Montrose House is a residential care home that provides care for up to 10 people, living with long term mental health conditions such as schizophrenia and bipolar disorder. At the time of this unannounced inspection of 12 April 2018 there were nine people who used the service.

At our last inspection on 12 and 14 August 2015, we rated the service overall Good. At this inspection 12 April 2018 we found that the service had improved to an overall rating of Outstanding and met all the fundamental standards we inspected against.

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. Statutory notifications received showed us that the registered manager understood their registration requirements.

Montrose House was exceptionally well led. There was visible and highly effective leadership in an open and transparent culture that resulted in an organised and well run service. The registered manager was able to demonstrate how their robust quality assurance systems had sustained continual development and improvement at the service. They were clear about their expectations relating to how the service should be provided and led by example. They were supported by a management team and care workers that were fully committed to delivering the highest standard of care to each person.

Morale was extremely high, at all levels within the service with employees describing how well supported and appreciated they were by the registered manager. All of the staff were proud of where they worked and told us they felt valued and respected. They shared positive experiences about the leadership of the service, and how they were continually motivated and encouraged to professionally develop by the registered manager.

There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result the quality of the service continued to develop. The registered manager demonstrated an open, reflective leadership style working in partnership with other stakeholders to drive continual improvement within the service and to raise awareness of the needs of people living with mental health conditions within the local community.

Feedback from health and social care professionals cited collaborative and extremely effective working relationships. Montrose House was awarded care home of the year in 2017 at the Suffolk care awards and was highly commended in the food and catering category, for providing food in an interesting way that responds to people’s individual needs. In addition the registered manager nominated by the staff at Montrose House, won the award for inspiring leaders and managers.

Care staff were highly skilled and competent to meet people’s needs. They demonstrated an enhanced understanding and knowledge of mental health and how to meet people’s needs. They were available when people needed assistance and had been recruited safely.

Care staff were exceptional at supporting people with their dietary needs. People enjoyed a positive meal time experience and were enabled to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Care staff were confident about using the mental capacity and best interest decisions made were in line with legislation and people’s wishes.

People and their relatives were complimentary about the care and support they received and the approach of the registered manager and

We spoke with five of the nine people who used the service. They told us that they were happy living in the service, that they chose what they wanted to do in their lives and that the staff treated them with respect and kindness. One person said, “I am happy living here. I always do what I want.” Another person said, “No one tells me what to do." Another said, "They (staff) always help me when I need it." People told us about the activities that they chose to participate in.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

We found that people who used the service were protected by the service's infection control processes and procedures. Equipment used in the service was safe and fit for purpose.

People's complaints were listened to and acted upon in a timely manner.

We spoke with seven of the ten people who used the service. They told us that they were consulted about the care they were provided with. One person told us about the meetings that they regularly attended and said, "We talk about what we want like going out."

People told us that the staff listened and acted on what they said. One person said, "I choose what I want to do."

People told us that they felt that their needs were met. One person told us about how their health care needs were met and said, "If I feel ill the staff help me to see the doctor." Another person told us that they had been visited by an assessor who would, "Help me get something to help me walk."

We spoke with two people who used the service. They told us that they were happy living in the service. One person said that their choices were listened to and acted upon and they were enjoying listening to music.

During our visit we spoke with four people who lived in the home. They were involved in various activities including making tea, watching television, being out in the garden and getting ready to go out to shops. They told us about their lives and what they liked to do. They talked about the staff and told us they liked them. There was a friendly and relaxed atmosphere in the home.

We saw visitors were welcomed into the home by people living there and one person told us they were waiting for their friend who was going out with them for the day. One person told us they regularly saw their relatives and called them on the telephone.

Montrose House provides accommodation and care for people with mental health needs. In June 2011 we were told that there were concerns about people living in Montrose House and their ability to make decisions and choices about their own lives. It was alleged that this was because of inappropriate practices by staff and management. A local authority investigation took place and the provider (Suffolk Mind) sent information to us about how they were addressing the issues raised. We considered the action to be appropriate and this planned review was scheduled to look at their progress. At the time of our unannounced visit on 27 October 2011, we were told that an internal investigation and disciplinary procedures were ongoing.

We spoke with four people who lived in the home. They were positive about the staff they knew and there was a relaxed and jovial atmosphere. One person told us they liked gardening. We saw that people living in the home were able to access the garden freely and spend time sitting outside. One person told us they were able to go out by themselves but they preferred to have the support of someone (staff) with them.

Some people living in the home did not want to speak with us. They had spoken with a number of visiting professionals in the preceding months and there had been a lot of staff changes in the home. This meant they were unsure of people they did not know.

We spent time observing the daily activities at the home. We saw people were able to choose where they spent their time. One person was supported to go out to buy craft materials. We saw visitors were able to come into the home to see relatives and friends.

Montrose House provides accommodation and personal care for up to 10 people, aged 50 and above, living with long term mental health conditions such as Schizophrenia and Bipolar disorder.

There were 10 people living in the service when we inspected over two days, arriving unannounced on 12 August 2015, and announced on the 14 August 2015.

There was a registered manager in post. 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.

There were procedures and processes in place to manage risks to people using the service, including safeguarding matters and behaviours that impacted on the welfare of others. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff were trained and supported to meet the needs of the people who used the service.

People, and where appropriate their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information to support their mental health needs and their ability to make decisions.

People were supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff knew people well and had developed good relations with people who used the service. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

A complaints procedure was in place. People’s concerns and complaints were listened to and addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.