This unannounced inspection was undertaken on 12 June 2018 and was carried out by one inspector. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Number Residential Care Home is a ‘care home’ for people who have mental health needs and who may also have additional disabilities. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates a maximum of 10 people. At the time of our inspection there were 10 women living in the home. Most of the people using the service had been living at the home for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the manager and deputy manager.

People 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.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

We have made a recommendation relating to notifying the Commission about certain changes, events and incidents that affect services or the people who use it.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs people had.

Both people who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements.

All parts of the home, including the kitchen, were clean and no malodours were detected.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an individual plan of care which was reviewed on a regular basis.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care.

We inspected this service on 2 February 2016. The inspection was unannounced. Number Residential Care Home is a care home registered for a maximum of ten adults. Some of the people living there had long term mental health needs, some with additional disabilities.

At the time of our inspection there were ten women living at the service. The service is located in two adjoining terraced houses, on two floors with access to a front and back garden. We previously inspected the service on 6 August 2014 and the service was found to be meeting the regulations inspected.

Number Residential Care Home had a registered manager at the service. 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 using the service informed us that they were happy with the care and services provided. During the inspection we saw staff were caring, kind and compassionate and treated people with dignity and respect.

Care records were individualised, contained people’s personal histories and reflected their choices, likes and dislikes, and arrangements were in place to ensure that these were responded to. Care plans provided detailed information about people’s mental health needs which were closely monitored. Risk assessments had been carried out and updated regularly. These contained guidance for staff about protecting people. Staff were able to tell us about the needs of people they cared for and were aware of the most effective way of supporting them with their mental health needs.

People were supported to maintain good health through regular access to healthcare professionals, such as the local mental health team and GPs. We saw people had access to opticians and dentists on a regular basis.

People’s cultural and religious needs were facilitated by staff.

People had their medicines managed safely, and they received their medicines as prescribed. Storage and management of medicines was safe with clear systems in place.

Staff had been carefully recruited and provided with training to enable them to care effectively for people. Staff felt supported and there was evidence of regular supervision taking place in recent months. Staff knew how to recognise and report any concerns or allegations of abuse and were able to tell us what action they would take to protect people against harm. Staff knew what whistleblowing was and were able to tell us what they would do if they were concerned about the quality of the service.

There were enough staff to meet people's needs and management of money for people using the service was safe.

We found the premises were clean and tidy, and measures were in place for infection control. There was a record of essential services such as gas and electricity being checked, with fire drills taking place regularly. There was clear documentation relating to complaints and incidents.

Staff told us the management was a visible presence within the home, and the staff we met were

caring, kind and compassionate.

There was a wide age range of people living at the service. The provider focused on the compatibility of people living at the service and prioritised this when considering new admissions.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

At the time of the inspection there were nine people living in the home. We spoke with five of them, two did not wish to talk with us, and two were out during the inspection visit.

Is the service safe?

People told us that they felt safe at the home. Clear records were maintained of people’s property held for safekeeping and risk assessments had been undertaken with care plans in place to keep people safe from known risks.

Staff had undertaken first aid training and safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home environment appeared safe, clean and hygienic.

Recruitment records for staff indicated that appropriate checks had been undertaken to ensure their fitness to work with vulnerable people.

Is the service effective?

People told us that they were happy with the care and support provided to them. They had consented to any restrictions to their freedom, and where they were unable to do so, the appropriate action had been taken to safeguard their rights.

They told us that they engaged in a range of activities within and outside of the home. One person noted “I’m taking a course at the library,” others advised “I go to church,” “I go out for lunch with staff,” and “ I go out to feed the birds.” Within the home activities included yoga classes, beauty therapy, and jewellery making.

People’s health and social care needs were assessed with them, and they were involved in writing their care plans which were reviewed regularly to ensure that staff met people’s needs consistently.

Staff received appropriate support and supervision to enable them to deliver care and support to people to an appropriate standard.

Is the service caring?

People we spoke with told us that staff were responsive to their needs and treated them with respect. We observed staff knocking on people’s bedroom doors, and waiting for a response. They were sensitive and patient when supporting people. People’s preferences and interests, goals and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

People using the service, and visitors to the home had completed an annual satisfaction survey indicating that they were happy with the support provided at the home.

Is the service responsive?

We saw that staff had identified people’s cultural and religious needs, and people were supported to attend places of worship and have cultural foods. Some people living at the home said that they were being supported to develop daily living skills to move onto more independent accommodation.

There were records in place to indicate that people's consent had been obtained in relation to any restrictions placed upon them within the home. Where this was not possible Deprivation of Liberty Safeguards had been applied for as appropriate. People told us that they were satisfied with the choices available to them including choices about the food, and activities provided. One person told us that the food had improved recently noting “It’s more healthy.”

Is the service well-led?

People we spoke with were happy with the home’s management. Staff spoke positively about training, supervision and support provided to them.

We reviewed several monthly audits that took place and the most recent quality assurance survey. Staff told us they were clear about their roles and responsibilities, and demonstrated an understanding of the needs of the individual people they cared for.

Records were clear, well organised, and had been reviewed up to date. Where improvements were recommended following a particular incident, we noted that the manager had implemented these promptly.

During our inspection carried out on 12 July 2013 we found that the provider did not meet requirements of the Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider did not have suitable systems for recording and storage of medicines. We visited the service to follow up on a compliance action set in our report published August 2013.

At this inspection we found that the provider had taken action to meet the requirements of regulation. We found that all prescribed medicines were available, medicines were stored safely and at the correct temperatures. We found that accurate and up-to-date records were kept of medicines received, administered to people and returned. Therefore medicines were now being managed safely for the protection of people who use the service.

When we visited the home there were nine people living there. We spoke with four of the people living at the home, with the manager and three members of care staff. We also observed how staff interacted with people using the service.

People using the service told us that they liked the home and felt that it provided good care. They told us that they liked the homely environment that was provided. We received the following comments about the home:

“I like it here.”

“It is nice. It is well run.”

“It is good here.”

“There are two cats. They are nice.”

We found that people’s privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had a system to regularly assess and monitor the quality of service that people receive.

We spoke to six of the ten people who live at the home. Most of them told us they liked living at the home. Comments included “Yeah, it’s not too bad”, “I like it here. I like the people” and “I like living here.” One person explained they liked it far more than where they had been previously.

All of the people we spoke to said they liked the staff. For example, one person said “I like the staff. Yeah, I do like the staff.” People also told us they found the staff polite and that they helped them when they wanted help. One person told us, “If I have any problems, I just go to them.”

When we asked people if they felt safe living at the home, everyone we spoke to responded that they did.

People told us they liked the food and they were given a choice over what they could eat. They also told us they were able to do the things they liked to do. Two people told us she liked to go out to the shops and that they were able to do this.