Mosaic House is a care home situated in North Wembley which is registered to provide accommodation and personal care to five people who have mental health needs. At the time of our inspection the home had no vacancies.

At our last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People living at Mosaic House spoke positively about the management of the home and the support that they received from staff. They had been involved in planning their care and support and met regularly with their nominated keyworker to discuss their progress.

Staff members understood their roles and responsibilities in ensuring that people were safe. Risk assessments for people were personalised and included guidance about risk management. Staff members had received training to ensure that they were competent and knowledgeable in their roles. They had regular supervision sessions with a manager to discuss good practice and address any concerns they had and told us that they felt well supported by their manager.

The home was clean and tidy and regular health and safety monitoring and checks had taken place. However, we found that food items used by people during the day of our inspection had not been appropriately stored. The registered manager told us that they would ensure that people who lived at the home and their support staff were reminded about food safety as a matter of priority.

People’s medicines were well managed and monitored. They were supported by staff to attend regular health appointments.

People living at the home were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The home was supporting people to develop the skills that they required to become more independent. This approach was confirmed by the people we spoke with and recorded in their care documents.

Staff at the home spoke positively about the people they supported. We observed that they treated them with dignity and respect.

People were supported to participate in a range of group and individualised activities of their choice by staff at the home. They told us about holidays that had taken place or were planned, and other activities such as attending a football match and support to find employment.

Care plans were up to date and regularly reviewed with people. People told us that they knew how to make a complaint if they were unhappy about any aspect of their care and support.

Regular meetings took place where people were supported to discuss their views about the home and request and plan activities and improvements. An annual survey of people’s views had taken place and this showed that people had high levels of satisfaction with the support they received.

Systems were in place to ensure that the quality of the service provided at the home was monitored and reviewed. We saw that any actions arising from quality monitoring had been addressed.

Further information is contained within the detailed findings below.

Our inspection of Mosaic House took place on 10 May 2016. This was an unannounced inspection.

Mosaic House is a home situated in North Wembley and is registered to provide accommodation and personal care to five people who have mental health needs. At the time of our inspection the home had no vacancies.

At our last inspection of Mosaic House on 29 January 2015 we made recommendations in relation to staff training and the quality of care plans. During this inspection we found that the provider had taken significant steps to improve the service in order to meet these recommendations,

At the time of our inspection, a new manager was working at the home and they were undertaking the process of becoming the registered manager for 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 2008 and associated Regulations about how the service is run.

People living at Mosaic House told us that they felt safe. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting.

People had up to date risk assessments to ensure that they were kept safe from avoidable harm. These were person centred and contained detailed guidance for staff about how they should support people to ensure that risks were minimised.

People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

There were enough staff members on duty to meet the needs of people living at the home. Additional staffing was provided when people required support for planned activities or appointments. Staff supported people in a caring and respectful way, and responded promptly to support their needs and requests.

Staff who worked at the service received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff members were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported. A regular programme of staff training was in place which met national training standards for workers in health and social care.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of people’s capacity to make a wide range of decisions were in place and had been undertaken and we saw that these were regularly reviewed. All staff members had received training in MCA and the Deprivation of Liberty Safeguards (DoLS). People were not restricted from leaving the home unaccompanied.

People’s dietary needs were met by the home, and we saw that people were enabled to make choices about food and drink. People usually cooked for themselves, and support was provided to enable them to develop cooking skills.

The care plans maintained by the home were detailed and up to date. These contained guidance for staff about how they should support people. Staff met regularly with people to discuss their views about their care and support and their progress in relation to their care plans. The home liaised with other health and social care professionals to ensure that people received the care and support that they required.

People were supported to participate in range of individual and group activities. The home also supported people’s cultural, religious, and other preferred needs and requirements.

People told us that they knew how to make a complaint. We saw complaints that had been received by the home had been addressed quickly and appropriately.

The provider visited the home regularly. During our inspection we saw that the manager and the deputy manager spent time e

This inspection took place on 29 January 2015 and was unannounced.

During our last inspection of Mosaic House on 29 July 2013 we found no breaches of the regulations assessed.

Mosaic House is a home situated in North Wembley and is registered to provide accommodation and personal care to five people who have mental health needs. At the time of our inspection the home had no vacancies. The registered provider was also the registered manager, as they had previously provided direct management to the home. However, at the time of our inspection a new manager had been appointed and they were undergoing the process of becoming the registered manager for 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 2008 and associated Regulations about how the service is run.

People we spoke with told us that they felt safe living at the home. They were positive about the care that they received and told us that staff members respected their privacy and dignity.

People were protected from the risk of abuse. The provider had taken reasonable steps to identify potential areas of concern and prevent abuse from happening. Staff members demonstrated that they understood how to safeguard the people whom they were supporting. People living at Mosaic House told us that they felt safe.

Written risk assessments were in place for people living at Mosaic House. These were up to date and reflected identified needs.

Medicines at the home were well managed and people told us that they received these on time.

The physical environment at the home was suitable for the people who lived there and was clean and well maintained. Regular safety checks took place and we saw that these were up to date.

Staff recruitment processes were in place to ensure that workers employed at the home were suitable. Staffing rotas met the current support needs of people, and we saw that additional staff were provided to support activities where required.

Staff members received regular supervision, team meetings took place each month, and staff felt that they were well supported.

People’s dietary needs were met by the home, and there was evidence that people were enabled to make choices about the food and drink that they received.

Other health and social care professionals were involved with people’s treatment and support.

Quality assurance monitoring took place regularly and records of this were in place. Policies and procedures were in place that generally met requirements. However, we did not see a policy in respect of the Mental Capacity Act, although there was one in relation to Deprivation of Liberty that required updating to encompass recent guidance.

There was limited evidence to show that people who used the service had been involved in making decisions about their care. Care documents were not always signed to show consent, and some people told us that they had not been involved in the process. We discussed our concerns with the manager and were assured that this would be addressed.

Staff training was generally good and met national standards for staff working in social care organisations. A number of staff members had achieved a relevant qualification. However, Mental Capacity Act training had not been updated to reflect recent developments to the Deprivation of Liberty Safeguards.

We have made a recommendation about staff training on The Mental Capacity Act and Deprivation of Liberty Safeguards.

The care plans maintained by the home lacked detail about people’s needs and did not provide guidance in respect of how support should be provided by staff.

The new manager told us that they had already identified some of our concerns, and we saw evidence that these had been discussed with staff and that action had commenced to improve the quality of care plans.

We have made a recommendation about the development of care plans.

We spoke with three of the five people who use the service. Each person told us they were satisfied with the support they received. One person told us “I think it’s ok here, the staff are ok, they’re nice. What I hate most is that it’s hard to get moved from here". Another person said "I am comfortable here. I like it here and I like the staff".

We found that the service met people's needs in a safe, secure environment.

We found that the provider had taken steps to ensure involvement with other stakeholders involved in people's care and treatment, and that the service was provided in premises that were safe and generally suitable for people's needs. We saw evidence that the staff were skilled, qualified and experienced, and that all appropriate checks had been conducted before staff started work.

We saw that the service had an appropriate complaints procedure, and that people who use the service were encouraged to discuss any issues in residents' meetings and keyworker meetings.

During our inspection of Mosaic House we spent time talking to people to gain an understanding of their experience of living in the home. We asked people if they felt they received the care that they needed and wanted. People spoke positively about the service and told us they were happy with the care they received and the staff that supported them.

We saw staff provide support to people in a friendly, sensitive and professional manner. The interaction between staff and people using the service was respectful. People told us that staff respected their privacy, and understood their needs.

Comments from people included “I am happy here”, “I can talk to staff at anytime”, “They talk to me about the support I need”, “I feel involved in decisions about my care”, “I have a key worker who helps me with things like making doctor’s appointments” “I have my own key” and “I can choose to stay in my room”.

People told us they could choose what they wanted to eat or drink. They told us they could make snacks and drinks at anytime. People commented “I like the food”, “I buy food from the shops”, “I can cook some of my own meals” and “I enjoy curry night on Tuesdays”.

People told us they had the opportunity to participate in many varied activities that they enjoyed and met their individual needs.

People told us they felt safe and knew who to talk to if they had any worries or concerns. One person told us “I talk to any of the staff if I am worried at anytime, there are always staff available to talk to”. They told us they had access to hospital appointments and to support, and treatment from healthcare and social care professionals such as doctors, opticians, dentist’s chiropodists and social workers. We spoke with a social care professional who spoke very positively about the service.

There were a number of systems in place to monitor and to make improvements to the quality of care and support provided to people by the home.

As part of this review, we spent time talking to all the people using the service to gain their views about living in Mosaic House. They told us that; they were happy living in the home, they liked their bedrooms, the food was good, they had their health needs met, the staff were approachable, listened to them, and they had the opportunity to participate in a wide range of activities of their choice.

People told us that they were fully involved in their plan of care and support. They confirmed that they were consulted and fully involved during its development and review.

People were positive about the care and support they receive at the home. People spoke of the staff being ‘nice’, and said staff ‘listened to them’. They told us that they ‘could talk to staff at anytime’. People told us they felt safe living in the home and they knew who to talk to if they had any worries or concerns. A person told us that ‘we can say what we want’. People told us they had recently been asked for their views of the service provided by the home. They confirmed they had the opportunity to participate fully in residents meetings and key worker meetings.

People told us about the varied meals provided. They told us they had the opportunity to purchase foods that they particularly enjoyed, often prepared their own meals. We saw a person using the service cooking his lunch.

People said they saw a doctor when they needed to, and had contact with a variety of other health care and social care professionals. A person spoke of seeing his social worker regularly.

People confirmed that they were happy with the environment of the home, and spent ‘lots of time in the garden in the summer’. Some people kindly showed us their bedrooms, and confirmed that they had been individually personalised by them.

People told us about the varied activities that they enjoyed. These included shopping for clothes, voluntary work, going out for meals, going to the local sports centre, listening to music, watching television.

We saw some written feedback from relatives, others and social care professionals about the service. Comments included; ‘a relaxed and friendly home environment’, ‘well experienced and compassionate staff and management’, ‘very professional in dealing with very difficult clients’, who can be ‘very challenging’, and ‘there is great communication with us’.

We spoke with health and social care professionals. They told us that the staff at Mosaic House are competent, there is good risk management, and they are always kept well in formed about the progress of people using the service. Other comments included staff ‘manage clients very well’,’ staff give residents the time that they need’, ‘there is very good communication’, and the home ‘provides good rehabilitation for people’.