We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 18 September 2018 and was unannounced and was carried out by two inspectors.

The Mendips is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered for up to nine people. There were five people living at the home on the day of our visit.

There was a registered manager for the service. They were also the provider, and have been referred to as the provider throughout our report. 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 our last inspection in March 2016 we had found that staffing levels failed to ensure known risks to people from another person at the home were minimised. The staffing numbers had not been risk assessed to ensure the home was fully safe for people who could be aggressive towards each other.

At this inspection we found that actions had been taken to ensure that a safe number of staff were on duty at any time.

Formal quality checking audits were not up to date. This could put people at risk of receiving unsafe care if it was not being formally regularly checked and monitored. The provider acknowledged that quality checks were not up to date. However, they lived on the premises and they told us they had a constant and daily contact with the service and the people at the home. This in turn meant they were constantly informally reviewing and checking the services people received.

People told us they felt safe with the staff. People were very comfortable to approach the staff member and the provider thought our visit. This conveyed that they felt relaxed with them. People looked very relaxed and comfortable in the home environment. People told us they liked it being a small care home as it was like home to them.

Risks to the safety of people were identified and the staff had been on safeguarding adults training. This meant they knew how to identify the different types of abuse. Staff also understood the procedure for reporting concerns. Written risk assessments were in place that identified the areas where the safety of people could be at risk.

People received care and support that met their mental health and range of other needs. People were supported whenever possible to make their own choices and decisions in all aspects of their daily life. If people did not have full capacity to make decisions for themselves staff understood what to do to ensure that decisions made on behalf of the person were in their best interests. This showed that the home was meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. It also showed that the home was acting in ways that protected the legal rights of the people concerned.

The staff understood how to support people effectively. The staff team were caring and attentive in manner towards each person who lived at the home. People felt that staff and the provider were kind and caring toward them. The staff and the people we met told us they felt supported by the provider.

People were provided with the food and drink they enjoyed and they could make a choice. People were given discreet assistance if they needed support to

The inspection took place on 28 March 2016 and was unannounced. The service was last inspected in on 21 May 2015. This was a focused inspection and we found that the provider had taken action in order to meet the legal requirements from the comprehensive inspection in November 2014.

The Mendips Residential Home is registered to provide personal care and accommodation to up to nine people with mental health needs.

At this inspection we found that one person’s behaviours had changed over the last four months. This had lead to a number of potential and actual safeguarding incidents. These involved the person and other people at the home and sometimes staff. Due to the potential increased risks to people’s safety and that of staff the numbers of staff deployed should be reviewed as a matter of priority.

There was a registered manager for the service who was also one of the providers. 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 that all of the staff who assisted them were always kind and caring in manner. People interacted in a positive and warm way with the staff who provided them with personal care and other support.

People were assisted with their needs by staff who were monitored and supervised in their work. People also benefited because they were supported by staff who were trained to understand their needs.

People spoke highly about the care and support they received from the staff. Everyone we asked said that staff treated them properly and were kind to them.

Care records were informative and clearly showed what to do to effectively assist people with their personal care needs.

People were well supported to make complaints about the service that was provided if they were unhappy about any aspect of the service .

The staff knew what the provider’s values were for the service. The staff followed their values in their work. These included providing personalised care to ensure people were treated as unique individuals.

There was a system in place to ensure that checks on the quality of care and service were carried out. The concerns we found at the inspection in relation to staffing had been identified by the registered manager as part of their checks of the service .

We carried out a comprehensive inspection of The Mendips Residential Care Home on 19 November 2014. Five breaches of the legal requirements were found at that time. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

We undertook a focused inspection on 21 May 2015 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘The Mendips Residential Care Home’ on our website at www.cqc.org.uk

The Mendips Residential Care Home is a care home without nursing for up to nine adults with mental health needs. There were six people living at the home at the time of our 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 our focused inspection on 21 May 2015 we found that the provider had taken action in order to meet the legal requirements.

Action had been taken to improve the way people’s medicines were managed. We also found the documentation had improved in respect of people’s mental capacity. The records showed people’s rights were being protected in accordance with the Mental Capacity Act 2005.

People told us they could talk to staff or the registered manager about changes in their needs. Action had been taken since the last inspection to ensure people’s care plans were kept up to date. For example, a change in one person’s health had been recorded in their care plan and information added about how this affected their diet.

The provider was meeting the legal requirements by ensuring the Commission was notified of certain events. Audits were being undertaken in order to check standards in the home and to identify where any improvements were needed.

This inspection took place on 19 November 2014 and was unannounced. The previous inspection of The Mendips Residential Care Home was on 11 April 2013. There were no breaches of the legal requirements at that time.

The Mendips Residential Care Home is a care home without nursing for up to nine adults with mental health needs 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.

Improvements were needed in a number of areas. Although systems and procedures were in place, these were not always being followed in a consistent way which ensured good standards were maintained. This was evident in four of the five questions that we asked about the service.

People told us that they felt safe in the home. This was because they could talk to staff and staff were available to support them when needed. However, there were shortcomings in how health and safety, and risks to people, were being managed in the home. We also found that records did not clearly show that people’s rights were being protected in accordance with the Mental Capacity Act 2005.

People were supported to use the health services they needed. People liked the meals which were prepared by staff, but said they could make their own food and drinks if they wanted to. One person commented "Staff always ask what we would like to eat and it's never late."

People were responded to in a caring way. Staff and the registered manager spoke with people in a friendly and respectful manner. People received support to maintain good relationships with their relatives and others.

People had individual care plans which set out their needs and the support to be provided by staff. However, reviews of people’s plans and assessments were not being undertaken as planned. As a result, there was a risk that the care plans did not reflect people’s current needs and they would not receive the right care. People did not have plans for social activities and personal development although new documentation had been produced in connection with this.

New systems and procedures had been set up prior to our last inspection. These included checks on different aspects of the service as part of a new policy for quality assurance. We found that these new procedures were not being followed consistently and areas in need of improvement were not always being identified and followed up.

We found five breaches of regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we looked at those standards which were not being met when we last inspected the home in January 2013. At that inspection we had told the provider that they needed to make improvements in several areas, which included care planning, staff training, quality assurance and record keeping.

Overall, we found that there was a more organised and planned approach in these areas. People’s rights were being better protected, for example because of improved procedures for obtaining consent and for the reporting of incidents between people.

A new care plan format had been introduced; this showed a more ‘person centred’ way of supporting people who used the service. A staff member commented that the people’s care records were now “clearer and more structured”. We found that the records provided better information about people’s strengths and needs and the support that they wanted from staff.

People who used the service said that they felt settled in the home. One person told us “the best thing is the meals” and they said that vegetarians were well catered for. Meetings were being held when people could pass on their views about the home and their daily routines. A new system of monthly audits had been set up and this provided a means of monitoring the quality of service that people received.

A number of the essential standards were not being met when we inspected the home in May 2012. When we visited the home again on 10 January 2013 we found that the provider had not taken the action that was needed in order to meet these standards.

The areas of non-compliance included the arrangements being made for planning people’s care and for staff training. Standards in relation to consent and safeguarding were also not being met. Significantly, the provider did not have an effective system in place for monitoring their own performance on a regular basis.

One person who used the service told us that they were able to do some things independently. They said that they enjoyed visiting local cafes. We saw that other people were more dependent on staff to ensure that their health and care needs were met. We found that people’s care records were not being well kept. Overall, care and support was not being planned in a person centred way which reflected the needs of the people who used the service.

We had not planned to look at records as a separate standard however this was included because of the shortcomings we found during our visit.

People told us they had lived at the home for several years and had well established routines. People chose how to spend their time and did a lot of things by themselves. For some people this included going out on a regular basis, for example to the shops or to a nearby park. Other people were more dependent on staff; one person told us “everything’s organised here, staff cook the meals and keep the place clean”.

One person said “you’re allowed to be yourself here”. We were told that people received support which helped them with their relationships and with managing behaviour. However, we found that people’s support plans were not up to date and risk assessments did not take into account people’s current needs.

We were told about improvements that had been made in the home but found that more needed to be done. This included having a better system in place for monitoring the service.