This inspection took place on 17 November 2016 and was unannounced. Three C's Support - 71-73 Dunton Road is a care home that provides accommodation and support for up to seven people, who live with mental ill health. At the time of the inspection 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.

We last inspected this service on 17 November 2015 and at this time the service had not met the regulations we inspected. We found that the service was in breach of five regulations. These breaches were related to person centred care, dignity and respect, need for consent, safe care and treatment, meeting nutritional and hydration needs, good governance and staffing. We issued requirement notices for each of these breaches. We made a recommendation to assess the effectiveness of training provided to staff based . In addition we made another recommendation to support people to express their views and involving them in decisions about their care, treatment and support. We asked the registered provider for an action plan for improvements and we received this as requested.

At this inspection we followed up on the breaches of the regulations and to see whether the registered provider had made improvements to the service. We found the service had made the required improvements to meet the standards of the regulations. We have made a recommendation to improve the quality of care in connection with methods of communication for people with Autistic Spectrum.

People took part in activities that interested them and there were some planned activities in the service.

The registered provider had guidance in place to reduce the risk of harm. Staff had acted appropriately in the management of allegations of abuse. Staff informed people’s care coordinator and the local authority safeguarding team if abuse of risk of harm was suspected.

Risks associated with people health and well-being needs were identified. Plans were put in place to manage those risks. The provider managed and identified environmental risks at the service.

People were cared for by staff who were supported by the provider. Staff had access to regular training, supervision and an annual appraisal to help them in their roles and reflect on their working practices.

People gave consent to care and support to staff. People were cared for in a way that protected them from risks from the unlawful deprivation of their liberty. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff understood how to support people within the Mental Capacity Act 2005.

People were treated with respect and dignity by staff, and people we spoke with confirmed this. There were sufficient staff employed to meet the needs of people that was also flexible to meet people’s individual needs.

Meals were provided by the service and people had a choice in the meals they received. Meal times were flexible so people could choose when they ate. Food and drink was stored appropriately, labelled and in date.

Health care support was available to people when they chose. Care assessments and care plans were updated and reflected changing needs.

Medicines were managed safely and people received them to manage their health needs. People had their medicines as prescribed and staff ordered and stored them safely. Medicine administration records were accurate and updated. When people required ‘as when’ medicines these were recorded appropriately.

The provider monitored the service and carried out quality audits to en

This inspection took place on 27 August 2015 and was unannounced. Three C's Support - 71-73 Dunton Road is a care home that provides accommodation and support for up to seven people, who live with mental ill health. At the time of the inspection there were seven people using the service.

There was no registered manager in post as at the time of our inspection. 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 previous inspection on 25 February 2014 the service had met the regulations we inspected. At this inspection we found that the service was in breach of five regulations.

Staff had not acted promptly to report two allegations of abuse to the local authority safeguarding team.

Staff were supported by the provider to carry out their caring roles. Training needs were identified and discussed in supervision and in their annual appraisal. We found that the effectiveness of staff training was not assessed. We have made a recommendation about the effectiveness of staff training.

Consent to received care was not always sought by staff. The provider was not aware of their responsibilities within the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People and their relatives were not always involved in assessments about their mental capacity, when this need had been identified.

People were not provided with planned activities carried out in the home. People were not able to make a choice in the meals they had, because there was not a menu that they could choose from. We also found expired food in the fridge.

People did not have access to healthcare when needed or to maintain their health. Assessments were not always updated to identify or manage their changing needs. The service did not identify and manage risks associated with people smoking in their bedrooms and communal living areas. we made a recommendation about involving people in decisions about their care.

The provider monitored the service and carried out quality audits; however, these did not identify areas of concern we found or make improvements to ensure people received consistent quality care. The was no clear management accountability or overall responsibility of the service.

People were provided with information on how they could make a complaint and how this would be managed.

Incidents and accidents which occurred at the service were reported and managed appropriately. Medicines were managed safely and people received them to manage their health needs.

People were treated with respect and dignity by staff, and people we spoke with confirmed this. There were sufficient staff to meet some the needs of people they cared for.

We are considering the action we take and will publish an updated inspection report in the future.

On the day of our inspection, we met with the registered manager and a senior care worker. We spoke to three people who used the service and looked at seven records of those who used the service. We spoke to a Community Psychiatric Nurse. We looked at three staff records on-line.

We noted that the provider made suitable arrangements to obtain the consent of those who used the service in relation to the care provided for them. A person who used the service told us "Staff give me choices, I don't have to do what I don't want to."

We found that people's care needs were met. We saw that each person who used the service had a care plan specific to their needs. A member of staff said "Our vision is about integration and encouragement to take part in own life planning."

We saw that there was a robust system in place to ensure the safe use and management of medicines.

We saw that there were effective recruitment procedures in place. The registered manager told us how "Staff are very aware of the needs of those whom we serve, that is the advantage of being a consistent staff team."

We saw that the provider kept in regular contact with people who used their services and regularly sought feedback information. A care coordinator told us how "This is one of the best homes I have worked with. They are always seeking to improve the quality of their service."

During our inspection we spoke with two staff members and four people who were using the service. We reviewed four staff records and seven care records for people who were using the service.

One person using the service told us, “I love it here.”

Peoples’ diversity, values and human rights were respected and people were treated as individuals. Staff told us they understood peoples' care and mental health needs. People using the service had their needs, physical health, mental health and social support needs assessed and monitored through the care planning processes and regular one to one sessions.

People using the service told us they felt safe and we found that staff were knowledgeable in identifying potential signs of abuse. A system for monitoring the quality of the care provided was in place and there were regular discussions with people using the service and staff about how the service could be improved.

People we met during our visit said they were comfortable and that they could choose what they wanted to do with their time. We observed that people were confident in approaching staff.

Staff spoke positively about the homely atmosphere of the service and said they were well supported by management.