About the service: Syrian House is a care home supporting up to 17 people with mental health needs. At the time of inspection, there were 17 people being supported by the service. The home is set in well-maintained grounds in a quiet, suburban area of Sale, Trafford. The home is close to local amenities.

People’s experience of using this service:

People felt safe while being supported by the staff team at Syrian House. Relatives also confirmed this. Staff had received training to enable them to spot and report any allegations of abuse. Staff were confident they could report any concerns and they would be acted upon.

Risk assessments were in place to mitigate the risks people presented. The risk assessments were regularly reviewed and involved people. Staff were aware of what risks people presented and could describe strategies in place to reduce risk to effectively support people.

Staff were recruited safety and had the appropriate pre-employment checks in place prior to commencing employment. Staff received regular supervision and training to enable them to carry out their job role.

The premises was regularly inspected to ensure it complied with lift, fire, infection control, gas and electrical regulations.

People received a thorough assessment of their needs to ensure the service was suitable for them. People’s choices and preferences were captured on assessment and fed into care plans.

People were supported to receive a healthy and nutritious diet. People were given choice of what they wished to eat and had free access to drinks and snacks.

The service acted in line with the Mental Capacity Act 2005 and ensured people’s capacity to make particular decisions were assessed. Where people could not make a decision and were being deprived of their liberty, appropriate referrals were made under deprivation of liberty safeguards.

People were supported to receive health surveillance and were supported to attend health and medical appointments when required.

We observed kind and caring interactions between people living at Syrian House and the staff team. People and their relatives told us, they felt cared for and the staff were kind to them. People were at ease with staff supporting them and staff had a good understanding of how to support people with their mental health needs.

Care plans were detailed and involved people and their relatives. They were regularly reviewed and updated to ensure accuracy.

People had access to a wide range of internal and external activities. People were supported to access the local community and were risk assessed to enable them to leave the home unsupported.

People and relatives knew how to make complaints and felt they would be listened to. No complaints had been received by the service since the last inspection. People felt comfortable to speak to the registered manager and staff which enabled any minor concerns to be dealt with promptly.

The registered manager had oversight of the service and monitored the quality of the service to ensure they provided high quality care.

People, relatives and the staff felt the registered manager was approachable and supported the staff team well.

Rating at last inspection: The last inspection of this service was on 14 and 16 September 2016 and was rated good in all of our key questions. The report was published on 14 November 2016.

Why we inspected: This was a scheduled inspection as part of our inspection process.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit, as per our programme of inspection. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The unannounced inspection took place on 14 September 2016 and was followed by a second announced day on the 16 September. We last inspected Syrian House in July 2014. At that inspection we found the service was meeting all the regulations that we inspected.

Syrian House is registered to provide accommodation and personal care for up to 17 people. The service specialises in supporting people with enduring mental health needs and there were 14 people living at the service when we visited. Syrian House is a large detached property set in extensive, well maintained grounds within a quiet residential area. There are communal toilets and bathrooms for people to use. All bedrooms are for single occupancy with washbasins and one bedroom has ensuite facilities. There are communal areas, including lounge and smoking areas, a dining room and a large garden for people to use.

The service had 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 told us they felt safe living at the service and that any personal items remained safe too as bedrooms could be locked when they were not present.

The management of medicines followed safe working practices and people received their medicines on time and how they wanted.

Staff were aware of safeguarding responsibilities and knew how to implement safeguarding and whistleblowing procedures. The provider took safety seriously and risks identified were assessed and reviewed and people were kept as safe as possible. Accidents were recorded, reported and monitored by the provider.

Risk assessments were in place to ensure that people could be safely supported at all times. If accidents or incidents had occurred, these were recorded and monitored for any learning and staff had acted swiftly to address any additional needs that arose. For example, when a fall had occurred, emergency treatment was sourced when necessary.

There were enough staff employed at the service who had been recruited safely, who received appropriate support and who were continually trained to meet the needs of the people using the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. We found the provider was complying with its legal responsibilities.

People were able to enjoy enough food and refreshments to meet their needs and if people needed additional support from staff, this was provided. Special dietary needs were also catered for. People were supported to access a range of health care professionals. Examples included appointments with their GP and visits to hospital for any emergencies arising and also scheduled appointments with specialist practitioners.

We observed staff speaking with people in kind, respectful and reassuring ways. People told us they felt their dignity and privacy were respected by staff. They also told us staff encouraged them to be as independent as possible and involved them with the running of the service and to be fully informed as to what was happening.

People’s had been assessed for their needs and their care and support records were detailed and had been updated as the need arose.

The provider had a range of activities for people to participate in if they chose to. People were also able to facilitate their own activities away from the service, either on their o

The inspection was carried out by one inspector. 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?

Is the service effective?

Is the service caring?

Is the service responsive to people’s needs?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, looking at records and information from Trafford Council and Community Mental Health team.

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

Is the service safe?

Syrian House provides support for up to 17 people with mental health needs. The premises are located in a quiet residential area of Sale. The building belongs to Trafford NHS Property Services Limited. The manager has a contact person to liaise with when any major repairs are required. Day to day maintenance is undertaken by the maintenance person who works at Syrian House.

The premises were clean, tidy and well maintained both inside and outside of the building.

Training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) took place which ensured that people who were not able to make decisions or choices were protected and kept safe. Best interest meetings and any other legal requirements such as applications to DoLS or guardianships are completed in conjunction with other health care professionals such as social worker and community psychiatric nurse.

We saw people had received an assessment of their care needs and that these had been discussed with the person concerned.

There were a sufficient number of people in the staff team to ensure that people were supported with their care needs.

Is the service effective?

Training was in place that ensured services were provided at Syrian House by a qualified staff team with up to date skills to provide support. National Vocational Qualifications (NVQ) and mandatory training which included moving and handling, safeguarding adults, infection control, mental health awareness, health and safety were all completed by the staff team.

We saw from looking at the care plans that people had received an assessment and that there was a good understanding of the person's needs and the support they required.

Everyone had their own room which they were able to personalise and receive visitors.

Is the service caring?

All of the people we spoke with were happy with the service and the care provided.

We spoke with two people who used the service and two family members. They told us that the staff team were very welcoming. Comments we received; “I feel that my relative is comfortable and safe and feel that they are respected by the staff; I am always made to feel welcome;” “I like living here the staff are wonderful and work hard;” “I am kept informed about everything;” “The staff get the GP for me or help me to go to the surgery when I need it."

We observed during our inspection people being treated with respect and patience.

People’s preferences were recorded in the care plan and they were able to express their views and opinions through talking to members of the staff team, taking part in reviews and resident meetings.

Is the service responsive to people’s needs?

We saw that people’s needs were assessed before they were offered a place at Syrian House.

The support to be provided and the recovery programme were agreed with the person and documented on the care plan.

A service user involvement worker employed by the organisation visited Syrian House every month. During these visits they conducted ‘Building Skills Workshops’. These covered such areas as ‘Introduction to Budgeting’ and ‘Communication Skills’.

Is the service well led?

Syrian House is part of the wider organisation Making Space Limited which is a registered charity.

Surveys were conducted regularly and replies were analysed in order to improve the service provided.

Every month there was a resident meeting where items regarding food, trips out and safeguarding were discussed.

A representative of Making Space Limited visited the home every month and completed a quality monitoring report. The report covered such areas as; record keeping, safeguarding and safety.

The organisation had the Investors in People (IIP) Accreditation. IIP assess and accredit organisations on the management and quality of the service they provide to both people who use the service and those who work for the service.

Syrian House had also been awarded The Dignity in Care Award by Trafford Council.

We found there were appropriate systems in place to ensure that consent to provide care and treatment had been obtained.

We looked at the service’s policy on consent and found it to be comprehensive and detailed.

One visiting relative told us; “I think it is nice, no concerns with staffing or management. I’m quite happy for X to be here. If he had any concerns he tells me, nothing major though.”

Care was planned and delivered in a way that was intended to ensure people’s safety and welfare during their stay.

We spoke to people about the quality of food and comments included; “The food is very good quality,” “I think it is good most of the time,“ “I’m very happy here and like the food” and “The food is excellent and the current cook is the best one we have had.”

We did not observe anyone who used the service who gave any cause for concern in relation to nutrition and hydration.

We looked at five staff personnel files and found robust checks had been undertaken prior to the commencement of employment of any new staff.

We found that the provider had systems in place to monitor the quality of the service they provided.

We found that the provider had effective systems in place to record, respond and investigate any complaints made about the service.

We found a large well maintained, bright, airy environment where residents told us they feel safe and well cared for. The home had 17 rooms 1 of which is ensuite and 10 bathrooms across 2 floors. The dinning room had recently been refurbished and the plan was to refurbish the remaining communal areas, the residents had been involved in choosing colours and decoration. People we spoke to were happy with the care and support offered and said they got on well together.

People told us: "I've been here 4 years and its as good as living alone but you have support when you need it". "We have kittens here the manager bought them for us and we all look after them we love them". "Everything here is perfect".

People who talked to us were happy to be living or working at Syrian House, and we saw that the service promoted their wellbeing and safety.

They told us:

”Nothing needs to change, I’m content, no problems.”

“I feel safe and can rely on staff for a chat and company.”

“We can build strong friendships between the residents, we help each other out, and we have a lot to offer each other.”

And

“I like coming to work everyday.”

We found that the service at Syrian House was compliant with the essential standards of quality and safety which were assessed. We found that the manager and staff were competent and had a positive attitude and enthusiasm towards supporting people at Syrian House.