This inspection took place on the 4 July 2016 and was unannounced. Yarningdale provides care and support for up to 20 younger adults with complex mental health needs. At the time of this inspection 13 people were living at the service.

At the last inspection carried out in December 2015 there were four breaches of Regulations. The provider send an action plan to show how they were going to resolve these breaches and we found they had been successfully addressed at this inspection.

The home is required to have a registered manager and a registered manager was in post. However at the time of the inspection the registered manager had been on a planned absence from the home for three months. 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’s medicines were generally administered safely. However we found some incidents in recording that needed to be addressed. People were supported to access other healthcare professionals to maintain their physical and mental health and well-being.

Staff were trained to meet the needs of people. They had the training the provider considered necessary to support people using the service. Although some specialist training was on going, this had not been fully completed. Staff had safeguarding training and knew how to keep people safe.

People were offered the opportunity to pursue hobbies and interests either inside and outside the home. They had access to fresh air and we saw the garden was in constant use. People who lived upstairs were assisted to spend time in the garden.

Staff were deployed in the best interests of people and there was enough staff to meet people’s needs in a timely manner. There was a thorough recruitment processes in place.

People were given the opportunity to plan their meals and had a choice of nutritious food and drink throughout the day. People were happy with the food. People’s dignity was promoted at all times. Care was taken during meal times to preserve the dignity of people by ensuring all people who were on a special diet had food that appeared the same as those on a regular diet. Staff were caring at all times and had good relationships with people.

The staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. All the staff we spoke with understood the implications for people who were living under different sections of the Mental Health Act 1983.

Staff had read people’s care plans and therefore they were aware of information relating to people’s needs and wishes. The provider had introduced a handover sheet that included an easy read page of important details in relation to people’s needs and wishes.

There was an effective quality assurance system in place that was carried out at registered manager level and provider level. This included visits from the provider to verify the information provided with people and staff.

On this inspection we spoke with three people who lived at Yarningdale Health Care as well as two visiting families and visiting health professionals.

Is the service safe?

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff we spoke with had received training in safeguarding vulnerable adults and described different types of abuse and how they may recognise them. In addition to safeguarding staff had also been trained in ‘non-abusive psychological and physical interventions.” When we spoke with staff they were able to describe interventions that calmed people down to keep them safe.

Is the service effective?

Staff that we spoke with had received training and were able to explain the basic principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DOLS).Staff were aware of the current DOLS in place at the service and what subsequent procedures had been put in place to support the agreed arrangements. This meant that people who lacked capacity were cared for in line with legal requirements.

We found records that staff had attended training courses within the last year. Training was relevant to people’s needs and included amongst others, first aid, food hygiene, health and safety, fire awareness, medication administration and infection control. We also found records to show that staffs’ knowledge on these areas was tested and checked. When we spoke with staff they expressed they felt supported by the training they had received and that it had developed and benefitted their practice. This meant that staff were receiving learning and development opportunities they needed to carry out their role and keep their skills up to date.

Is the service caring?

We spoke to two visiting families and they told us that the service responded well to any comments or concerns that they raised. One person said, “Nothing is too much trouble, the staff are fabulous,” and another person told us, “The carers always make sure my relative is wearing nice clothes when they go out.” All the three people we spoke with who used the service told us they had good relationships with the staff. One person said, “The staff are lovely, they take me out on trips,” and another person told us, “Staff are fantastic they always check with me if it's ok to help.” During our inspection we observed staff being friendly and spending time with people who used the service. This meant that care reflected people’s needs and preferences.

Is the service responsive?

All three people we spoke with told us what interests and activities they enjoyed doing while living at Yarningdale. One person had a particular talent for art and crafts and had access to a wide range of art materials, other people told us that they enjoyed playing board games with staff and watching their favourite TV programmes. When we read people’s care files we found that as well as people’s preferences, people discussed their goals and aspirations. For one person this was to go to college and when we spoke with this person they told us how much they were enjoying going to college

Is the service well led?

The service has a quality assurance system and records we read showed that any shortfalls were addressed promptly. Regular checks were completed on bed rails, care plan records, medication and personnel files. Actions had been identified from these audits including identifying where reviews were needed and how standards of record keeping could be improved. As a result the quality of the service was continuously improving.

This inspection took place on 11, 14 & 18, December 2015 and was unannounced. At the last inspection of the service in April 2014, we found the service was meeting the regulations.

Yarningdale Health Care provides care and support for up to 20 younger adults with complex mental health needs. At the time of this inspection 18 people were living at the service.

The service had a registered manager in post. The home is required to have a registered manager. 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.

Staff were not fully trained to meet the needs of people. They did not have the training the provider considered necessary to support people living at Yarningdale. The provider was aware of this and had not acted on this knowledge. However, they knowingly admitted people with complex needs that staff were not trained to meet.

Staff had received safeguarding training however; they had not used their training appropriately to keep people safe. Senior staff did not act on safeguarding concerns that had been reported to them and escalate the information to the LA safeguarding team or to their own internal senior managers. This put people that used the service at risk of abuse.

There were not enough staff to meet people’s needs, neither were they effectively deployed to meet people’s needs.  However, we saw that there were thorough recruitment processes in place.

We observed that some staff were kind, compassionate and caring. However, staff were not effectively supported within their roles.

Staff had not read people’s care plans and therefore they were unaware of information relating to people’s needs and wishes. They were unaware of how to care for a people in a manner that built on their wish to be more independent and recover from their injury or condition.

Peoples’ dignity and independence was not always promoted. People were not offered the opportunity to pursue hobbies and interests both inside and outside the home. They did not have free access to fresh air and some people had not been out of the building, even to the garden, since the summer.

People’s feedback about the service had not always been listened to and acted upon. Verbal complaints had not been recorded or investigated in any way.

There was not an effective quality assurance system in place. The quality system failed to recognise the service was not providing personalised care to people to promote their independence, health and welfare.

The service had not always notified the Care Quality Commission of incidents and accidents that occurred in the service.

The staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. However, none of the staff we spoke with understood the implications for people who were living under different sections of the Mental Health Act 1983.

People were given the opportunity to plan their meals and had a choice of nutritious food and drink throughout the day. People were happy with the food.

People’s medicines were administered safely and people were supported to access other healthcare professionals to maintain their physical health and well-being.

We identified breaches 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.