Milton Residential Care Home is registered to provide accommodation and personal care for up to seven people with mental health support needs. At the time of our inspection the service was providing support to four people. Some people were required to adhere to the terms of their license agreement. Being released 'on licence' means that for the rest of their sentence the released person must adhere to certain conditions.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. People told us they felt safe living at the service.

The provider ensured that new staff completed an induction training programme which prepared them for their role. Training was completed in essential matters to ensure staff and people at the service were safe. Staff were supported through a supervision programme. Supervision is where staff meet one to one with their line manager to discuss their work and development.

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated an understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service. Staff described the registered manager as supportive. Comments from people confirmed they were happy with the service and the support received.

This inspection took place on 22 February 2015 and was unannounced. The previous inspection was carried out on 18 August 2013 and there had been no breaches of legal requirements at that time.

Milton Residential Care Home is registered to provide accommodation and personal for up to three people with mental health support needs.

A registered manager was in post at the time of inspection. 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.

At the time of our inspection there were two people living in the home and they told us they were happy with the service they received. Comments included: “this is the happiest place I have ever been. The staff are great and treats us well”.

Staff received training and understood their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. Within people’s support plans we found the service had acted in accordance with legal requirements when decisions had been made where people lacked capacity to make that decision themselves.

Staff had attended Deprivation of Liberty Safeguards training (DoLS). This is legislation to protect people who lack mental capacity and need to have their freedom restricted to keep them safe. No one living in the home was subject any DoLS authorisation.

We found the provider had systems in place that safeguarded people. One person we spoke with told us “It is safe here they make sure we are”. Staff we spoke with had a good understanding of what safeguarding processes to follow.

Staffing levels were sufficient on the day of our inspection and people told us there were sufficient staff to support them.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively. Training was provided and staff we spoke with were knowledgeable about people’s needs. One member of staff told us how they were being supported to undertake further development training that would enhance their role.

People were supported to manage their own medicines where possible. Safe procedures and a policy was in place to guide staff to manage people’s medicines safely.

People received and were involved in reviews of their care needs to ensure that staff had up to date information about how to meet their needs. The care reviews also ensured the support plans continued to effectively meet people’s needs. Care and support plans were individual and promoted people’s independence.

People’s records demonstrated their involvement in their support planning and decision making processes. One person we spoke with told us how they were involved and felt consulted at each stage. This person said “Yes I talk with [name] and I plan what I do and want but I’m lucky I can do a lot for myself”.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. A member of staff that we spoke with confirmed this.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. The registered manager undertook regular audits.

There were systems in place to obtain the views of people who used the service and their relatives and satisfaction surveys were used 2014 – 2015. This was provided to people, their relatives, staff and external professionals.

On the day of our inspection there were three people living at the home, and they were able to tell us what it was like to live there. People we spoke with told us they were happy with the service they received. Comments included; “staff are good here they always knock on my door and ask what I'm up to and if I want any help", "I went on holiday to Paignton and I get my own shopping".

Another person said "when I have to go to the doctors they come with me, they go out of their way to help me, I get the help I need and want".

Staff we spoke with were knowledgeable about the needs of people living in the home, and told us they had recently received excellent training in mental health, that was relevant to the needs of people they were supporting. On the day of our visit people appeared relaxed and engaged in their own environment.

People were observed in the kitchen area preparing a cooked meal, and staff supported them when required. Staff were observed engaging with people in a positive way, and were heard asking people what they were planning to do with the rest of their day.

A nurse who was visiting the home on the day of our inspection told us communication across the staff team was excellent and they felt the team had really supported a person since their discharge from hospital. Comments included; "the home is proactive in the support they give, it’s a great home", " they have done wonders with X on their motivation and engagement with others".

We spoke with people about living at the home and about the staff that provided their care. People told us they were able to make decisions about their daily lives and about their daily activities. They said that staff helped them with their independent living skills for example, budgeting, cleaning and cooking.

People told us that the staff were always polite and their rights was respected. They told us “staff never discuss other people in our presence; we have keys to the house, our bedrooms and our medication cabinets. “ Other examples about the way privacy and dignity were respected included “staff knock before they enter bedrooms” and “there are no set times for retiring or rising.”

We were told that key workers (the person's preferred member of staff to contact about their needs) were appointed and their role included accompanying people on shopping trips, going to the cinemas and supporting people on health care visits.

People at the home said they watched television during the day, participated in voluntary employment such as dog walking, attended college and joined clubs for example pigeon fancying.

When we asked about the staff, we were told that staff knew how to meet their needs.

We were told “I have a lovely room, it’s en suite and I have a big telly.”

People said they felt safe at the home.

At the time of our inspection there were three people living in the home. However, only one person was at home during our inspection. We were told the other two people were out engaged in their chosen community activity.

The person we spoke with told us it was ‘ok’ living at Milton residential home and proceeded to tell us how they were going to move out soon. Staff confirmed that the person is being supported by the Community Mental Health team (CMHT) to move into an independent living flat. People’s independence was being actively promoted.

Throughout our inspection we saw that staff engaged positively with people in a calm and relaxed manner. The person at home moved freely around their own environment and accessed the community independently.

Records that we viewed confirmed that people were actively involved with their support planning and setting of personal goals.

Staff told us “recruitment is a stringent process and took months”, “training is excellent”,” I wasn’t able to work alone until I was deemed competent which was good”, “we are small supportive team”. One member of staff also told us how they worked with people living in the home, to promote fitness and healthy eating.

The provider had systems in place to monitor the quality of the service and completed regular audits on the service that people received.