We carried out an unannounced comprehensive inspection of Winnett Cottage on 23 November 2017. Winnett Cottage 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.

We previously carried out a comprehensive inspection at Winnett Cottage on 11and 16 December 2015 and we found breaches of regulations 09, 13, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. The provider submitted an action plan that told us they would meet the minimum requirements by 29 April 2016. We carried out an unannounced focused inspection at Winnett Cottage on 26 May 2016 and found improvements had been made.

At this inspection we found that further improvements had been made and the provider was meeting the required standards.

Winnett Cottage is registered to provide residential care for up 12 people living with mental health needs. At the time of our inspection seven people were living at Winnett Cottage.

The home had a manager in post who was in the process of registering at the time of the inspection. 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. We received information shortly after the inspection that the manager had been registered with CQC.

People felt safe living in the home and told us they regularly discussed with staff their needs and how to keep safe.

Staff received training and appropriate support from the managers to carry out their roles effectively.

Risk to people`s wellbeing were identified, regularly discussed with people and measures to mitigate the risks were regularly reviewed to ensure they were still effective.

People`s medicines were managed safely by well trained staff who had their competencies assessed. Where people were able they were supported to manage their medicines.

The provider had policies and procedures in place to protect people from the risk of infections and staff adhered to these.

There were enough staff employed through robust procedures to meet people`s needs effectively.

People were involved in planning their care and support, signed their own care plans and consented to the support they received.

People were involved in duties around the home like cleaning, laundry, cooking meals. Some people were working towards achieving their goals of moving to less supported care services.

People had opportunities to pursue their hobbies, interests and socialise in-house and in the community.

People`s feedback about the service they received was regularly sought and they felt they could voice their opinions in meetings and one to one conversations they had with staff.

People and staff were positive about the management of the service. There were systems in place to ensure the quality of the service was monitored and improved if the need was identified.

We carried out an unannounced comprehensive inspection of Winnett Cottage on 11 and 16 December 2015. At this inspection we found breaches of regulations 09, 13, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. The provider submitted an action plan that told us they would meet the minimum requirements by 29 April 2016.

We carried out an unannounced focused inspection of Winnett Cottage on 26 May 2016 and found improvements had been made.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Winnett Cottage on our website at www.cqc.org.uk.

Winnett Cottage is registered to provide residential care for up twelve people living with mental health needs. At the time of our inspection ten people were living at Winnett Cottage.

The home did not have a registered manager in post, however at the time of the inspection they had begun the registration process. 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.

We found that the manager had reviewed and investigated all incidents and accidents to keep people safe from the risk of harm or abuse. Risk assessments had been developed to positively manage risks to people.

Staff were aware of people’s individual needs and how to respond to these. People felt listened to, and felt the changes made to their care planning was an improvement.

People received care that was well led by. Regular reviews of the quality of care people received were carried out by the manager and provider. People's care records were now stored securely. People's views about the quality of service they received had been sought and the manager had reported untoward incidents to the local authority, police, and CQC as required.

Winnett Cottage is registered to provide residential care for up 12 people living with mental health needs. At the time of our inspection 10 people were living at Winnett Cottage.

The inspection took place on 11 and 16 December 2015 and was unannounced which meant the provider did not know we were inspecting.

The home had a registered manager in post; 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.

At this inspection we found sufficient numbers of staff were deployed to provide care to people living in Winnett Cottage. The registered manager had not reviewed and investigated all incidents and accidents to keep people safe from the risk of harm or abuse. Risk assessments had not always been developed to positively manage risks to people. People’s medicines were stored safely and information was available to staff about how to manage medicines, however this information was under development. People were supported by staff who had undergone a robust recruitment process which ensured they were of sufficiently good character to provide care to people.

Staff felt supported by the manager which enabled them to carry out their role effectively. Staff had received training relevant to their role. People’s nutritional needs were met and monitored where required. People were able to freely choose what they ate. People’s weights and dietary records had been maintained where needed. People we spoke with told us they had access to a range of health professionals, and records demonstrated they were referred quickly when their needs changed, which was confirmed by visiting professionals.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA requirements.

Staff spoke to people in a kind, patient and friendly way; however people told us that the responsiveness of staff varied. Staff consistently ensured people’s social needs were met; however people did not always receive care that was responsive to their needs.

People did not always receive high quality care that was well led and people’s care records were not stored securely. People's views about the quality of service they received had been sought, however these had not prompted a review of the service provided in order to see how improvements could be made. The manager had reported untoward incidents to the local authority, however not to CQC as required.

We used the information we had gathered to answer the five questions we always ask:

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found:

Is the service safe?

People had not been cared for in a clean and hygienic environment. Regular cleaning of all areas of the home had not been carried out. This meant that people were exposed to the risk of acquiring an infection. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People had agreed and signed their care plans to indicate that they had been consulted about the care support they received. One person said "We are well looked after. The staff are very caring and supportive. I go out all the time, mainly to the local shops. Another person said “I feel safe here and my privacy and dignity is respected.” Each person had a daily activity plan which they were aware of and participated in. People had their own keys to their bedrooms. Staff had received relevant training so that they were competent in their roles.

There were systems in place for safe management and administration of medicines. This meant that people received their medicines regularly and on time.

Information about people who used the service had been maintained so that they were protected against the risk of unsafe or inappropriate care and support. Confidential records have been kept safely and securely and retained for the required length of time.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications had been submitted under this system. We saw evidence that staff had received training in Mental Capacity Act and DoLS and there were appropriate policies in place. The manager stated that they were aware of the process for making a DoLS application if required.

Is the service effective?

Although risk assessments for people had been carried out, there were no action plans on how to mitigate the identified risks. This meant that staff would not be aware of the actions they should take to support the person to manage the risks. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that the staff were caring and helpful. They felt that their needs were met. We observed that there was a good interaction between staff members and people. One person said "I like living here. I prepare my own meals. The staff are kind and I have no concerns."

Is the service responsive?

The care plans we looked at showed that people's needs had been assessed and met appropriately. People had been involved in the decisions about their care and any changes in their care needs had been discussed with them.

Is the service well-led?

People’s care and support had been planned and delivered in accordance with their identified needs. The home carried out an annual questionnaire survey of people who used the service, their relatives and the staff. The feedback from the surveys had been positive. People said that they had regular ‘house’ meetings and discussed issues relating to the day to day running of the home. They said they felt that their views were listened to and acted on.

We saw, and people told us, that consent was obtained prior to any care being given. Records showed that people were encouraged to sign the plans that recorded any actions agreed to demonstrate that their consent was given.

A person’s identified needs were assessed and recorded in the care plan. This detailed how to support someone to achieve their goals, triggers for changes in a person’s welfare and what action was to be taken if this occurred. We spoke with three people who used the service. One person told us, "I feel cared for.”

The service had taken steps to identify and prevent the possibility of abuse occurring. Staff had received training and were aware of their responsibility in relation to safeguarding vulnerable adults from the risk of abuse. There was information displayed so that people who used the service knew who they should contact if they felt unsafe.

We found that although there were cleaning schedules and monthly audits in place, there were some areas of the service that required deep cleaning.

There were quality assurance systems in place. These included monthly audits, surveys, meetings and monitoring visits from a senior manager. The service also had an effective complaints system.

Staff were observed supporting people who used the service with correspondence, arranging appointments and managing their finances and medication. People told us that staff help them to make choices, attend appointments, keep their room clean, do their washing and shop and prepare food.

One person who used the service told us that they had all chosen how they wanted the lounge decorated and furnished. They also told us that the wallpapering and painting was carried out by some of the people who used the service as they used to work as decorators in the past.

Staff received appropriate professional development they attended mandatory training and received regular refresher training. They also told us that they received regular day to day support from the manager and supervision every one to two months, annual appraisal and attended weekly team meetings regarding reflective practice. Records seen confirmed this.

The provider regularly assesses and monitors the quality of the service by conducting monthly audits on care plans, risk assessment, medication, accidents, incidents, complaints, fire safety. Areas for improvement are identified but the documentation seen is unclear who is responsible for carrying out the required action, when by and if and when it had been satisfactorily completed within the identified timescales.

The people who use the service told us that the staff were very supportive and that the staff assist them in gaining or regaining their independence. We were told by the people who use the service that their aim was to move out to live in the community as soon as possible. They said that they were learning the skills to achieve this.

We were told that while independence is promoted the staff are always at hand should they need assistance and support.