This inspection took place on 19 and 21 September 2017 and was announced. The provider was given 24 hours’ notice because the location provides extra care housing and we needed to be sure that people would be available to speak with us. We told the manager we would be returning on the second day. At the last comprehensive inspection in November 2014, with the inspection report being published in April 2015, the service was rated as ‘Good’.

James Hill House provides extra care housing for up to 30 older people with mental health problems, physical or other disabilities. At the time of our visit the service was supporting 28 people, but only providing personal care to 24 of them.

There was a manager in post at the time of our inspection who had recently been recruited and was in the process of completing their application to be a registered manager. They had been a registered manager previously with another provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were supported to follow their interests and maintain relationships with friends and family to increase their well-being. There were opportunities for people to take part in a wide range of activities, day trips and events, which included working in partnership with local organisations. There was evidence that cultural requirements were considered when discussing this and making sure these needs were met.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. The provider made sure people were confident their complaints would be taken seriously and encouraged them to raise any issues or concerns.

An initial assessment was completed from which care plans and risk assessments were developed. Care records were person centred and developed to meet people’s individual needs and discussed regularly during key work sessions. Staff had carried out unique training which helped them to understand more clearly the needs of people living with dementia.

People who required support with their medicines received them safely from staff who had completed training in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked by staff and audited monthly to minimise medicines errors.

People and their relatives told us they felt safe using the service and staff had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with.

The service had a robust recruitment process where applicants were assessed against the organisation’s values. Staff had the necessary checks to ensure they were suitable to work with people using the service. People using the service were also involved in the recruitment of staff.

People’s risks were managed effectively and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed.

People were supported to have a healthy and balanced diet, which took into account their preferences as well as medical, cultural and nutritional needs.

Staff received the training and supervision they needed to meet people’s needs and were knowledgeable about their jobs.

People had regular access to healthcare services and other health and social care professionals, such as GPs, dentists and social workers. Concerns about people’s health were discussed at monthly multidisciplinary team (MDT) meetings.

People were spoken with and treated in a respectful manner. We saw that staff treated people with respect and kindness, respected their privacy and dignity and promoted their independence.

People

We conducted an unannounced inspection of James Hill House on 24 November 2014. The service provides extra care housing for up to 30 older people with mental health problems, physical or other disabilities. There were 28 people using the service when we visited.

At our last inspection on 3 January 2014 the service met the regulations we inspected.

The service had 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.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard the people they supported. The registered manager and staff had received training on safeguarding adults and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Risk assessments were based on people’s individual needs and lifestyle choices. We saw evidence that people were involved in decisions relating to risks they wanted to take in order to increase their independence.

Staff received first aid training and were able to explain how they would respond to a medical emergency. The service operated an out of hours on call system which ensured a manager was always on duty to respond to emergencies and give advice.

There were enough, safely recruited staff available to meet people’s needs. Staffing numbers were adjusted depending on people’s requirements.

Medicines were managed safely. Records were kept when medicines were administered, and appropriate checks were undertaken by staff. Records were clear and accurate and regular auditing of medicines was undertaken.

Staff were trained in the Mental Capacity Act 2005 which is a law to protect people who do not have the capacity to make decisions for themselves. Staff were also trained in the Deprivation of Liberty Safeguards which are part of the Mental Capacity Act and exist to make sure that people’s freedom is not inappropriately restricted where they lack the capacity to make certain decisions. Staff demonstrated a good understanding of their responsibilities.

People and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs and staff followed these.

Recruitment procedures ensured that only people who were deemed suitable worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with a range of ongoing training to help them carry out their duties. Staff received regular supervision and appraisal to support them to meet people’s needs.

People were supported to eat and drink a balanced diet that they enjoyed and their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals. Healthcare professionals spoke positively about their working relationship with staff at the service.

People told us staff treated them in a caring and respectful way. People’s privacy and dignity was respected and we observed positive interactions between people and staff throughout our visit. Staff demonstrated a good understanding of people’s life histories and their individual preferences and choices.

Staff and people who used the service felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints policy and procedure in place. We found complaints were dealt with appropriately and in accordance with the policy.

The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these.

Staff worked with other organisations to implement best practice. We saw evidence of multi- disciplinary team working and this was monitored to ensure best outcomes were achieved for people. The service also had good links with the local community. People told us they participated in activities at local day centres and that they enjoyed doing so.

We spoke with three people who used the service and overall they were complimentary about the care and welfare they received in the service.

Care plans and risk assessment were reviewed in line with the service’s own guidelines and this was reviewed more frequently dependent on the complexity of people’s needs. People’s health and safety was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

There were infection control policies in place and staff ensured that all protocols were followed.

The provider had effective recruitment and selection processes in place.

Files for people using the service were securely stored and locked away in the staff office.

In this report the name of a registered manager, Vlado Veljanoski, appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Overall people who used the service and relatives we spoke with told us they were satisfied with the care they received at the service.

People told us that staff asked for permission before offering them support and that they knew what kind of support staff would offer and when. They said they understood what their medicines were and had consented to taking them.

People told us that they liked the staff and one person said the manager was ‘’brilliant’’. They also felt there were enough staff in the home.

People told us that complaints could be raised in writing on a complaints form. However they said that if they had a concern they would raise it in person with staff or a manager and felt that it would be acted on.

On the day of the inspection we found there were appropriate arrangements in place in relation to the management and administration of medicines.

People told us that they enjoyed living at James Hill House and spent their time doing what they enjoyed. Staff were supportive and helped them with daily tasks for example preparing food and tidying their flats. They were involved in their support and felt staff were responsive to their needs.