We inspected this service on 8 February 2017. This was an unannounced inspection. At our previous inspection in January 2015, we found that the service met the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service is registered to provide accommodation and personal care for up to six people. People who use the service have a learning disability and or a mental health condition. At the time of our inspection six people were using 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 and associated Regulations about how the service is run.

Staff understood how to keep people safe and people were involved in the assessment and management of risks to their health, safety and wellbeing. People’s medicines were managed safely.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse. Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals as required.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 were followed. At the time of our inspection, no one was being restricted under the Deprivation of Liberty Safeguards (DoLS). However, staff knew how to apply for a DoLS authorisation if this was required.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People were treated with care, kindness and respect and staff promoted people’s independence and right to privacy.

People were supported and enabled to make choices about their care and the choices people made were respected by the staff.

People were involved in the assessment and review of their care and staff supported people to access the community and participate in activities that met their individual preferences.

Staff sought and listened to people’s views about the care and action was taken to make improvements to care. People understood how to complain about their care and a suitable complaints procedure was in place.

People and staff told us that the registered manager was supportive and approachable. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

The registered manager understood the requirements of their registration with us and they notified us of reportable incidents as required.

We inspected this service on 30 January 2015. This was an unannounced inspection.

The service was registered to provide accommodation and personal care for up to six people. People who use the service have a learning disability and/or a mental health needs.

At the time of our inspection six people were using 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 and associated Regulations about how the service is run. A home manager was also in post. The registered manager told us that the home manager was applying to register with us to take on the registered manager role at the service.

People’s safety was maintained in a manner that promoted and respected their right to independence. Staff understood how to keep people safe and they helped people to understand risks. Medicines were managed safely by staff who were skilled to administer medicines.

There were sufficient numbers of suitable staff to meet people’s needs and keep people safe. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. Staff supported people to make decisions about their care by helping people to understand the information they needed to make informed decisions.

Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People could access suitable amounts of food and drink and specialist diets such as diabetes were catered for.

People’s health and wellbeing needs were monitored and people were supported to attend both urgent and routine health appointments as required.

People were involved in the assessment and review of their care and staff supported and encouraged people to access the community and maintain relationships with their families and friends.

Staff sought and listened to people’s views about the care and action was taken to make improvements to care as a result of people’s views and experiences. People understood how to complain about their care and we saw that complaints were managed in accordance with the provider’s complaints procedure.

There was a positive atmosphere within the home and the managers and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us and they and the provider kept up to date with changes in health and social care regulation.

We carried out this unannounced inspection to check that the service was compliant with the regulations we inspect against, where non-compliance was identified at the last inspection we carried out. This inspection focused on these outcome areas only.

People we spoke with told us. "I've been happy since I've been here".

We saw that people had been involved in making decisions about their care and welfare and saw that records reflected the stated assessed needs of people.

We saw that the environment met people's needs and because of this, they were able to exercise their independence within the home.

At the time of the inspection we saw that staffing levels were responsive to the needs of people who used the service to ensure that their care and social needs could be met.

We looked at a sample of two peoples care records, to determine if people had been involved in decisions affecting them. We were not able to evidence from records if people had been included in care planning and reviews of their care.

We saw that people had plans of care in place detailing their needs, the plans were based upon their assessment of need. We saw that one person's personal care needs, privacy and dignity had been compromised because of the lack of suitable facilities.

We looked at staffing levels to determine if they were suitable to meet peoples needs. We noted that insufficient staffing levels were provided at times.

People we spoke with told us that felt able to raise concerns with staff if they needed to and any complaints would be listened to. One person told us, "I really feel settled here, the staff have been great and I'm not worried about things".

Information we hold about the home showed that we hadn't visit the service for some time. We needed to undertake a monitoring visit in order to update our records and to establish that people's needs were being safely met. Prior to our visit to the home we attended a safeguarding meeting, convened following concerns about the welfare and safety of people at the home, these matters had been reported by the manager of the home. Concerns were raised at this meeting re staffing levels.

Also prior to this visit we spoke to other agencies who may have an interest in the home and people living there. This included fire safety officers, the local authority quality monitoring officer and social workers, the environmental health officer and Local Involvement Networks (LINks). LINks are groups of individual members of the public and local voluntary and community groups who work together to improve health and social care services. To do this they gather the views of local people. No concerns were identified by any of these agencies.

People who used the service were able to speak freely to staff and there was a relaxed atmosphere. Staff had developed good relationships with people who told us that they knew who their key staff were, and talked to them about the things they wanted to do.

Staff had a good knowledge of the care needs of people using the service. People felt they were listened to and staff acted on what they said if they raised any concerns. They were confident their issues would be addressed. One person said, "I know staff will help me if I need help."

An expert by experience accompanied us for this review. Our experts by experience are people of all ages, with different experiences, from diverse cultural backgrounds who have used a range of care services. They talked to the people who used the service. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found and details were included in this report.

The manager completed her own very detailed assessment of how the service complies with the outcomes of the Essential Standards of Quality and Safety and provided a copy of this during our visit. We have included elements from it the main body of our report.

We saw during the review that people had detailed care records and risk assessments that had been subject to review, but observed that they were not always included in decisions that affected them and don't always have access to meaningful activity in their home or in the local community.

We observed that people were supported to access community health services, and received support from the home to follow health professional guidance, to keep them healthy.

We confirmed from discussion that staff were aware of the procedures and guidance agreed locally, to protect vulnerable people from harm.

We saw that staffing levels were not sufficient to ensure that people's individual needs could be met.