This unannounced inspection took place on the 21 and 26 July 2017.

Support for Living Limited - 43 Shirley Gardens is a care home for seven people with mental health needs. Support for living Limited is an organisation with a number of services for people with mental health needs. At the time of our inspection there were seven people living at the service.

At the last inspection on the 27 August and 1 September 2015, the service was rated Good. At this inspection, we found the rating remained Good.

People spoke positively about the registered manager and staff. The registered manager spoke passionately about improving people’s wellbeing and staff were caring and kind in their approach.

People’s care plans contained their views and stated how they wished to be supported. Staff reviewed care plans on a regular basis.

Staffing needs were assessed to ensure people had adequate staff support when it was required. The staff recruitment procedure was robust to ensure the safety of people who use the service.

People told us they felt safe and staff had received safeguarding adults training so they knew what to do if they suspect people were at risk of abuse. People had risk assessments in place to minimise the risk of harm to them and others.

Staff had received training to administer medicines and people’s medicine administration records were completed without errors or omissions.

The service was clean and well –maintained and staff had received infection control training to prevent cross infection.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005. 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.

Staff received appropriate training and confirmed they received supervision sessions and appraisals to support them to undertake their role.

Staff told us about people’s mental and physical health and the support they required to keep well. Staff supported people to access the appropriate health services in a timely manner. There was close liaison between the service and mental health professionals.

Staff supported people to eat a nutritious and healthy diet and remain hydrated.

The service was well-led, the registered manager was well thought of by staff and people. People and staff said they felt comfortable in raising concerns and knew how to complain. Auditing and checks took place to ensure the quality of the service.

The service worked in partnership with the health and social care professionals and the commissioning body.

We spoke with three people using the service, four staff and one healthcare professional. At the time of inspection there were six people using the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

All the people we spoke with said they felt safe and they were able to raise any concerns with the staff. Risks to individual people had been assessed; plans were in place and reviewed to maintain people’s safety. These were personalised and individual people had been involved in their own risk management. The premises were clean and well maintained. People were involved in making decisions about all aspects of their care. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and were aware of their responsibilities in relation to Deprivation of Liberty Safeguards. They were able to describe the process to make sure that the right professionals were involved in taking decisions in the person’s best interests.

• Is the service effective?

People told us that staff supported them and, where they had raised concerns about their safety, the staff had listened and acted upon these. People’s needs were regularly reviewed and care, treatment and support plans reflected people’s needs choices and preferences. One person told us “we are involved in all decisions regarding our care”. Staff worked closely with other healthcare professionals so that people received safe and coordinated care, treatment and support. People had been involved in decisions regarding some areas of redecoration. Information on advocacy services available to people was clearly displayed.

• Is the service caring?

People told us the staff were kind and caring. We saw that the staff offered people choices and treated them with respect. Personalised care plans were in place and identified individual needs and preferences. This meant that care was provided in accordance with people’s wishes. People were involved in the development and review of their care plan. Staff supported people to attend appointments with other healthcare professionals. The healthcare professional we spoke with said the staff had a caring manner and always sought advice if they were unsure about a person’s condition.

• Is the service responsive?

Staff responded to people’s changing needs. We spoke with one health professional who was involved in the care of people living at the home. They told us that staff contacted them for advice and support when needed and this had helped make sure people’s healthcare needs were met. They said staff assessed people’s needs, were proactive and responsive to any changes. Regular care reviews were held and any changes to the care planned was discussed and agreed with the individual person concerned. People told us they liked to participate in individual activities and that staff were supportive if they wanted to carry out a new activity.

• Is the service well led?

Governance and quality assurance systems were in place. The provider had an overview of the performance of the service and areas that required improvement. There was good partnership working with other stakeholders. People using the service said that it was well managed. Staff had a good understanding of their roles and responsibilities. They spoke positively about person centred care and valuing people’s diverse needs. CQC had not been notified of three notifiable incidents. Staff had taken action to maintain the safety of the people involved.

During the inspection we talked with four people using the service and three members of staff to find out about the service provided in the home.

The previous inspection visit on 19 December 2012 had found that outcomes 4 and 16 of the essential standards of quality and safety were non-compliant. During this inspection we found that the provider was complying with the outcome areas we assessed. We found that improvements had been made to ensure that people’s needs had been assessed and care was planned and delivered to meet people’s individual needs. Improvements had also been made to ensure that effective systems to assess and monitor the quality of the service were in place.

People told us they had been involved in the review of their care plan and risk assessments.

The provider had in place appropriate arrangements for the management of medicines. There were sufficient staff on duty to meet the needs of the people using the service.

People using the service told us that improvements had been made since our last inspection such as the decoration and new flooring in the communal areas.

There was an effective complaints management system in place. People told us they had “no complaints”.

We spoke with five people living at the service and five members of staff, including the manager.

People told us they liked living at the home and that they had choices about where they spent their time and what activities they participated in. One person told us “I’m well settled here”. We observed staff interacting with people in a positive and respectful manner. Two people that we spoke with said the staff were “good” and “alright”. One person said “the staff encourage us to express ourselves. We can tell them anything”.

People told us they attended care reviews and were involved in the development of their care plan. We found that people’s needs were not always assessed and care and treatment was not planned and delivered in line with their individual care plan. This meant that they were at risk of receiving unsafe and inappropriate care.

People told us they felt safe in the home. The provider has taken steps to provide care in an environment that was suitably designed and adequately maintained.

Effective systems to regularly assess and monitor the quality of services provided to people and to identify, assess and manage risks relating to the health, welfare and safety of people were not in place.

People said the staff “understand me” and listen to me if I need to talk to them. People said they had seen their care plans and agreed to their contents.

People told us that they were encouraged to make choices and decisions about their lives. People said they were able to go out alone and attend appointments. They also reported that staff were available to them if they needed support.

People confirmed that they knew the medication they were taking and the side effects. They said they were happy for staff to look after their medicines.

People said they were asked about their views about the service and attended meetings where they could voice their opinions.

This inspection took place on 27 August and 1 September 2015 and was unannounced. At the last inspection on 10 April 2014 we found the service was not meeting the regulation relating to notifications. At this inspection we found that improvements had been made in the required area.

43 Shirley Gardens is a care home which provides accommodation and personal care for up to seven people. The service specialises in the care and support of adults who have mental health needs. At the time of our visit there were six people using the service. 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. However, the registered manager was on long term leave and an interim manager was in post, we have referred to them as the manager throughout the report.

People told us they felt safe and that staff worked with them to keep them safe in the home and in the community. Staff were knowledgeable about how to recognise signs of potential abuse and aware of the reporting procedures.

Assessments identified risks to people and management plans to reduce the risks were in place, these were regularly reviewed to minimise potential harm to people using the service.

Recruitment processes were thorough and included checks to ensure that staff employed were of good character, appropriately skilled, and physically and mentally fit. There were appropriate numbers of staff to meet people’s needs and provide a safe and effective service.

People received care and support from staff that had the required skills, knowledge and training to meet their needs effectively. Staff support was provided through a programme of supervision and appraisal.

Safe arrangements were in place for the management of medicines and people received their prescribed medicines when they needed them.

People had been assessed as to whether or not they had capacity to make decisions and consent to care and treatment. Staff understood and had a good working knowledge of the key principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They put these into practice effectively, and ensured people’s human and legal rights were respected.

People were supported to eat and drink well and stay healthy.

Staff monitored people's health and wellbeing and sought advice and assistance from other health and social care professionals promptly if they had any concerns.

People had positive relationships with staff who treated people with kindness, dignity and respect. Staff knew the people they cared for well and were committed to helping them achieve a good quality of life.

People received care that was based on an assessment of their needs and preferences. They were involved in all aspects of their care and were supported to lead their lives in the way they wished to.

The management team provided good leadership and direction so that people received safe and effective care that was responsive to their needs. People and staff told us the management team were approachable, inclusive, and supportive. The service had an open and transparent culture, with clear vision and values.

The provider had effective systems in place to monitor the quality and safety of the service so areas for improvement were identified and addressed.