The inspection was carried out on 11 April 2017, and was an unannounced inspection.

Welcome House - Leeza Court is registered to provide accommodation and personal care for up to 16 people with mental health needs who do not require nursing care. Accommodation is provided in a detached property in Rainham, Kent, close to the town centre. At this inspection, there were 14 people living in the home.

At the last Care Quality Commission (CQC) inspection in 11 August 2015, the service was rated Good in all domains and overall.

At this inspection we found the service remained Good.

People continued to be safe at Welcome House - Leeza Court. People were protected against the risk of abuse. People felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. 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.

The registered manager ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

We undertook this focused inspection on 11 August 2015 and it was unannounced.

At our previous inspection on 25 November 2014, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to the regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.. The breach was in relation to care and welfare of the people. The provider failed to meet individual’s need in relation to providing meaningful activities and treating people as individuals to be able to choose when they wanted to get up and when they wanted to go to bed.

The provider wrote to us and said they would be compliant by 31 July 2015. We inspected the home against three of the five questions we ask about services: is the service effective, caring and well led. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Welcome House - Leeza Court on our website at www.cqc.org.uk.

Welcome House - Leeza Court is registered to provide accommodation and personal care for up to 16 people with mental health needs who do not require nursing care. Accommodation is provided in a detached property in Rainham, close to the town centre. At this inspection we found that there were 14 people living in the home.

There was a registered manager at 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 this inspection, we found that the provider had taken action to address the breach and recommendations from the previous inspection and improved the quality of service they were providing to people.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke with them politely and respectfully.

We observed that staff had developed very positive relationships with the people who used the service. Staff respected people’s privacy and dignity. People told us that they made their own choices and decisions, which were respected by staff and they found staff provided really helpful advice.

People told us they were involved in their food preparation, which promoted their life skills. Staff assisted them to select healthy food and drinks which helped to ensure that their nutritional needs were met. People were generally complimentary about the food and drinks were readily available throughout the day.

People were supported to maintain good health and accessed a range of healthcare professionals and services. We found that staff worked well with people’s healthcare professionals such as consultants, community nurses and district nurses.

People were provided with personalised care. They were able to choose what time they went to bed and got up. They were provided with sufficient, meaningful activities to promote their wellbeing.

Staff were cheerful and patient in their approach and had a good rapport with people. The atmosphere in the home was generally calm and relaxed.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the commission.

There were twelve people living in the home. We spoke with five of the people, four of the five people told us they were happy living at the home and that staff looked after them well. They said, "The manager is really good." "The staff are very good. Couldn't ask for better." "I am very happy in this home". One person told us they were waiting to move on from the home as they were not happy there. We saw that people were comfortable with the manager and staff who were supporting them. People knew who to talk to if they were unhappy about anything. The atmosphere in the home was calm and relaxed.

People were treated with respect and their privacy and dignity was upheld. People were involved in planning the kind of support they needed.

People received support that was well planned and sensitively delivered.

People received the medicines they needed, when they needed them.

Robust recruitment and selection procedures ensured that people were supported by suitable staff.

Effective quality assurance systems ensured that people were provided with a good service.

Overall we found that this service was safe, effective, caring, responsive and well-led and had achieved compliance.

There were 13 people living in the home at the time of our visit. There was 24 hour support provided. People told us they were happy living in the home. They said, "Everyone is well looked after." "If there are any problems you go to the staff and they sort it out." "I like it here; they always respect my privacy and dignity." "The food here is good; we choose what we want to eat."

The service made sure people were able to make their own decisions about their care and treatment. We found that the care and support that people received was well planned and sensitively delivered. People were supported to eat a balanced and healthy diet, they were given choice and had their preferences taken into account. Staff were given appropriate professional development to enable them to understand people's needs and provide appropriate care and support. People were protected against risk of infection.

People told us that they liked the home, the staff members were very nice, the food was good and they felt looked after.

The inspection took place on 25 November 2014 and it was unannounced, which meant that the provider did not know that we were coming.

Welcome House - Leeza Court is registered to provide accommodation and personal care for up to 16 people with mental health needs who do not require nursing care. Accommodation is provided in a detached property in Rainham, close to the town centre.

There was a registered manager at 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.

While some people said that the food was good, others told us the food was not nutritious. Staff did not adequately support people in preparation of their meals. For example, one person’s food was kept in the oven for too long by staff and was clearly overcooked. At no point was the person actively involved in making their own lunch or in choosing what they ate or how it was prepared.

We have made a recommendation that the provider seeks and follows guidance on how to provide nutritious meals and on including people in choosing and preparing their own food as part of developing their daily living skills.

People did not have copies of their own care plans and did not understand what their plans were for. The care plans were kept in the registered manager’s office. However, we noted that people were able to access the office to see their care plan if they so wished.

Some people told us they felt they were not involved in managing their health care needs. One person said, “They arrange all things for hospital appointments for me”. People told us they were able to see a doctor whenever they wanted to but they were not involved.

We have made a recommendation about involving people in decisions about their care.

People were not always provided with a range of suitable individual and group activities they could choose from. Our observation showed that people were not encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished. For example, people sat down watching TV, or doing nothing in the home throughout our visit. People told us that they were not able to choose when they wanted to get up and when they wanted to go to bed.

The examples above show that people did not have their individual needs met and proper steps had not been taken to ensure their welfare. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The provider had a clear set of vision and values, which staff had not followed. The management and staff team had not demonstrated their commitment to implementing these by putting people at the centre when planning, delivering, maintaining and improving the service they provided.

The home had a system to assure the quality of service they provided and the way the home was run had been regularly reviewed. Prompt action had not always been taken to improve the home and put right any shortfalls they had found. However, the same recent internal home audit failed to identify people not being involved in their care plan, people not being able to go to bed at a time that suits them and the non-provision of nutritious food.

There were systems in place to protect people from abuse or harm and make sure that safeguarding alerts were raised with other agencies, such as the local authority safeguarding team. People told us they felt safe in the home and indicated that if they had any concerns they were confident these would be quickly addressed by the registered manager.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s mental health and details of how the risks could be reduced. These risk assessments were last reviewed in October 2014. They contained relapse indicators such as violence, self-harm and neglect. These records were reviewed monthly to look for trends. This enabled the staff to take immediate action to minimise or prevent harm to people. These audits were part of the quality assurance system.

There were sufficient staff to meet people’s needs. The registered manager and staff told us there were enough staff to care for people and keep them safe. The registered manager told us staffing levels were regularly assessed depending on people’s needs and occupancy levels, and adjusted accordingly. The weekly roster confirmed this. The provider operated safe recruitment procedures which included carrying out legally required checks. This was to make sure staff were suitable to work with the people who lived at this home. Staff told us there was a good atmosphere and they worked as a team.

Medicines were safely stored and administered correctly. People showed that they had been given information about their medicines by being able to describe the names and purpose of the medicines they took. Medication administration record (MAR) sheets showed that people received their medicines as prescribed. Clear and accurate records were maintained.

People said, “Staff were well trained and knew what they were doing”. Staff knew each person well and had a good knowledge of the needs of people. Staff had completed training in a range of areas that reflected their job role. Staff told us that they had received one to one supervision and yearly appraisals, which enabled them to develop their skills further.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. For example, one person who did not agree with the use of a disability term in their care records was listened to and a best interest meeting took place where a decision was reached by everyone that it was in their best interest to have the word in their care records.

People told us that staff supported them with health care appointments and visits from health care professionals such as mental health professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People told us that they received the care and support they needed. They said they liked living in the home. One person said, “I like living here. The staff are much better than my old place”

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person concerned and their relatives and care plans had been updated as people’s needs changed.

Staff demonstrated respect for people’s dignity during our visit, as they were discreet in their conversations with one another and with people who were in communal areas of the home. People knew how to make a complaint if they were unhappy. One person said, “I have no complaint and if they did, they will speak with staff”.

People spoke positively about the way the home was run. Members of staff told us that the registered manager was very approachable and understanding. They said they were encouraged to raise issues or make suggestions and felt they were listened to.

A quality audit was carried out by NHS West Kent Clinical Commissioning Group (CCG), named ‘Quality and Safety Site Visit’ to the home in October 2014. The CCG shared the results with us and these were mainly positive. They did ask the registered manager to make information about the MCA and DoLS, advocacy services and safeguarding available to people.