We inspected Montague Street Care Home on 19 and 20 January 2017. The inspection was unannounced.

Montague Street Care Home is situated in the town of Mansfield in North Nottinghamshire. The service comprises of two residential homes which have been adapted to provide care and support for up to 12 people with a learning disability. At the time of our inspection 11 people lived at the service.

The service had a registered manager in place at the time of our visit. 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 at Montague Street Care Home and did not have any concerns about the care they received. Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff deployed. Appropriate pre-employment checks were carried out before staff began work at Montague Street Care Home.

People received their prescribed medicines when required and these were stored and administered safely. Procedures were in place to ensure people received their medicines safely when they were away from the service.

People received effective care from staff who received training and support to ensure they could meet people’s needs. Ongoing training and assessment for all staff was scheduled to help maintain their knowledge.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people using the service. Where possible people were involved in making decisions about their care and daily activities.

Staff understood people’s support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities and maintain family and social relationships. When a complaint or concern was raised this was acted on quickly and investigated thoroughly by the service.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Robust quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

This inspection took place on 14 October 2014 and was unannounced.

The last detailed inspection was carried out in May 2013. We found there was a breach of regulations in respect of eating and drinking. The menu did not demonstrate people were receiving a choice of well-balanced meals at that time. We received an action plan and checked improvements were made. We found staff received further training, the menu had been reviewed and there were greater choices of well balanced meals for people.

Montague Street Care Home provides accommodation for people with learning disabilities. There were 12 people living there when we visited. The home is made up of two adjoining houses with separate internal communal areas and a shared garden area.

As this service is a care home, a manager is required to register with us by law and there was a registered manager at the home. 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.

The provider used safe systems when new staff were recruited and the staff were aware of their responsibility to protect people from harm or abuse. Although risks to safety were minimised, as far as possible action was needed to improve the administration of medicines and to attend to advice given by a fire inspector in order to eliminate all risks to health and safety.

Staff received regular training and knew how to meet people’s individual needs. Any important changes in people’s needs were passed on to all staff when they started their shifts, so that they all knew the up to date information.

The staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and there was currently no need for any applications for DoLS. Staff gained consent from people whenever they could and where people lacked capacity we saw that arrangements were in place for staff to act in their best interests.

People had appropriate food and drink and staff supported them individually, so that their health needs were met.

Staff were kind and people appreciated the positive relationships they had with staff. Choices were given to people at all times. People’s privacy and dignity were respected and all confidential information was respectfully held securely.

People’s individual needs were assessed and full clear plans were specific to people as individuals. Staff were knowledgeable about how to manage people’s individual needs and assisted people to take part in appropriate daily activities and holidays.

Overall, the service was well led by a registered manager, but we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and this was in relation to medicines. You can see what action we told the provider to take at the back of the full version of this report.

At this follow up inspection we did not speak with people who used the service.

We spoke with the registered manager and two support workers. We checked the food stocks, looked at menus and audit systems.

Comments made by support workers included, “The staff found the training really helpful, it’s given us more confidence and developed our awareness and understanding.” Another support worker said, “There have been some positive changes since the last inspection, the menus have changed, we’ve received some training and all the staff share the responsibility of providing meals, it’s on the rota who will be cooking.”

People received well balanced and nutritional meals. Menus had improved, new auditing systems had been introduced and staff had received training in nutrition.

As part of our inspection we spoke with three relatives of people who used the service. We used observation to help us understand the experiences of people using the service, because some of the people had communication needs which meant they were not all able to tell us their experiences. We also spoke with the registered manager and four members of staff and looked at service information and records.

The relatives we spoke with told us they were more than satisfied with the service provided. They talked positively about the staff team. They said communication from the home was good and they were asked to attend review meetings to discuss their relative's needs.

We saw people’s human rights were respected and taken into account in relation to consent to care and treatment. People received social and recreational activities and opportunities within their community and their independence was respected and promoted.

We found that some people could not always be assured that they would receive the dietary requirements for which they had been assessed. Menus looked at did not show people were offered daily nutritional and well balanced meals.

People received medication from knowledgeable and competent staff. Staffing levels were adequate in meeting people assessed needs. We found records used were person centred, user friendly and provided staff with the information required to meet people’s needs.

We observed and spoke with a total of seven people who were at home during our visit. Their comments included, "I like it here" and "All good". Two people said they looked at their care and support plans with staff. One person said, "I'm glad I came here." We asked two people if they felt safe at the home and they confirmed that they did.

We observed the staff working with people and they were confident and respectful with people. One person told us that the staff always knew how to look after the people living there and this person said they knew the staff had received some training. Another person said "The staff are sometimes busy, but they help me."

People told us that there were regular house meetings so that they could express their views about activities and anything new that they wanted in the home.