We inspected The Talbots on 11 and 14 January 2019. The first day of the inspection was unannounced. The home supported people with mental health conditions and could accommodate up to 16 people. At the time of the inspection there were two people in hospital and 14 people living in the home.

The Talbots 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 home is in a residential area in the centre of Norwich. Two semi-detached properties have been joined to make a large home over three floors. There were large communal areas to the ground floor including a lounge and conservatory. The staff did not have a separate office and sat in the main communal areas at all times. There was a large domestic kitchen and laundry area on the ground floor. Bedrooms and communal shower and bathrooms were on the upper floors as well as toilets on the ground floor.

The Talbots had a registered manager who lived on site in a self-contained flat above the home. 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 in November 2017 we found one breach in how the home was managed and found there was not an effective system of quality audit and assurance. We found this was still the case at this inspection.

A recommendation was made at the last inspection to ensure staff received up to date training to meet people’s needs. We found this had been done at during this inspection.

The home is in a residential area in the centre of Norwich. Two semi-detached properties have been joined to make a large home over three floors. There were large communal areas to the ground floor including a lounge and conservatory. The staff did not have a separate office and sat in the main communal areas at all times. There was a large domestic kitchen and laundry area on the ground floor. Bedrooms and communal shower and bathrooms were on the upper floors as well as toilets on the ground floor.

The Talbots had a registered manager who lived on site in a self-contained flat above the home. 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 in November 2017 we found one breach in how the home was managed and found there was not an effective system of quality audit and assurance. We found this was still the case at this inspection.

A recommendation was made at the last inspection to ensure staff received up to date training to meet people’s needs. We found this had been done at this inspection and more training was scheduled.

Whilst we did not give any other recommendations we found a number of issues with other aspects of how the service was delivered. This included a lack of protocols for people taking medicine as and when required and a lack of risk assessments to support people in the home with their health and safety.

We had concerns that appropriate action identified to address issues with the health and safety of the building and environment had not been taken. This inspection found action had been taken in this area and whilst further action was required, recent steps assured us the home and environment were safe at the time of the inspection. However, we had concerns as the assessment of risks to people’s health and wellbeing in line with their care plan we

This inspection took place on 10 October 2017 and was unannounced.

The Talbots provides accommodation and care for up to 16 people, many of whom may be living with mental health and/or learning difficulties. At the time our inspection there were 16 people living in the home.

A registered manager was 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.

We had previously inspected this service on 29 June 2015 and found that regular quality monitoring was not recorded, people’s medicines were not managed appropriately and that daily records were written in a disrespectful way. We found during our most recent inspection that steps had not been taken to address these issues.

We found that the provider was in breach of one of the regulations. This was because there was no robust system in place to monitor and assess the quality of service being delivered. People’s care records were not audited and quality monitoring checks in relation to the general safety of the service were not thorough. Staff training records showed that most staff had not had refresher training in the courses the provider expected them to attend.

Risk assessments were not in place where risks to people’s health or wellbeing had been identified. Risks within the environment were carried out on an annual basis. However, these checks did not cover all areas of the home. Regular sampling of water was not carried out and the only inspection that was carried out on the water system was done on an annual basis. We found that all other utilities and fire equipment had been regularly serviced.

Not all members of staff had received the necessary training to administer people’s medicines in a safe way and there was no formal checking in place to assess staffs’ competency in this area. In addition to this, there were no PRN protocols in place and people’s medicines and their associated records were not audited.

People’s care records did not contain sufficient detail about their physical and emotional care needs. We also saw that daily notes written about people were not done so in a respectful way. However, staff knew people’s care needs well and treated people in a kind and caring manner.

People were involved in reviewing their care and were able to make choices about the care and support they received. Staff supported people to be as independent as possible and people were able to continue with their hobbies and interests in and outside of the home.

The Talbots is a care home registered to provide accommodation and personal care for up to 16 people who have mental health support needs and/or a learning disability. There were 15 people living at the home at the time of our visit. The home is two converted houses that have been knocked through to make one home and accommodation is provided on two floors with stairs as access. There are internal and external communal areas, including a lounge / dining area, a conservatory, an outside smoking area and a garden for people and their visitors to use.

This inspection was carried out on 29 June 2015 and we gave the service 24 hours’ notice of our inspection. Our last inspection took place on 28 August 2014 and as a result of our findings we asked the provider to make improvements to requirements relating to workers, supporting workers and assessing and monitoring the quality of service provision. We received an action plan detailing how and when the required improvements would be made by. During this inspection we found that the provider had made the required improvements.

There was a registered manager in place. They had been in post since October 2010. 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. The management team were aware that they needed to safeguard the rights of people who were assessed as being unable to make their own decisions. People were not deprived of their liberty as people had capacity to make their own decisions and to come and go from the home as they wished.

People who lived in the home were supported by staff in a kind way that maintained their safety, but also supported their independence. People’s daily notes, in which staff recorded how they supported people, were sometimes written using language that was disrespectful to the person they were supporting.

People had care and support plans in place which recorded their likes and dislikes, needs and wishes. Risks to people were identified by staff to enable people to live as safe and independent a life as possible. There were arrangements in place for the safe storage, disposal, management and administration of people’s prescribed medicines.

There was an ‘open’ culture within the home. People and staff were able to raise any suggestions or concerns that they might have had with the management team or the registered manager and feel listened too.

There were a sufficient number of staff on duty. Staff were trained to provide effective care which met people’s individual care and support needs. Staff understood their role and responsibilities to report poor care. Staff were supported by the registered manager to maintain their skills through supervision, appraisals and training.

The registered manager had in place a quality monitoring process to identify areas of improvement required within the home. However, these checks were not formally recorded.

One adult social care inspector undertook the inspection of The Talbots. At the time of the inspection there were 16 people using the service.

We spoke with six people who used the service, the registered manager and two care staff. We reviewed three people’s care records and three staff files. We also reviewed a selection of other records that included the complaints procedure and accidents and incidents.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. At the time of this inspection no person was subject to a DoLS authorisation.

The registered manager told us that all of the people who used the service had mental capacity and could make their own decisions. This was reflected in people’s care records and each person had signed their care plan in agreement with it.

People’s care records showed that their needs had been assessed and that care and treatment was planned and delivered in a way that intended to ensure their safety and wellbeing. We noted that the care plans were reviewed on an annual basis. Some people’s risk assessments however, had not been reviewed within an appropriate time scale.

Medicines were managed in an appropriate and safe manner. All of the staff who administered medicines had received the appropriate training. We reviewed the Medicines Administration Records (MARs) for nine people and found these had been completed appropriately with no gaps.

The information provided to us by the manager showed that there were significant shortfalls in relation to staff undertaking mandatory training. This training is designed to ensure people have their care and support needs met by competent people. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to supporting workers.

Effective recruitment procedures were not always in place. We found that the provider had not undertaken the appropriate recruitment checks for three people who had commenced employment within the last year. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to the requirements relating to workers.

The service had an effective system in place to manage accidents and incidents. We saw evidence that these were audited by the manager and actions were taken to reduce the risk of further occurrences.

There were processes in place to collect people’s views about the care and support people received. Satisfaction surveys had been sent out to the people who used the service, their general practitioners and staff. We noted that there were positive comments about the service on all of the returned questionnaires.

There were procedures in place to manage and mitigate foreseeable emergencies. These included procedures in relation to fire and evacuation and the loss of lighting.

Is the service effective?

People’s care records demonstrated that their needs had been assessed and there were some risk assessments in place in relation to their activities of daily living.

Plans of care were updated on an annual basis. We found that not all of people’s risk assessments had been reviewed and updated in a timely manner in order to reflect any changes in people’s needs. This has been highlighted to the provider.

People’s records included information about the involvement of other health and social care professionals. This helped to maintain multidisciplinary working to help ensure that all of the person’s needs were being met.

Is the service caring?

We spoke with six people who used the service and they told us that generally, they were happy with the care and support that they received. One person said, “I am happy here and get on well with everyone. The food isn’t as good as it used to be. The staff are alright; there is always someone to talk to. I don’t have any worries.” Another person said, “I go to church regularly. The food here is good but very repetitive and there’s not much choice. The staff are good.” A third person we spoke with said, “I like it here and I have been here for a while. The staff are nice but the staff have changed a lot which is unsettling.”

During our inspection we observed positive interaction between the staff and the people who used the service. It was evident that the staff knew the needs of people well. People’s privacy and dignity were maintained at all times and staff showed compassion and respect towards the people they supported.

Is the service responsive?

People’s needs were assessed and the planned care and support reflected these needs. The people we spoke with who used the service told us that the staff assisted them to maintain as much independence for themselves as possible. This was reflected in people’s care plans and the activities that people chose to undertake.

The service had a complaints procedure. Although the service had not received any written complaints, there was evidence that the provider took account of any verbal concerns to improve the service. All of the people we spoke with told us that they felt confident to raise any concerns or issues that they may have.

Is the service well-led?

The care staff we spoke with told us that they felt well supported and that the manager was approachable. We noted that staff meetings were held on a three monthly basis. However, there were no minutes or action plans in relation to these. We also found insufficient evidence to show that staff had received supervisions and appraisals. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to supporting workers.

The service has a system in place for monitoring the quality of the service. This included audits in relation to medicines management and the reporting of accidents and incidents. The provider also used satisfaction surveys and questionnaires to obtain people’s views about all aspects of the service.

We spoke with people living at The Talbots. One person told us, “They look after me well.” Another person said, “We have rules and they [staff] have rules. It’s all fair and it works out.” A third person told us, “It’s okay here. [The day to day manager] is great.” Another person told us, “I like being here.”

We spent most of our time in the main lounge and were able to observe how people spent their time at the home. If people wanted to spend time alone there was space for them to do so without needing to go to their room. We found people were engaged in a wide variety of activities when outside of the home.

People’s records held detailed information including assessments of needs and how care was to be planned to meet these needs. Risk assessments were also in place and plans were in place to minimise identified risks. Staff knew people well and could identify when their mental health was changing and take the necessary action. We saw that staff supported people whilst enabling them to be as independent as possible.

We were satisfied that the premises and surrounding grounds were well maintained. This meant that people living, working or visiting The Talbots were not at risk because plans were in place to ensure their safety in relation to the environment.

The home ensured that staff were appropriately vetted prior to people commencing work.

The provider had systems in place to assess and monitor the service they were providing.

We saw that people had been involved in their assessments and had signed their own care plans wherever possible. One person told us, “I am well supported by staff and if I have any concerns I know that I will be listened to”. This showed us that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The individual care records reviewed demonstrated that people’s care needs were recorded in detail and that they were being met in line with people’s assessed needs. This showed us that people experienced care, treatment and support that met their needs and protected their rights.

Everyone we spoke with was complimentary about the quantity and quality of the food provided. This demonstrated to us that people were protected from the risks of inadequate nutrition and dehydration. People told us that the staff were supportive and responded promptly if assistance was needed. This showed us that there were enough qualified, skilled and experienced staff to meet people’s needs. Staff spoken with were aware of how to address any complaints that they received or were aware of and could outline how they would address these with the support of senior staff. This demonstrated to us that there was an effective complaints system available and that any comments and complaints people made were responded to appropriately.

People using the service told us they liked living in The Talbots and that staff were nice and kind. One person said “They encourage us to be independent”. They said that the service provider and day-to-day manager were “Very good”. People spoke with us about their daily living and the choices they could make. They told us the food was good and they could choose to have something different to what was on the menu if they wanted to. One person described how they were being supported by staff to eat more healthily.

The people we spoke with told us about how they like to spend their day. Two people went out with their friends during the day and other people went shopping for themselves and also for other people living at the home. They said they were free to go out whenever they wished.