Topaz House in Cleethorpes has a maximum occupancy of four people. The service is registered to provide accommodation for people requiring nursing or personal care and treatment of disease, disorder or injury. People that use the service may have a learning disability or mental health diagnosis. The house is indistinguishable from any other residential property on the street. At the last inspection the service was rated as Good. At this inspection we found the service remained Good.

The registered provider was required to have a registered manager in post and on the day of the inspection this requirement was being met. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to manage safeguarding concerns and staff were trained in safeguarding adults from abuse and understood their responsibilities in managing safeguarding concerns. Risks were also managed and reduced so that people avoided injury or harm.

The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters cross referenced with the staff that were on duty. Recruitment systems were followed to ensure staff were suitable to support people. The management of medicines was safe.

Qualified and competent staff were employed and supervised. Their personal performance was checked at an annual appraisal. Communication was effective.

People’s mental capacity was appropriately assessed and their rights were protected. 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.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitably designed and furnished for providing care and support to people with mild learning disability and mental health needs.

People received compassionate care from kind staff that knew about people’s needs and preferences. People were supplied with the information they needed, were involved in their care and asked for their consent before staff undertook any support tasks.

People’s wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.

People were supported according to their person-centred care plans, which reflected their needs and were reviewed. People engaged in some pastimes and activities if they wished to and developed their living skills. People had very good family connections and support networks.

An effective complaint system was used and complaints were investigated without bias. People and their friends and relatives were encouraged to maintain relationships of their choosing.

The service was well-led and people had the benefit of a culture and management style that were positive. An effective system was in place for checking the quality of the service using audits, satisfaction surveys and meetings.

People made their views known through direct discussion with the registered provider or the staff and via the complaint and quality monitoring systems. People’s privacy and confidentiality were maintained as records were held securely in the premises.

Further information is in the detailed findings below.

We undertook this unannounced inspection on the 26 November 2014. We previously visited the service on 2 and 3 June 2014. We found that the registered provider did not meet the regulations that we assessed in respect of consent, care and support, keeping people safe, medicines, staff recruitment, staffing levels, staff support, supervision , monitoring the quality of the service and the reporting of notifiable incidents and we asked them to take action. Following the inspection the registered provider sent us an action plan telling us about the improvements they were going to make. At this inspection we found that appropriate action had been taken to make the identified improvements.

The service is registered to provide accommodation for persons who require nursing and personal care and treatment of disease, disorder or injury. Topaz House can accommodate up to four people with a learning disability and mental health diagnosis.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 8 June 2011. 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.

When we had previously visited the service on 2 and 3 June 2014 we found that the registered manager was working on a part time basis at the service, a manager had been appointed from within the organisation but after a high staff turnover, was finding it difficult to manage the responsibilities of the role.

During this inspection we found the management arrangements at the home were more consistent than we had seen at the last inspection. An experienced manager had been appointed in July to deal with the day to day management of the home along with a further two deputy managers and this meant there was a manager on duty over a seven day period.

The new manager has applied to become the registered manager of the service and when the registration process has been completed the current registered manager intends to de register from this role.

People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005. We saw where a person may not have the ability to make a certain decision, an assessment was completed to establish if they understood the choice they had been asked to make. When people were assessed as lacking capacity to make their own decisions, meetings were held with relatives and health and social care professionals to plan care that was in the person’s best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit applications for a DoLS where it was identified a person needed to have their liberty restricted in order to care for them safely, and that this was in their best interests. At the time of the inspection one person who used the service had their freedom restricted and the registered provider had acted in accordance with the Mental Capacity Act, 2005.

People spoken with told us the staff listened to them and supported them in a caring manner. They were very happy with the care they received. People told us they had many different opportunities to engage in a variety of structured activities and had access to the local community.

People lived in a safe environment. Staff knew how to protect people from abuse and equipment used in the service was checked and maintained. Risk assessments were carried out and staff took steps to minimise risks without taking away people’s rights to make decisions.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health based professionals in the community.

People’s nutritional needs had been assessed and people told us they were satisfied with the meals provided by the home.

Medicines were stored, administered and disposed of safety. Training records showed the staff had received training in the safe handling and administration of medicines. Staff administering medicines had also had competency checks before being approved to administer medicines.

Staff had been recruited following the home’s policies and procedures to ensure that only people considered suitable to work with vulnerable people had been employed.

Staffing levels had been reviewed and increased to meet people’s needs and to support people to access activities. Staff received training and support to enable them to carry out their tasks in a skilled and confident way.

The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns.

We found that both people living at Topaz House were assessed for their needs, both clinically and for their accommodation aspect. We were told that "It's alright here. I get to go out and my room is private for me." We saw that people were cared for with 24 hour support within the home and access to 24 hour nursing care where necessary.

People's clinical care was provided through a multi disciplinary approach which included clinical psychology and psychiatric input as well as peoples' own opinions taken into account. We were told "I see [nurse] regularly and he sorts things out for me. [Care support worker] is alright, they all are really."

We found that improvements had been made to the environment to ensure people were protected from the risk of excessive hot water temperatures.

We found that staffing provision had improved and that people who used the service received a consistent group of staff. The people who used the service told us they were satisfied with the staff and care provided.

The provider had failed to ensure that staff had adequate training to meet peoples complex needs safely.

The provider had failed to ensure that all incidents of alleged abuse had been reported or investigated and there may be a risk of further abuse occurring if appropriate action has not been taken.

The provider had failed to notify the Commission of incidents reported to the police and incidents of possible abuse and allegations of abuse.