We inspected this service on 16 December 2016. This was an unannounced inspection. At our previous inspection in February 2016, we found that improvements were required to ensure people received care that was safe, responsive and well-led. The service was rated as ‘requires improvement’.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service have enduring mental health needs. At the time of our inspection 21 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

At this inspection, we found that the required improvements had been made.

Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

Risks to people’s health, safety and wellbeing were assessed and planned for. Staff knew how to keep people safe and risks were managed effectively to promote people’s safety.

Medicines were managed safely and people received their medicines as prescribed.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals when needed.

Staff knew people well which meant they could interact with them positively and effectively. People were treated with kindness and respect and staff promoted people’s independence, dignity and right to privacy.

People were involved in the assessment and review of their care and staff supported and encouraged people to participate in leisure and social based activities that met their personal preferences.

People knew how to complain about their care and an effective system was in place to manage complaints.

Effective systems were in place to assess, monitor and improve the quality of care. Feedback from people was sought to enable the provider to identify if improvements to care were needed.

The registered manager understood the requirements of their registration with us and they reported notifiable incidents to us.

This inspection took place on the 2 February 2016 and was unannounced. At our last inspection in August 2013 there were no issues identified in the areas we inspected.

The service offers accommodation and nursing care for up to 22 people with enduing mental health needs. At the time of the inspection 22 people were using the service. Not everyone was able to speak to us due to their communication difficulties.

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.

There were insufficient staff to keep people safe and to meet their individual needs. The registered manager was actively recruiting new staff using safe recruitment procedures.

People's medicines were not always managed safely. The provider could not be sure that people had their prescribed medicines at the times they needed them.

Risks to people were assessed and reviewed. However accurate records of all incidents were not kept to ensure that care being delivered was safe and appropriate.

People were not always treated with dignity and respect and their independence was not always promoted.

Systems the provider had in place to monitor the quality of the service were not always effective.

The provider followed the principles of the Mental Capacity Act 2005 and ensured that people were consenting to or being supported to consent to their care, treatment and support.

When people lacked capacity to make decisions, they were supported to make decisions in their best interests with support from their representatives.

People's health care needs were met and they had sufficient to eat and drink to maintain a healthy lifestyle.

People received care that was personalised and reflected their individual preferences. When people's needs changed, staff responded and reviewed the way they delivered care to them.

People's religious needs were met.

The provider had a complaints procedure and people and their representatives were encouraged to have a say in the way in which the service was run.

We carried out this inspection at Queensway House as part of our scheduled inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

During the inspection we spoke with four staff, one volunteer and two people living in the home. We looked at how staff gained consent from people and how their care and welfare needs were met. Staff told us how they always asked people before they did anything, for example, what they would like to do, what they want to wear or their choice of meal.

We saw that care records were up to date and showed the staff clearly recorded that the person’s needs were being met and how they were doing this with their consent. Staff told us about how they protect the people living in the home from abuse. They had a good understanding of what constituted abuse and how they would report it.

We spoke with two of the staff about how they were supervised at work. Both staff members told us that they were well supported by the management and senior staff. Both staff members had been through the annual appraisal system and they told us how they were encouraged to attend mandatory and extra training ensuring they developed their skills whilst working at the home.

We talked with the manager about the complaints process and how complaints were dealt with. There were no current complaints at the time of the inspection.

The emphasis at Queensway House is on rehabilitation, maintaining the skills of individuals and ensuring that links within the community were maintained. The accommodation was a mix of single rooms on the upper floor with individual bedrooms with a shared bathroom and some ground floor self-contained flats.

Some people living at the home were unable to fully communicate with us, due to their health needs, so we used a short observational framework tool (SOFI) to observe the support they received and how they responded to it.

An expert by experience took part in this inspection and talked to the people who used the service. Our experts by experience are people of all ages, from diverse cultural backgrounds who have used a range of health and/or social care services. They looked at what happened in the house groups and what it was like to live there. They wrote a report about what they found and details were included in this report.

We saw that documentation was up to date and reflected the current condition of people living in the home. We saw that staff were trained to safeguard people from abuse and had a good understanding of what constituted abuse and how to look for signs. We spoke with staff that told us they enjoyed their work and they were able to discuss their individual roles and responsibilities. The results of a questionnaire, sent to relatives demonstrated almost full satisfaction in all areas.

Information we hold about the home showed that we needed to undertake a monitoring visit in order to update our records and to establish that people's needs were being safely met.

People who live in the home have different forms of mental health needs, so we were unable to discuss their care with them. Where people were not able to express their views to us, we observed the interaction between people and staff and how people chose to spend their time.

We saw that the staff supported the people using the service to remain independent. We saw one person who had been at the home only a few weeks talk with the care manager and they arranged to meet for a private coffee in the next few days. The person told us “They are all very friendly, that’s the boss you know?”

We observed people using the service doing varying activities. Some people were relaxing watching the television, some were sitting in the dining room having a chat and a coffee and some were talking to staff. The staff encouraged people to make choices throughout their day and we saw that the unit was led by the people living in it, and the staff were there for guidance.