This inspection took place on 19 and 25 January 2018 and was announced. We gave the service 24 hours’ notice of the inspection because we wanted people to be available to talk to. The service is registered to provide accommodation and personal care for up to five people with enduring mental health conditions. At the time of the inspection there were five people in residence but one person was in hospital.

There was 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.

At the inspection in December 2016 we found improvements were required in practices around infection control and auditing the quality and safety of the services provided. Following the inspection the provider sent us an action plan about how they would address this and with set timescales. We found at this inspection things had improved and the overall rating had changed from requires improvement to Good.

People were safe. The staff team had received safeguarding adults training and knew what to look out for. The staff were aware of their responsibility to keep people safe, to liaise with community facilities used by people, and also how to maintain their own safety.

Risk assessments were completed for each person and ensured where risks were identified there were plans in place to reduce or eliminate the risk. There was a culture of learning following any accidents and incidents. Regular checks on the premises were undertaken to ensure the home and facilities were safe. Checks were also made of the fire safety systems, the hot and cold water temperatures and equipment to make sure they were safe for staff and people to use. Any repairs were attended to in a timely manner.

People were looked after by a small staff team, they had worked at the home for many years. Staffing levels were based upon the needs of the five people who resided in the service. The service had not recruited any new staff but would follow safe staff recruitment procedures to ensure they employed the right staff. The appropriate measures were in place to protect people from being harmed.

The management of medicines was safe. Staff who supported people with their medicines had received training and weekly stock checks of medicine supplies were undertaken. The measures in place to prevent the spread of any infection had improved so that people were protected from the risks of cross infection. However we have suggested checks on the bed mattresses be added to the infection control audit process.

The service was effective. People’s care and support needs were assessed to ensure the way they were looked after was effective. There was training programme for the staff team to complete and training was refreshed to ensure the staff had the necessary skills and knowledge to care for people correctly. The training programme included the Mental Capacity Act 2005 and the service worked within the principles of this. People were always asked to consent before receiving any support. The staff team were well supported by the registered and assistant manager and their work performance was monitored.

People were provided with sufficient food and drink and the staff team took account of their likes and dislikes in respect of food and drink. The staff took the appropriate action where people were at risk of losing weight. There were good arrangements in place to ensure people saw their psychiatrist, GP or other healthcare professionals as and when needed.

The service was caring. Staff knew the people they were looking after well and spoke respectfully about them. People were prompted and encouraged to maintain good personal hygiene, and to change their cl

This inspection took place on 10 December 2016. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in August 2013 here were no breaches of the legal requirements identified.

Proctor Residential Care Home provides accommodation and personal care for up to five people with mental health care needs. At the time of our inspection there were five people living at the service.

A registered manager was in post at the time of inspection. 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 were not supported in a safe and clean environment. The building and environment required maintenance and upkeep as areas of the home and grounds were not suitable for their intended use. There were no infection control audits undertaken. This meant that there were inadequate systems in place to manage and monitor the prevention and control of infection. The provider had not taken all reasonable steps to protect people and staff from acquiring infections and cross infection.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Safe recruitment procedures ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff members received regular training and supervision to enable them to carry out their duties.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.

People were supported to maintain good health and had access to external health care professionals when required.

People were supported by a small experienced staff team. Enabling relationships had been established between staff and the people they supported. Action plans to enhance people’s independence were promoted by the service and staff members.

People received care that was personal to them and staff assisted them with the things they made the choices to do. Care plans were written and agreed with individuals and other interested parties, as appropriate. Care records were personalised and described how people preferred to be supported.

Staff felt well supported by the registered manager. Staff were knowledgeable of all aspects of the service and felt they worked well as a team. The management team encouraged team work and staff felt listened to. Staff members have contributed towards changes to the service and have identified solutions and improvements, most often in the area of people’s behaviour.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection there were five people living in the home. However, only one person was at home during our inspection. We were told the other people were out engaged in their chosen community activity. The person we spoke with told us “I’m ok here I suppose".

The registered manager and the member of staff on duty were knowledgeable about the needs of people living in the home. The person at home moved freely around their own environment and accessed the community independently.

Records that we viewed confirmed that people were involved with their support planning and were asked for their opinion about the service they received.

We asked staff what it was like to work at Proctor House. Staff told us “the manager is approachable and deals with any problems that arise”. “I feel I have enough time to safely meet people’s needs”. “We look at doing the best for our clients and ensure they are comfortable”.

The provider had systems in place to monitor the quality of the service and completed regular audits on the service that people received.

We previously visited the home on the 13 June 2012 and found the provider was not meeting all of the essential standards.

We found non compliance in outcome 16; The provider did not have an effective system to regularly assess, and monitor the quality of service that people receive. We visited again on the 18 October 2012 and we found the required improvements had been made.

People we spoke with generally told us the care was good and that staff were" nice and helpful". One person told us "Yeah its good here, it suits me for now I want my own flat really, but its hard". Another person told us "I like it here".

The purpose of our inspection was to undertake a scheduled review and to also follow up the improvement relating to outcome 1 and outcome 14 and compliance actions relating to outcome 4 and outcome 7 served at the last inspection in February 2012. We saw that improvements had been made in all of these outcome areas since our last visit.

We used a number of different methods to help us understand the experiences of people using the service including talking with people who live there, talking with staff and the registered provider, looking at records, care files and observations of practice.

On the day of our visit three people who use the service were present and two people choose to speak with us. We also spoke with three members of staff.

One person said “Its ok here I can come and go and do my own thing, Staff are good here”.

We asked four people to tell us about the home and three people agreed to give feedback about the home. The people we asked told us they “liked living at the home.”

We were told that introductory visits before they moved to the home permanently took place. People were not able to say if they had a care plan about the way their needs were to be met.

People told us that they were able to make decisions about their care and treatment but some people had conditions imposed under the Mental Health Act 1983, as a Community Treatment Order (CTO) which they were able to explain to us.

We were told that people could leave the home independently and the staff accompanied people on health care visits.

When we asked people about the staff we were told they were respectful, for example knocked on their bedroom doors before entering. People said that staff knew how to meet their needs and the staff cared for them in the way they wanted.

We were told that the food was good and they had enough to eat.

People told us they would approach the manager with complaints and they felt “safe” living at home.