The inspection took place on 21 February 2017 and was unannounced. At our last inspection in November 2015 we found one breach of regulation in relation to complaints. At this inspection we found that action had been taken to meet the requirements of the regulation.

The service provides nursing care and accommodation for up to 14 people with Mental Health concerns. At the time of our inspection 13 people were living in the home.

There was a registered manager in place. 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 inspected the home in November 2015, we rated the service as ‘requires improvement’. We found a breach of regulation in relation to complaints. There was also concerns about odours in the home. When we returned to the service in February 2017, we found that improvements had been made. We found that steps had been taken to meet the requirements of regulation in relation to complaints. There was a good standard of cleanliness throughout the home.

People in the home received safe support with their medicines. These were stored appropriately and there were systems in place to check stock levels on a regular basis. There were sufficient numbers of staff to care for people safely and to meet their needs. Staff told us staffing levels worked well and enabled them to spend time with people outside of care tasks.

People’s rights were protected and consideration as given to their ability to consent to their care arrangements. Applications under the Deprivation of Liberty Safeguards (DoLS) framework had been made for people who required them. DoLS is a framework that protects the rights of people who may need to be deprived of their liberty in order to received safe care.

Staff worked with other healthcare professionals to ensure that people’s needs were met. This included district nurses and community psychiatric nurses. People’s care plans contained clear guidance for staff on how to meet people’s mental health needs.

Staff were trained and received good support to enable them to carry out their roles. Staff told us they felt about to approach senior staff with queries or concerns. Training included safeguarding vulnerable adults and this helped staff feel confident about identifying any potential signs of abuse. Staff were aware of where to find policies and procedures if they needed them. We did find that some staff had long gaps between formal supervision with their line manager; however staff did not feel this was a concern as they were able to speak with senior staff at any time and had regular team meetings. The registered manager was aware that some staff were not up to date with supervision and had plans in place to address this.

Staff spoke to people with kindness and respect. People spoke positively about how staff supported them. People had opportunity to take part in activities if they wished to and many were able to go out independently. Some people preferred to spend time alone in their rooms and this was respected.

There was a registered manager in place. There were systems to monitor the quality and service provided.

The inspection took place on 11 November 2015 and was unannounced. At our last inspection in January 2014, the service was meeting the regulations inspected.

Tramways is one of the services provided by Milestones Trust. It is a home for 12 people with mental health needs. At the time of our visit there were 12 people living there.

There was not currently a registered manager for the service. 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 were not cared for in an hygienic environment. There was a very strong odour in parts of the home. Domestic staff were hardworking however the odour was impacting on the quality of life for the people who lived there.

Complaints were not always investigated or action taken in response to any failure identified by the complaint or investigation. One person had made a complaint about the odour in parts of the home. This had not been investigated and the person who made the complaint had not been given any response to the matter that they had raised.

The manager’s system for auditing the quality of the care and the overall service was not up to date. This meant there was a risk that the quality of care people received was not properly checked to ensure it was safe and suitable for people.

We have recommended that the service seek support and advice to ensure that it has in place an effective system to monitor quality and address shortfalls.

People had positive views of the staff and the way that they were supported with their particular mental health needs.

People were treated with kindness and care by the staff who supported them. Staff spent lots of time with people they were supporting. There were positive interactions between them. People approached staff in a relaxed way when they wanted to talk with them.

People’s mental health needs were assessed and the care was planned and delivered in a way that properly met their needs.

People were supported to eat and drink enough to stay healthy and they were involved in planning meal choices were acted upon so that they were included in the options available.

There were systems in place to support staff so that they followed the Mental Capacity Act 2005. This law aims to protect people who may lack capacity to make informed decisions in their daily lives. The provider had completed one application under the Deprivation of Liberty Safeguards (DoLS) for one person. This had been accepted and DoLS safeguards were in place for the person.

The staff on duty demonstrated that they understood the complex mental health needs of the people they supported. People were being well supported and to make choices about their care and in their lives. For example how they spent their day and what meals they wanted to eat.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was undertaken by one Adult Social Care Inspector. At the time of the inspection 12 people were living at the home. The purpose of our inspection was to answer these key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We saw that people were treated in a respectful and courteous manner by the staff who supported them at Tramways. People who used the service spoke positively about the way they were treated by the staff. Examples of comments made included, “the staff are understanding”, “they are alright” and “they are quite nice”.

The people we spoke with said they felt safe living at Tramways and also with the staff who worked there. People were safeguarded from the risk of abuse because the provider had robust procedures in place. The staff knew how to safeguard people who used the service and they also understood how to report concerns.

Staff were guided to support people safely by suitable policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) . One DoLS application had been properly submitted by the registered manager in the year. This showed people who used the service were safeguarded and their rights were upheld.

People who used the service were protected from the risks of unsuitable staff being employed at the home. Recruitment procedures were robust and people who lived at the home were involved in the selection process of new staff.

Health and safety audits were undertaken on a regular basis to help ensure that the environment was safe and suitable for people who lived there, staff and visitors.

Is the service effective?

People who lived at Tramways said they were either happy or satisfied with the care and assistance that the staff provided them with.

We saw staff provided assistance to people in a calm and attentive way when they needed support with their needs. Staff showed that they had an in depth understanding of the complex mental health needs of the people they supported at the home. The staff we spoke with were able to give us example of approaches they took to ensure they assisted people in a safe and suitable way. For example they told us some examples of how and when they used a calm approach when people were agitated and anxious in mood.

We saw that care plans were written based on the needs and wishes of the person concerned. We saw that people were involved, if they had chosen to be, in devising their own plan of care to meet their mental health and other needs.

Is the service caring?

We saw that people were supported by staff who assisted them in a caring and sensitive way. One person told us. "they are nice to me ” another comment made was “I can do what I want here I go out when I want it’s much better then where I lived before ”.

People who used the service were supported so that they were able to undertake a variety of therapeutic activities and interests. People told us that they also went out regularly with the support of staff. For example people went out to a regular bowling afternoon, and regular cinema trips at a nearby cinema and bowling alley.

Is the service responsive?

People told us they spoke with the staff whenever they needed to .They said the staff listened to them if they wanted to talk with them about any issues they had. One person told us “the staff are nice to me and it’s a people home”.

Regular ‘house meetings’ were held and the minutes showed people’s views were sought about the way the home was run. For example we saw that people were regularly asked their views about menus and about the overall services at the home.

Is the service well-led?

People who used the service and the staff that we met spoke highly about the leadership from the registered manager. One person told us that the manager was “lovely”. We saw people looked very comfortable to approach the registered manager. We observed that they had an ‘open door’ policy and were attentive and made time for each person who wanted to see them.

The quality of care and service that people received was being effectively monitored and reviewed. The views of people who lived at Tramways were regularly sought as part of the process of monitoring quality in the home.

Everyone we spoke with told us that they liked living at the home and were involved in their care and support. One person said “I came to visit Tramways before I moved in and I like it here” another person told us “I am able to make my own choices here”.

People told us they attended meetings to review the care and support they received.

Observations of staff interacting with people and records we viewed evidenced that the service recognised people’s diversity. This was promoted and respected by the staff team.

They told us that staff supported them to go out on activities such as shopping or visiting local cafés.

We saw that care plans were reviewed at regular intervals by the person’s key worker.

Staff we spoke with demonstrated good knowledge of the people they supported, they were aware of their health needs.

People we spoke with told us that they liked the food at the home. We saw that their needs were identified in relation to food and drink and care plans were put in place to ensure these needs were met.

All the staff we spoke with told us that they enjoyed working at the home and were supported well by the management of the home. We found that they received appropriate training for their role.

The provider audited the home regularly and audit results were positive. Where shortfalls were identified, actions were set with timescales for completing the actions and who was responsible for ensuring they were met.

We visited the home on 15 June 2012. We spoke to four people who lived at the home they all said they liked living at Tramways.

People we spoke with knew who there key worker was and said that they spoke with them about their care and support. One person told us that staff supported them to maintain contact with a friend who moved out of the home the previous year.

We spoke to a relative who was visiting the home, they said that the home was ‘one of the best places that their relative had lived in’ and that they were ‘very settled at the home and seemed happy.’

We found that the care plans were very comprehensive and very person centred. The care plans had evidence of input from the person and they were signed by the individual.

Since the last our last Inspection the manager has completed their registration and staff told us that they felt well supported and had both planned supervision and informal chats with the manager.

We spoke to 4 people about living at Tramways and with 1 visitor about their experiences of the care delivery to their relative at the home.

1 person told us about the re-structuring of the home which has made them sad because they had known the staff that were leaving for a long time. Another person told us ‘its easy living here and we are well looked after.’ However, 1 person said ‘staff don’t know how to respect people; I am treated like a lunatic.’

The responses from the 4 people we consulted indicated that they felt safe at the home and would approach the manager with complaints.

1 person said that they were involved in their planning for the life they want and another knew that reports about were kept.

The visitor at the home told us that suggestions could be made to the staff about caring for their relative and would know how to complain. This visitor also told us about the changes in staff and raised concerns on the way continuity would be achieved with these changes