About the service:

Palmyra is a residential service that was providing personal care to 13 adults living with an enduring mental health condition at the time of the inspection.

Situated close to local amenities, the service appears externally as a domestic property on a residential street. Palmyra accommodates up to 15 people in one building. There is ramp access to the front of the house. Bedrooms are situated over three floors. A kitchen, dining room and lounge are situated to the ground floor. There is a large enclosed garden situated to the rear.

People's experience of using this service:

Although Palmyra catered for adults of all ages, most of the people living at Palmyra were older adults. Palmyra offered support to people who had been unable to live independently in the community.

People living at Palmyra were very much a part of the local community and accessed the community and its facilities through both socialising and activities. Some people had family members and friends who lived locally and visited them on a regular basis.

There was enough staff to support people to engage in whatever activity they chose. This helped to promote people’s choice, independence and inclusion. The size, layout and staffing arrangements meant that Palmyra had a homely feel. People and their relatives told us they were settled and happy living at Palmyra and considered it as home.

People received care from staff who had been supported in their role with appropriate training and supervision. Staff were caring and compassionate and knew people's needs and preferences well.

Regular checks and audits were carried out to determine the quality and safety of the care being provided.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs. People were encouraged to be as independent as possible.

People were encouraged to express their views and were actively involved in decisions about their care.

The registered manager and registered provider promoted a person centred and transparent culture within the service. The ethos of the service was to give people the freedom to enjoy an everyday life.

Rating at last inspection:

At our last inspection, the service was rated "Good.’’ Our last report was published in October 2016.

Why we inspected:

All services rated "Good" are re-inspected within 30 months of our prior inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The service met the characteristics for a rating of "Good" in all the key questions we inspected.

More information is in our full report.

This inspection took place on 17 August 2016 and was unannounced.

Palmyra is a Making Space residential care home which provides accommodation and personal care for 14 people with mental health needs. The home is situated in a residential area of Waterloo, Merseyside which has easy access to local amenities and transport links. The service is provided over four floors with lift access available.

During the inspection, there were 14 people living in the home, including one person who had been admitted to hospital.

A registered manager was 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.

People we spoke with told us they felt safe living in Palmyra and we observed people to be relaxed and comfortable within the home. Staff we spoke with demonstrated a good understanding of safeguarding procedures and were able to tell us how they would report any concerns. Safe recruitment practices were also followed to ensure staff were suitable to work with vulnerable people.

We looked at how medicines were managed within the home and found there were processes in place to ensure safe storage and checking the stock balance of medicines. Not all handwritten directions on the MAR charts were checked by two people and photographs were not always available to ensure all staff could identify people and we made a recommendation regarding this.

We looked at how the home was staffed and found that there were sufficient numbers of staff on duty to meet people’s individual needs.

Incidents were reported appropriately using the provider’s electronic system. There were systems in place to assess risks to people and the environment to ensure measures could be put in place to minimise risks and help ensure people’s safety. Regular fire drills were completed and recorded. The last drill reflected that response was poor and the registered manager took steps to help improve this.

The registered manager told us that no people living in Palmyra required a DoLS to be in place and was aware of when a person may require an application to be made and how to undertake this.

Staff we spoke with told us they always asked for people’s consent before providing care and we observed this during the visit and within care files. When there were concerns that people may be unable to provide consent, the Mental Capacity Act was followed.

New staff completed an induction in line with the requirements of the care certificate and staff were supported through regular supervisions, an annual appraisal and on-going training.

Feedback regarding meals available was positive. The menu offered choices and advised that alternatives were always available. Staff we spoke with were aware of people’s dietary needs and preferences.

People told us staff were kind and caring. We observed people sitting with staff in the dining room throughout the day, listening to music, drawing and chatting and people were relaxed and comfortable. We observed people’s dignity and privacy being respected by staff.

All care plans we viewed showed that people had been involved in the completion of relevant risk assessments and the creation of their care plans and had agreed to the care in place.

Care files included information on people’s preferences, what was important to people, what people admired about the person and how best to support them to ensure their needs were met. They had been reviewed regularly and it was evident that people were involved in these reviews.

The registered manager told us they had an open door policy and that there were no restrictions in visiting, encouraging relationships to be maintained.

We found that staff knew people well and we observed staff responding to peo

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

During our inspection, we observed people living in the care home were treated with respect and dignity. Staff members had a good knowledge of people`s needs which meant people received appropriate care which met their needs.

Recruitment processes were robust. They included all potential employees undergoing all required security checks before starting work at the care home. This ensured the safety and welfare of all people living at the care home. We observed policies and procedures were in place that comprehensively explained the recruitment process.

Deprivation of Liberty Safeguards (DoLS) are important when it is judged a person living at the care home may be lacking the capacity to make an informed decision related to their care and treatment. The provider informed us that there had been no recent DoLS applications. However, the provider told us they knew the process for making an application, which ensured people would be supported to make their own decisions at all times.

Is the service effective?

All people living at the care home were involved in the development of their care plans. People told us they had been involved during their assessment and the care plans reflected their needs and wishes. Staff members had received relevant training which helped them meet the needs and wishes of all people living at Palmyra.

Is the service caring?

We observed staff members providing care in a patient and caring manner. We saw individual `daily planners` which focused on people`s needs and so helped staff members meet those identified needs. One person living at the care home said "My needs are so well met here". A family member told us, "All the staff are wonderful". All people living at Palmyra were asked to complete annual surveys and attended resident meetings if they wished to. Any issues raised were addressed by the provider which helped meet people`s needs in a good quality manner.

Is the service responsive?

All people living at the care home had their needs assessed before they moved into Palmyra. The provider and people living at the care home told us regular resident and staff meetings were held. This allowed people and staff members the opportunity to raise any concerns or complaints they may have had, which was aimed at improving the quality of care being provided. One person living at the care home told us, "If I have a problem, I can talk to staff at any time, day or night". People living at Palmyra were actively encouraged and supported to maintain relationships with their friends and family.

Is the service well-led?

We observed evidence in care plans and from talking to staff members that Palmyra worked actively with other agencies. We saw records of both internal and external audits. These were aimed at continually improving the quality of service provided to people living at the care home. Any issues or concerns that were identified following completion of the audits were addressed without delay. Staff members we spoke with during our inspection had the necessary skills and knowledge to fulfil their role. This ensured a good quality of care and support was provided to all people living at Palmyra.

Palmyra is part of the Making Space organisation and provides care for 14 people.

The care being delivered at the home was person centred because people living there were involved in their care decisions were appropriate whilst respecting the person and their dignity.

We spoke with people who lived at the home and their relatives. We asked them to share with us their views and experience of the care and support they received. One relative told us “The care is brilliant; physical health needs are managed well with other health professionals, they link in with the staff at the home and they manage all aspects of care well.”

Making Space encouraged quality monitoring and assurance. They had an internal audit process in place were Registered Managers are involved in inspecting a home, which they do not manage, on a monthly basis to perform checks on duty staffing, service user records, staff information, facilities, complaints, finance, operational matters and human resources. An action plan is devised from the visit for highlighting areas of improvement, with a date for completion.

There was a business continuity plan in place to support safe care planning and delivery in the event of an incident or accident. The plan looked at possible foreseeable incidents and detailed how to deal with the situation.

We spoke with staff who told us they felt well supported by the management and peers. They said they worked well as a team and enjoyed their job.

The care being delivered at the home was person centre because people living there were involved in their care decisions were appropriate whilst respecting the person and their dignity. Reasonable processes were in place to ensure people are protected from harm and risk.

Some of the people living at the home were able to attend college courses; the home has links with the local college to facilitate this option. Other activities were delivered at the home by the staff. A timetable was displayed on the resident's notice board to show which activities would take place & the day.

We spoke to 7 people living there and the feedback was positive about the services they received. Some of their comments included;

"Staff are great. They are kind and understanding"

"I have lived at a lot of places, some were good but this is the best"

Staff said they support each other and the company had policies and procedures in place to maintain their personal development.

Questionnaires and quality assurance monitoring processes were in place with positive feedback on the most recent; any points highlighted on analysis of questionnaires were addressed taking into consideration the objectives/targets for the home. The Director of Operations also receives the details of the outcome of the questionnaire.

Appropriate emergency and contingency procedures were in place, including routine fire drills, emergency staff briefing, & evacuation of the building.