This inspection took place on 28 September 2016 and was unannounced which meant the provider did not know we were coming. We last inspected the service on 23 September 2013 and found the service was meeting the legal requirements in force at that time.

SignHealth Bowfell Road is a residential care home based in Urmston, Salford. The service provides 24 hour support within an independent living environment for up to six deaf people with mental health needs. Each person lives in their own self-contained flat with a kitchen and a bathroom. There is a shared lounge, communal entrance and hallways, and a staff office. There is also a large outdoor space with car parking, seating areas, vegetable and flower gardens.

There was a registered manager at the service. 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.

People, their relatives and healthcare professionals were very positive and highly complementary about the quality of care and support provided to people at the service. People using the service told us they felt very safe living at the home. One person told us, “I get great support from staff, they are great at knowing me and how to motivate me. I'm very happy living here."

People at the service, relatives, staff and professionals spoke highly of the registered manager and the senior team who they said demonstrated a strong leadership and provided a ‘hands on’ approach to the care people received. They told us the provider and staff went above and beyond to ensure they received a person centred service.

The registered manager involved people, relatives and healthcare professionals to ensure people received the support they required and to make decisions that were in their best interests. Healthcare professionals told us, “We at the unit cannot praise the team at SignHealth Bowfell Road enough, they are an amazing team, they have a holistic approach to the care they provide both physically, psychologically and socially."

There was a strong emphasis on person centred care. Risk assessments and care plans were very person centred and written in plain English which made it easier for people to understand them and what their purpose was so that people could be fully engaged in progress towards agreed goals.

People were encouraged to become more independent in their daily living skills. People were particularly well supported to be part of the local community and to access educational and vocational opportunities.

Staff were very clear on the values of the organisation and service. They spoke of their “Mission” to get people properly integrated into the community. Promoting equality was a major thrust of the service.

Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks of taking particular actions over others, in order to support people to live fulfilling lives. Staff understood how to manage risks to people's health and supported them to develop and reach their full potential. Staff had clear guidance on the positive management of behaviours that may challenge the service and others which protected people's dignity and rights.

An outstanding characteristic for the service was the time spent developing ways to accommodate the changing needs of the people who used the service, using innovative and flexible ways to support people to move forward. Staff supported people to identify and manage their changing needs in a flexible way to ensure they made progress towards their recovery, and to manage their sometimes very complex physical health needs.

People’s healthcare needs were particularly well managed by this service. Staff worked as part of multi-disciplinary teams to support people with a

As part of our inspection we spoke with the registered manager, three members of staff and three people who used the service. We also spent time looking at care plans, staff personnel files and policies and procedures. All staff were trained in British Sign Language (BSL) and we communicated with people using an external interpreter.

We found people living at SignHealth were happy and felt well supported by staff. Some of the comments from people who used the service included; “I’ve lived here for two years and I am happy. I’m a lot calmer here and the staff are good. I’m supported with cooking, hovering and domestic tasks. I like to go out when I can and go into town. I have no complaints”. Another person told us; “I’m really happy. I have routine and I’m able to follow it whilst living here. I have worked in the past and I’m currently on a course at Salford College. The staff are nice they treat me well”.

We found the building was clean, tidy and odour free. People who used the service were responsible for cleaning their own bedrooms and this was checked by staff.

We looked at the recruitment procedures to ensure staff were recruited safely. We found CRB’s had been sought as well as references from previous employers.

During our inspection we found there were appropriate quality monitoring systems in place. This was done with the use of annual surveys, staff and tenant meetings and regular auditing which captured areas of strength and improvement.

In addition to the Expert by Experience, we were also supported on this inspection by a British Sign Language interpreter.

The people using this service told us they preferred to be known as tenants for the purpose of this report. We spoke to four tenants during our visit. They told us that they were happy living at SignHealth Bowfell Road and were satisfied with the service they received. One of the tenants told us, “I don’t want to move anywhere. I want to stay here till I die.”

The tenants said that staff respected their rights to privacy, dignity and independence and they were supported to lead the lifestyle of their choice. They told us that they felt safe and that they got on well with the staff who provided their support. In conversation with four tenants they said, “Staff good. If I am not happy, I ask them for help, like if I am not happy with someone or get on my nerve”, “I felt more comfortable, safe and independent”, “There one staff who is my favourite, any problem I go to her” and “I know what I am doing with my medication, have own chart and staff help me, I am happy”.

We found that the provider had good systems in place for safeguarding people from harm and for reviewing and improving the quality of the service. The staff team had received training that was appropriate to their roles.