skills in the community. At the time of the inspection there were 23 people living in the service.

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.

During this inspection, we found that the provider had followed their plan which they had told us would be completed by October 2016 and legal requirements had been met.

There was enough staff to safely support people in the service. Processes were in place to monitor the staffing levels. One to one support was carried out monthly with people’s allocated support workers. Staff had received training that reflected the needs of people who used the service.

Safe food hygiene practices were implemented and maintained. Meetings were held with people and staff to keep them informed of the importance of best practice when handling food. Staff training in food safety and nutrition was up to date.

Systems were in place to effectively improve the quality of care delivered and sustain improvements.

We inspected Felstead Street on 29 and 30 March 2016, the inspection was unannounced. Our last inspection took place on 24 July 2013 and we found that the provider was meeting all of the regulations that we checked.

Felstead Street provides accommodation and care for 24 people with mental health needs. Look Ahead provide the support and an independent landlord owns the property. The building was divided into two separate services. On the ground floor the service provides long-term care for up to 16 people. The first floor provides rehabilitative support for up to eight people to help them prepare for independent living. The first floor was named the Felstead Street Independent Project (FSIP). This floor was overseen by Look Ahead and the community mental health team provided life skills workshops to help people learn independent living skills in the community.

At the time of the inspection there were 24 people living in the service. All the bedrooms had en suite bathrooms in addition to shared bathrooms. There was a large garden and comfortable lounge areas.

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.

All of the people we spoke to told us they felt safe in the service, however, there were not suitable numbers of staff employed to meet the needs of the people who used the service. This had an impact on the quality of care being provided.

Staff had a good understanding of the safeguarding procedures and followed protection plans to minimise the risk of harm to people. Staff had a good working relationship with the community policing team. Thorough recruitment checks were completed to assess the suitability of the staff employed.

Accidents and incidents were monitored closely through the use of an internal IT system. Prevention measures had been put in place to minimise future re-occurrences of incidents.

Regular testing and servicing of equipment was carried out. The building required repairs and these were reported to the property owner within the appropriate timescales.

People’s medicines were managed safely. Staff were knowledgeable regarding the administration, storage and disposal of medicines.

People told us they liked the food, however safe food hygiene practices were not always followed and maintained.

Menus reflected the diverse cultural needs and preferences of the people who used the service. People were supported to learn cooking skills before moving into their own homes in the community.

Staff had received sufficient training and were assisted with their ongoing learning and development needs. Training was reflective of the needs of the people who used the service.

Where people had been deprived of their liberty for their own safety the provider had taken appropriate steps to apply for authorisation from the local authority and to notify the Care Quality Commission (CQC). Where people did not have the capacity to make decisions for themselves, the provider had followed a best interests process in line with the Mental Capacity Act 2005 (MCA). Staff had completed training in these areas. People’s health care needs were regularly assessed and reviewed.

People told us staff were caring. Important relationships were encouraged and fostered between people; their relatives and friends. People who used the service were informed of their rights and responsibilities of living in the service. Staff encouraged people to take part in the activities that were important to them. People told us they felt motivated to do well.

People’s cultural identity was recognised and valued. Community meetings were held to keep people informed of changes to the service, and obtain their feedback on

People were treated with dignity and respect and were involved in making decisions about their care and support. People received support that promoted their independence and community involvement. People’s diverse individual, cultural and faith needs were met. Peoples' needs and risks were assessed and care was delivered in line with their individual care plan.

We spoke with five people who used the service who expressed positive comments about the care and support they received. One person who used the service told us, “staff treat me well. They are very nice. I’m comfortable and very well looked after.” Another said, “staff are very nice. Fabulous. Lovely.”

The service worked well with other professionals to effectively support people with their mental health needs. People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There were enough qualified, skilled and experienced staff to meet people’s needs. There was an effective complaints system available.

There were 24 people using the service. During the inspection, we spoke with four people and met several others.

The people we spoke with were pleased with the service although one person was still adjusting to moving into a residential service for the first time. One person described the service as "lovely". Another person said "I've got everything I need."

All the people we spoke with said they were involved in decisions about their care. People said that the staff respected their wishes, including when they changed their minds about things.

On the day we visited the service, we saw music therapy and cooking workshops taking place as scheduled. People told us they enjoyed the activities. One person described a recent day trip and said how much they had enjoyed this.

We asked people if anything about the service could be improved but people could not think of anything. One person said "can't do better."

We had positive comments from the residents who were able to communicate with us. One resident told us, “They look after me very well”. Another resident said, “There is nothing I don’t like about being here. The staff are all nice”.

Many of the residents were not able to communicate with us, so we spent more time observing the way they were being cared for and how the staff interacted with them. We found that staff interaction with residents was kind and respectful, and that residents were treated well.

A number of the residents were out taking part in community based activities when we visited the service, which they were supported to access by members of staff.