This inspection was carried out on 16 March 2017 and was unannounced. During our previous inspection of 29 April 2016, we found that the service was not meeting the legal requirements in the areas we looked at. We rated the service as requiring improvement. The manager had written an action plan to address these issues and at this inspection we found that significant improvements in all areas had been made.

The service provides a 24 hour care environment for people with mental health needs and learning disabilities. The service supports people to develop essential daily and community living skills. At the time of our inspection there were three people living at the service. The service is registered to provide care for up to six people.

The service had a registered manager in post at the time of our inspection. 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.

The staff were aware of risk assessments and the safeguarding processes. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments regarding the managing of the service, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. Where people had been involved in incidents because of behaviour that could have a negative effect on others, the triggers for such behaviour had been identified and action taken to reduce the occurrence.

People received their medicines as they had been prescribed and there were robust procedures for the safe management of medicines.

There were sufficiently skilled and qualified staff on duty throughout the day and night to provide for people’s needs. Robust recruitment and selection processes were in place and the manager had taken steps to ensure that staff were suitable to work with people who lived at the service.

All staff received training to ensure that they had the necessary skills to care for and support the people who lived at the service and were supported by supervision and appraisals. Staff were encouraged to undertake training to gain professional qualifications.

People’s needs had been assessed before they moved to the service and they, their relatives and other healthcare professionals had been involved in determining their support needs and the way in which their support was to be delivered. Peoples consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People using the service were supported to decide what food and drink they had and a variety of food and drinks were available as were snacks at all times.

Other health professionals were consulted as necessary by the service staff to support people to meet their individual health needs.

Staff were understanding, empathic and protected people’s dignity. People were treated with respect and supported with regard to their individual needs.

All people were assessed prior to coming to service to check that the service could meet the person’s needs. On-going assessments were planned and were also arranged with immediate effect if so required. Information was available to people and relatives about how they could make a complaint should they need to do so.

There were reviews of the care provided with family members. Staff meetings were arranged, so that staff could discuss and be involved with the smooth running of the service. People and their relatives were asked for feedback about the service to enable improvements to be made. The service had a statement of purpose and an effective quality assurance s

The inspection took place on the 29 April 2016. Inspections are generally unannounced but we telephoned this service the evening before to check that people using the service would be available to speak to us and could be informed ahead of our inspection what the purpose of our visit was.

The service provides accommodation for up to six people who may require nursing, have a mental health need and might have an additional learning disability and behaviours which can be challenging.

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.

The service was last inspected in March 2013 and at the time was judged as compliant for the areas inspected. Since the last inspection our methodology has changed in line with changes to legislation and we now carry out comprehensive, ratings inspections. This was the first ratings inspection for this service. During this inspection we found:

There were enough staff on duty at all times to meet people’s needs and they were sufficiently familiar with their roles.

There were systems in place to ensure people received their medicines as required and at the time prescribed. Audits were in place but not particularly robust. Medicines were administered by trained staff but we saw no evidence that nurses were assessed to ensure they remain competent and up to date with best practice.

Staff recruitment processes were in place but not particularly robust in terms of ensuring staff employed had the right skills, attributes and understanding of the needs of people using the service.

The risks to people’s safety were managed but we felt staff did not always get the balance right between promoting people’s independence and proportionate risk taking.

Staff were supported through an induction process and training but we were not assured that the training was sufficiently robust or provided around the needs of people using the service. The fact that some of the staff were registered nurses was not sufficient. Care staff had not received training around mental health, epilepsy or learning disability. Support for staff was in place but we could not see evidence of how staff were developed and how good practice in the service was promoted.

People were supported to eat and drink but this was managed by staff and there was insufficient opportunity for people to be involved in menu planning to ensure their dietary needs were met and they had their food preferences. We saw at least one person whose weight was not closely monitored.

People’s health care needs were met through a number of different professionals but we were unable to see from records how closely people’s needs were monitored and if people always had regular access to all the health services they needed.

Staff spoken with did not have much understanding about the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and we did not see people being given meaningful choice. Applications had been made as required under Deprivation of Liberty Safeguards (DoLS) when it was considered to be in the person's best interest.

We observed staff working in a functional way and paying attention to rigid routines rather than supporting people in accordance with their wishes and preferences. People’s independence was not sufficiently promoted and there was not enough consultation with people about their wishes.

Care plans were in place and kept under review but we could not see how care was individualised or how changes in people’s needs were recognised and acted upon. This was not a progressive service which helped people reach their goals.

There was limited activity for people and we could not see from their records w

We found that the provider had systems in place to maintain the safety and welfare of service users. The service provides staff with specialised training to ensure the safety of people who used the service with specific medical needs.

We found that the service was being maintained to a sufficient standard which made the premises fit for purpose and met the needs of people who lived there. The floors were in good condition and free of trip hazards. The environment was free from any offensive odours.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people’s care was regularly reviewed and that additional provisions to support their care were provided where required.

We found that there was a sufficient number of staff on duty to meet the needs of people who used the service. The staff group employed by the service were consistent and the provider had not been required to recruit staff for several years which provided continuity of care to people who used the service.

We spoke with three people who used the service. People told us that they were happy living in the service. One person showed us their room and items they were proud of. People seemed comfortable in the environment they were living with and seemed at ease with staff.

We saw that consent to treatment for those detained under the mental health Act 1983 and those who were not detained was sought correctly. We observed interactions between people who used the service and staff and saw that staff were kind and caring. Staff knew key information about the people including their triggers for behaviours and how to reassure them.

We found that staff were knowledgeable regarding safeguarding of potentially vulnerable adults. Staff could clearly define the types of abuse and the procedures within the service.

We found that there were sufficient staff on duty. Provision had been made to ensure staffing numbers remained consistent.

We saw that the service had appropriate policies and procedures in place for the management of complaints.

People with whom we spoke confirmed that they were respected and involved wherever possible in their care by staff. People also stated that they felt happy in this hospital and that staff were kind and would respond promptly if any assistance was needed.

People with whom we spoke confirmed that they were satisfied with the care and treatment provided by staff. They felt able to approach staff if they had any concerns and that these would be addressed appropriately.

Two people said that they frequently went out into the community and that staff supported them to do so.