We carried out an unannounced comprehensive inspection of this service on 8 and 10 August 2018.

The home is registered to provide accommodation and personal care for adults who have a mental health related illness. A maximum of 12 people can live at the home. There were 11 people living at home on the day of the inspection.

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 last inspection, the service was rated Good overall with the rating of Requires Improvement for safe. This was because the provider needed to improve their medication systems. The rating for safe remains as Requires Improvement following this inspection as medication management required further improvement and reporting procedures needed to be improved to ensure where required a notification was sent to CQC. We have made a recommendation about the management of some medicines.

The provider had a programme of audits in place to monitor the quality and safety of people’s care and support. The provider continually strived to make things work better so that people benefitted from a home that met their needs. However, further improvements are needed to demonstrate the provider’s overall governance on how reportable incidents are recognised and sent to the Care Quality Commission as part of their regulatory responsibilities.

People told they felt safe living at the home and that staff supported them to maintain their safety. Staff told us about how they minimised the risk to people’s safety and that they would report any suspected abuse to the management team. People got the help needed because staff offered guidance or support with their care that reduced their risk of harm.

There were staff available to meet people’s needs and respond to requests for support in a timely way. People told us they received their medicines from staff who managed their medicines in the right way. People also felt that if they needed extra pain relief or other medicines as needed these were provided. Staff wore protective gloves and aprons to reduce the risks of spreading infection within in the home.

People told us staff knew about their care and support needs. Staff told us they understood the needs of people and their knowledge was supported by the training they were given. Staff knowledge reflected the needs of people who lived at the home. People told us staff acted on their wishes and their agreement had been sought before staff carried out a task. People were supported to have 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 who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

People told us they enjoyed their meals, had a choice of the foods they enjoyed and were supported to eat and drink enough to keep them healthy. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us they enjoyed spending time with staff, chatting and relaxing with them. We saw people’s privacy and dignity was maintained. People’s day to day preferences were listened to by staff and people’s choices and decisions were respected. Staff knew it was important to promote a person’s independence and to ensure people had as much involvement as possible in their care and support.

People were involved in planning t

This unannounced inspection took place on 2 September 2015. At our last inspection in December 2013, we found that the provider was meeting the regulations that we assessed.

St Andrews Court is registered to provide accommodation, nursing or personal care for up to 12 people who are experiencing mental ill health. The home aims to provide a rehabilitation service to enable people to return to living independently. At the time of our inspection there were 10 people using the service.

The manager was registered with us as is required by law. 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.

Staff were provided with training and were knowledgeable about how to protect people from harm.

We found that medicines management within the service required some improvements in relation to the guidance available for staff in relation to ‘as required’ medicines.

There were a suitable amount of staff on duty with the skills, experience and training required in order to meet people’s needs. People and their relatives told us staff were available to provide the support they needed, when they needed it.

People’s nutritional needs were supported and monitored for any changes in their needs.

People subject to a Deprivation of Liberties Safeguard (DoLS) were supported in line with the terms of the authorisation.

We observed staff interacting with people in a positive manner. People, their relatives and professionals spoke to us about the genuine caring nature of the staff.

People told us they were encouraged to remain as independent as possible by staff. We observed that staff were respectful towards people and maintained people’s privacy and dignity whilst supporting them.

People were consulted about all aspects of the planning of their care and in relation to the daily activities they were involved in. Activities available within the service were centred on people’s rehabilitation needs, individual abilities and interests.

The providers complaints process was made available to people and their relatives in their contract with the service and was displayed on communal noticeboards for people to refer to.

The provider and registered manager undertook regular audits to reduce any risks to people and ensure that standards were maintained. Feedback was actively sought from people and others with knowledge of the service. This information was analysed and shared.

At the time of our inspection nine people lived at St Andrews Court. During our inspection we spoke with six people who lived there, five staff and the registered manager.

Everyone we spoke with was complimentary about the overall service provided, their care and the staff. One person who lived there told us, “It is good here. I can come and go as I want”. Another person said, “I would not like to have to go anywhere else to live I am happy here”.

We saw that people's needs had been assessed by a range of health care professionals including specialist doctors. This meant that staff had enabled people to have their health care and safety needs monitored and met.

People had been provided with varied food and drink options to prevent malnutrition and dehydration.

We found that the premises were spacious, adequately maintained, comfortable and safe.

Generally we determined that staffing levels were adequate to ensure that people’s needs were met and that they were safe.

We saw that complaints processes were in place for people or their relatives to use if they were not happy with the service provided.

There were five people living at the home when we carried out our inspection visit. We spoke with three people, two staff, the deputy manager and the manager of the home.

We saw that people were involved in making choices about what they wanted to do and what they ate and drank. One person told us that staff supported them to buy their clothes.

We found that people's care records provided an overview of people's needs and preferences. We found that people were involved in their care planning and a range of different activities. So that they were supported to do the things that were important to them. One person told us, "I was involved in my care planning”.

We found that arrangements were in place to ensure that people were safeguarded from abuse.

The provider ensured that staff were properly trained, supervised and appraised. Staff were properly supported so that they could provide safe care to people living in the home.

There was a system to monitor the quality of service people received through regular reviews and audits.