What life is like for people using this service:

Leadership and management of the service had not ensured people always received a high-quality service. The home had not had a consistent manager until shortly before the inspection.

The provider did not have effective systems to plan how the risks people faced were going to be managed. Support plans were not always developed in a timely way and kept up to date. Information about the support people needed to manage their mental and physical health was not always included in the support plans.

Despite the shortfalls in risk management and support planning, staff demonstrated a good understanding of people’s needs and how to meet them.

People were confident that staff had the right skills and felt safe in the service. People felt staff treated them in ways that maintained their dignity and privacy.

Staff were well trained and there were enough of them to provide the support people needed. Staff were thoroughly checked before they worked at the service.

People were confident any complaints would be investigated and action taken to resolve them.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 27 August 2016).

About the service:

Herbert House is a care home for people with mental health needs. Eight people were living in the home at the time of the inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have told the provider they must improve the service.

Herbert House is a care home which provides accommodation and personal care for up to 15 people with mental health needs. At the time of our inspection 13 people were living at Herbert House.

This inspection took place on 14 July 2016 and was unannounced. We returned on 19 July 2016 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

People who use the service were positive about the support they received and praised the quality of the staff and management. Comments from people included, “I feel safe. The staff have been very good. They help you when you need it” and “Staff provide good support for me to be as independent as possible”.

People told us they felt safe when receiving care and were involved in developing and reviewing their support plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were supporting. People told us staff provided support with kindness and compassion. Health and social care professionals we received feedback from were positive about the support provided. Comments included, “Herbert House communicate concerns with the appropriate professionals/teams regarding the safety of individuals. They are proactive with keeping in touch with the individual when out independently and have demonstrated the ability to self-assess risk and promote individual’s safety”.

Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. People had regular group and individual meetings to provide feedback and there were robust complaints procedures.

The registered manager assessed and monitored the quality of care. The service encouraged feedback from people, which they used to make improvements.

One inspector visited the home and answered our five questions, is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 six people using the service, several staff, the manager and a visiting professional. We reviewed five care plans, four staff files and other relevant records.

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. They were detailed and ensured staff cared for people in a safe way. People told us they felt: ‘‘very safe’’ living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home had trained their staff with regard to DoLS and understood when a DoLS referral may be necessary. The type of care the home provided and the needs of the people who lived there meant that it had never been necessary to deprive people of their liberty.

We found that medication was stored and administered safely.

The home made sure that staff were well trained and supported to enable them to provide safe care to the people who lived there.

Systems were in place to make sure that the manager and staff continually monitored the quality and safety of care offered to people.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to the people who lived in the home, staff and visitors.

Effective?

People’s health and care needs were assessed with them, their consent was gained and they were helped to make informed decisions about their lifestyle and recovery plan. Care plans were detailed and clearly identified people’s needs and how they should be met. We saw that staff gave support as described in individual’s care plans.

One person said: ‘‘I really like living here and I feel so much better’’ and another told us: ‘‘I now believe I have a future’’.

Caring?

People were supported by caring and patient staff. We saw that care staff constantly offered advice and guidance in a positive way. They showed understanding and knowledge of the individual’s personality and needs.

We noted that care staff worked hard to provide support and guidance to people to help them to look after their physical and mental health. They worked closely with other professionals to support people’s recovery.

People's diversity, values and human rights were respected. Care plans were individualised and person –centred. We saw that people were treated with respect and dignity by the staff.

Responsive?

Care plans were reviewed regularly and amended, as necessary, to meet people’s current needs. We saw that people could amend their care plans whenever they wanted to and had weekly meetings with their key workers. People who lived in the home were involved in the decision making process about all aspects of their care.

The home had received one complaint in 2014. This had been investigated and properly dealt with. People told us they knew how to make complaints and one said: ‘‘I’m sure the manager or the staff would deal with my complaint quickly’’.

We saw that the provider investigated accidents, incidents and near misses and took any action required to minimise the risk of recurrence.

Well led?

Staff members told us that they were supported to do their job well. They said that they felt valued and their views were listened to.

The service had a variety of methods and procedures, including a formal quality assurance system, to monitor the quality of the care they were providing. We saw records which showed that the home identified shortfalls and the actions to be taken to address them. Additionally they asked for the views of the people who lived in the home and acted on them, as appropriate. As a result the quality of the service was being maintained or improved.

The people we met and talked with were positive about the staff and the way they were supported by them. One person told us, I like it here."

We reviewed three people's care plans so we could find out how people were supported with their care needs. We saw people had individual support and recovery plans which described their preferences and routines. We saw the plans were well maintained by the staff team. We asked people about the care and support that they received. People told us, "the staff help me if I ask them."

We asked one person if they thought there were enough staff on duty, including at weekends. They told us they thought there was sufficient staff. One person said, “I think there's enough staff on duty. There is always someone to talk to.”

We saw the premises were well maintained. The toilets were clean and hygienic and all communal areas were tidy and organised. One person told us, "we tidy our own rooms and the kitchen and lounge. the staff help us but we all take turns."

People who used the service were overall positive about the care they received at the home. One person told us "I am quite independent but I know the staff are there when I need them. They always ask me my opinion about things and we decide together." The care files contained forms people could sign to confirm consent for staff to share information with the doctor.

We reviewed three people's care plans so we could find out how people gave consent for their care. We saw people signed their support and recovery plans to show they knew about and agreed to the content. We saw the care files contained signed consent forms for the staff to manage people’s money. There were also forms for people to give consent about aspects of their medication.

A staff member told us “we change people's plans when their needs change. Some people self cater and self medicate. Once we feel they are ready they move to independent living.”

We saw staff members supported people in a thoughtful and considerate way. They were able to convey to us a good understanding of the needs of people who used the service.

People who used the service told us the staff dealt appropriately with any complaint they had. They said that the views of both people who used the service and staff were listened to, and valued.