The unannounced comprehensive inspection took place on the 14 December 2017.

The last inspection was an unannounced focused inspection that took place on the 7 September 2016. During that inspection we found that the provider had improved the quality assurance systems in the service and met a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that had been found during our inspection on 28 January 2016. Although we rated the service as Good overall we rated the Well-led question as requires improvement as we required a longer term track record of consistent good practice.

We found that during this comprehensive inspection on 14 December 2017 the provider had taken appropriate action to further develop and improve the quality assurance systems and processes of the service. The service had met all the key questions and rated good in each with an overall good rating.

Randall House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Randall House is registered to accommodate a maximum of five people who have mental health needs. Public transport facilities and local shops are located close to the home.

The service had a registered manager. A registered manager is a person who has registered with the 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 told us that they felt safe living in the home. There were procedures for safeguarding people and staff understood how to respond to possible abuse. Staff knew how to raise any concerns about people's safety so people were protected.

Staff were respectful and demonstrated an understanding of each person’s needs and abilities. People’s choices were respected and accommodated. People’s care plans were personalised and reflected their current needs. They contained the information staff needed to provide people with the care and support they wanted and required.

Arrangements were in place to ensure people received the service that they required from sufficient numbers of appropriately recruited and suitably trained staff.

People's medicines were managed safely by staff whose competency to administer medicines had been assessed.

People's dietary needs and preferences were supported by the service. People chose what they wanted to eat and drink.

People decided how they wanted to spend their time. People had the opportunity to take part in a range of activities. People’s individual needs and preferences were understood and respected by staff.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 [MCA]. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People knew how to make a complaint and told us they felt comfortable providing feedback about the service.

There was a management structure in the service which provided clear lines of responsibility and accountability. Checks were carried out to monitor and improve the quality and safety of the service and improvements were made when needed. Management staff told us that they were in the process of further developing the quality assurance monitoring and improvement systems.

We carried out an unannounced comprehensive inspection of this service on 28 January 2016. At which a breach of legal requirements was found. This was because the provider did not always ensure that people who use the service were protected by appropriate systems or processes to assess, monitor and improve the quality of services provided.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on the 7 September 2016 to check they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Randall House on our website at www.cqc.org.uk

Randall House provides accommodation and personal care for up to five people who have mental health needs.

At the time of our inspection the home had a registered manager. 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.

At our focused inspection on the 7 September 2016, we found that the provider had followed their plan and legal requirements had been met. The provider had taken action to address our concerns about lack of appropriate systems and processes to assess, monitor and improve the quality of services provided to people living in Randall House. The provider had made improvements to develop and improve the checks of the service which were carried out and management staff told us about further improvements to the quality assurance systems that were planned.

This inspection took place on 28 January 2016 and was unannounced. We last inspected this service on May 2014 when all the regulations inspected were being met.

Randall House can provide care and support to up to five women who have enduring mental health issues. At the time of our inspection there were four women in the home.

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.

People’s views about the service were sought. However systems were not in place to monitor the quality of the service.

People who used the service felt safe and staff were knowledgeable about the signs of abuse. Staff were trained to identify the possibility of abuse occurring and knew what actions to take to protect people.

There were sufficient numbers of appropriately recruited staff to provide care to people.

People received effective care because they had been involved in planning their care and staff knew how to meet their individual needs. People were supported to remain healthy because they received food and drink at regular intervals during the day and on request. People were supported to see a variety of health care professionals when needed and received their medicines as prescribed.

People were supported by staff that cared for them and treated them with care and compassion ensuring their privacy and dignity was maintained. People were supported to make day to day decisions and choices about meals, activities they were involved in and the treatments they received.

People were able to choose group or individual activities that best suited their needs.

There was an open and inclusive environment where people were able to express their opinions about the service they received. People were able to raise concerns and felt they were listened to and issues addressed.

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 the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

During the inspection we spoke with two of the four people who used the service. Two other people were spending time away from the home. We spent time observing and we spoke with a care worker, the administrator, the general manager, and two managers. Following the inspection we spoke with a relative of a person who used the service and two social workers.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe and staff were friendly. We saw staff interact with people who used the service in a respectful manner. A relative of a person who used the service and a social worker told us that they were confident that people were safe.

Staff understood their role in safeguarding the people whom they supported and they understood the whistleblowing policy.

The home had systems in place to identify, assess and manage risks related to the health, welfare and safety of people who used the service. People whose behaviour challenged the service were safely supported.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Management staff knew when an application for deprivation of liberty would need to be submitted for authorisation.

Checks of the premises and other health and safety checks were carried out.

Is the service effective?

People told us that they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the staff included “Staff help me when I need it,” “I know my care plan,” and “It’s nice here, I feel involved in decisions about my care.”

Staff told us that they were very well supported by management staff and there was good communication amongst staff about the service and people’s needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people’s safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed. However, it was not always evident from records that people had participated in the monthly reviews of their care plan.

Is the service caring?

We saw that people were supported by kind, attentive staff who approached people in a friendly manner. People living in the home told us staff were kind. People who used the service spoke about the staff and told us that “The staff are all nice,” “I am taking little steps at the moment and they respect that,” and “I can talk with them.” A relative of a person who used the service told us they felt people were well cared for and staff treated people with respect.

Staff were knowledgeable regarding the specific care needs of people and respected the choices that people made. Staff had an understanding of people’s cultural and religious needs and where appropriate, arrangements had been made to meet these needs. People’s privacy and dignity were respected. People took part in activities of their choice.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. People told us told us that they were listened to and felt involved in decisions about their care. People's care and health were monitored closely. Written notes about people's health and care were completed by staff. Appropriate action was taken by staff when people's needs changed.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

People who used the service told us that if they had any concerns or complaints, they would feel comfortable raising them with staff. People had the opportunity to provide feedback about the service.

Is the service well-led?

The home had an experienced registered manager who was supported by other management staff including a general manager who visited the home at least daily and who carried out monitoring checks of the quality of the service. These included checks of the care provided to people and the quality of environment. Improvements were made when needed.

The service promoted a positive culture that was open, inclusive and empowering. Staff meetings took place regularly so staff views about the service were taken into account. Staff were clear about their roles and responsibilities and were well supported by management staff. The management team had systems in place to keep staffing levels under review. Staffing numbers and skill mix met people’s needs.

During the inspection we spoke with all the people who used the service, two care staff, a senior care worker, an administrator, the general manager, two management staff and a social worker.

Each person who used the service had a plan of care that had been regularly reviewed, and included information about the individual support and care that people who used the service needed. People were involved in decisions about their lives including their plan of care and support. People told us that they were asked for their consent about matters to do with their care and treatment.

Staff knew about their roles and responsibilities in meeting the needs of the people they supported. We saw people who used the service approach staff without hesitation and people accessed their bedrooms and the communal areas of the home without restriction. Staff received appropriate support, appraisal and training.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

The home was clean and maintenance issues were attended to. There were systems in place to monitor the quality of the service and to make improvements when needed.

People told us that they received the care they needed and wanted and were positive about the staff that supported them. Staff knew about their roles and responsibilities in meeting the needs of people who use the service. Staff had a good understanding of the varied needs of people living in the home.

People had been involved in the assessment of their needs and were central to their individual plan of care and support. People’s preferences and goals were considered in relation to the care and support that they received. People received treatment and advice from a variety of health and social care professionals.

People told us they made decisions about their lives. We saw people make a number of choices. These included deciding what they wanted to eat, when they wanted to get up and what they wanted to do. People’s independence and skills were promoted and supported by staff.

People told us they felt safe and knew who to talk to if they had any worries or concerns. Policies and the training received by staff protected people from abuse.

Staff numbers and skills mix met people’s varied needs. Records were comprehensive, accurate and up to date.