At our previous comprehensive inspection of the service in November 2017 we found the service was breaching regulations in relation to safe care and treatment and good governance. We rated the service requires improvement. People were at risk of not receiving sufficient levels of support that was appropriate to meet their needs. The care files and reviews we inspected were not all up to date. Some people's risk assessments were not updated or revised following changes in their circumstances and care. Some care plans, reviews and risk assessments had not been signed by people to indicate their agreement to what was written down on their behalf. We found the provider was not assessing or mitigating risks to people's safety effectively. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some areas of this home were tired and needed refurbishment and redecoration. The annexe particularly looked drab and needed redecoration throughout, together with new carpets in the communal areas. After the inspection the provider sent us an action plan which identified how improvements would be made. At this inspection we found the provider had made the necessary improvements and we rated the service Good.

31, York Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. 31, York Road can accommodate up to fourteen people with forensic mental health needs with care and support provided to help people rehabilitate in the community. There were eleven people using the service at the time of this inspection.

The service had a registered manager who was on long term sick leave and who left the service recently. The acting manager told us they would be applying to register as manager with the CQC. A registered manager is a person who has registered with the 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.

The provider managed risks to people’s care, including those relating to medicines management and infection control. Staff received training in managing medicines and the provider assessed staff were competent. Processes were in place to protect people from abuse and neglect including staff training.

People were supported to maintain good health and have appropriate access to healthcare services. People were encouraged to plan, shop and prepare their own food. We saw they had a varied and nutritious diet.

Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

There were safe recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable. There were enough staff to meet people's needs.

People were assessed as having the capacity to make decisions for themselves and were supported to do so. Staff had received appropriate training and had a good understanding of the Mental Health Act (MHA) 1983 and the Mental Capacity Act 2005 and knew when each set of legislation applied.

People had care plans outlining the goals they wished to achieve and what support they required from staff. People were involved in planning their care and their views were sought and planned for as an important part of the process.

Staff respected people's privacy and treated them with respect and dignity.

People knew how to make a complaint or how to raise a concern if they needed to do so. The acting manager told us they reviewed all complaints to check if there were any trends emerging that needed addressing in order to improve the service.

Staff said the acting

York Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

York Road can accommodate up to fourteen people with forensic mental health needs with care and supported provided to help people to rehabilitate them in the community. There were twelve people using the service at the time of this inspection.

The service had 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.

People were at risk of not receiving sufficient levels of support that was appropriate to meet their needs. The care files and reviews we inspected were not all up to date. Some people’s risk assessments were not updated or revised following changes in their circumstances and care. Some care plans, reviews and risk assessments had not been signed by people to indicate their agreement to what was written down on their behalf. The acting manager confirmed with us they would ensure all people’s care plans would be reviewed immediately together with people living in the home. This is in line with the provider’s own policies and procedures. The acting manager also told us that staff will receive additional training with this to ensure they fully understand their responsibilities and carry them out as required. The example above showed the provider was not assessing or mitigating risks to people’s safety effectively. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People received their medicines as prescribed and staff knew how to manage medicines safely. Those people who were able to, took their medicines themselves with minimal assistance from staff.

We inspected the home’s medicines administration policies and procedures. Staff completed medicines training and competency assessments before they were able to administer medicines to people. Safe medicines management processes were implemented and people were supported to self-medicate where they were able to do so. A new policy to do with clozapine was drawn up, to be implemented immediately with staff training to ensure all staff were knowledgeable and competent to administer clozapine where necessary.

Some areas of this home were tired and needed refurbishment and redecoration. The annexe particularly looked drab and needed redecoration throughout, together with new carpets in the communal areas.

Staff were suitably trained and supported to carry out their work effectively. The acting manager told us that the provider’s training schedule helped to ensure all staff received appropriate training and support for their roles and their work in the home.

Staff told us they were well supported with appropriate training and were able to discuss any concerns or issues with the manager whenever they needed to do so.

All of the people living at York Road had the capacity to make decisions about specific aspects of their care and support at the time of this inspection.

People were supported to maintain good health and have appropriate access to healthcare services.

People were encouraged to plan, shop and prepare their own food. We saw they had a varied and nutritious diet. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

The acting manager ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable.

People and staff said they thought there were enough staff to meet people’s

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

When we visited 31, York Road there were eleven people using the service. We spoke with seven of the people using the service, the registered manager, three members of staff and a visiting social worker. We reviewed three people's care plans and three staff files.

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. All the staff who had been recruited to the service had had their credentials checked to ensure they met the home's policy and procedures. This helped to ensure that people’s needs were met.

Was the service effective?

People who use the services health and care needs were assessed with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected three people’s care files. They included essential information about the person, comprehensive needs and risk assessment information, care and support plans as well as records of keyworker meetings.

Staff received regular and appropriate training and supervision to ensure they were able to meet the specific needs of people using the service.

Was the service caring?

People were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The seven people we talked to said the staff treated them well and respected their privacy.

People who use the services told us they attended regular house meetings where they were able to discuss relevant issues and make decisions about what they wanted to do. We saw from reading the minutes of these meetings that meeting the wishes and preferences of people was the main priority. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

People met regularly with their keyworker to review their care and support. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint and they said they would be supported if they made a complaint. There was an appropriate complaints procedure in place and the complaints that had been made had been properly dealt with under the policy guidelines. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in relation to developing their independence.

The views of people who use the services, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

We spoke to five people using the service. All told us they were able to express their views and opinions about the running of the home. One person said “It’s good that we have meetings everyday, it means that everybody knows what they have to do”.

All told us they had care and support plans. They told us they had key workers with whom they held regular meetings to discuss their care and support needs. They also told us they had regular contact with their care coordinators and appropriate health care professionals.

All spoke positively about staff. One person said “This place is pucker, the staff are very supportive, they always encourage me to do the things that help me keep well”. Another person said “The staff are interested in what we think, they are very nice people, they don’t go sticking their noses in but they help me when I need help”.

All of the people we spoke to told us they knew about the home's complaints procedure. They said if they had any concerns they would tell staff or the manager and they would do something about it.

People told us they took turns to shop, cook and wash up. Staff encouraged them to eat healthy meals and sometimes they helped them to cook.

We saw that people were receiving their medication as prescribed by health care professionals.

We spoke to 5 people who use the service. They told us they had a meeting each day with staff and managers. One person told us “the meetings are important because we all get together and talk about important things. We get to listen to one another and tell staff what we are thinking about, so we all know where we are at”.

They told us they felt safe living at the home and that staff treated them well. People who were living at the home when we last inspected told us things had improved. One person told us “things are a lot better. Staff are more respectful. It’s better with the new manager”. Another person told us “a lot of staff have left and we have new staff, things have improved, the new staff are respectful in the way they talk to us”. Another person told us “staff listen to us and it’s more relaxed, we still have problems sometimes but it’s better”.

We spoke to five people who use the service. They told us that there were daily meetings with managers and staff where they talked about what happened at the home. One person told us these meetings were very important to them as it gave structure to their lives. Four people told us that staff treated them with dignity and respect. One person alleged that staff had been verbally abusive towards them.

All of the people we spoke to told us they had regular contact with their key workers, care coordinators and consultants. They told us they had care plans and attended regular weekly key worker meetings.

Most people we spoke to felt that they were safe at the home and knew there were safeguarding procedures in place. One person told us that they could speak to the manager or staff if they had any concerns, if they felt they could not speak to the registered manager or staff they could speak to an independent advocate.

This inspection took place on 26 August and 1 September 2015. At our last inspection on 11 June 2014 the service met all the regulations we inspected.

York Road provides accommodation, care, and support with the aim of rehabilitation for up to fourteen people with mental health needs. The intention is to help people to live with more independence in the community and the average length of stay is approximately two years. There were twelve people using the service when we inspected the service.

There was a registered manager in place. 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 told us they felt safe with the service they received. Staff had received training to help them safeguard people from the risk of abuse. The registered manager and staff were aware about how to report suspected abuse. Review of the information we received showed us that when a concern was raised it had been reported appropriately to the local authority and to the Care Quality Commission.

People had risk assessments and risk management plans in place to reduce the likelihood of harm. Staff knew how to use the information to keep people safe and work with them positively to help them be as independent as possible.

The registered manager ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable.

Safe medicines management processes had been implemented and people were supported to self-medicate where they were able to do so.

People received effective care because staff were appropriately trained and supported to do their jobs.

People using the service had been assessed as having the capacity to make decisions for themselves and were supported to do so. Staff had received appropriate training and had a good understanding of the Mental Health Act (MHA) 1983 and the Mental Capacity Act 2005 and knew when each set of legislation applied.

People were encouraged and supported by staff to become more independent by developing the necessary skills and knowledge. This included eating well and staying healthy. When people needed care and support from healthcare professionals, staff ensured people received this.

People had care plans outlining the goals they wished to achieve and what support they required from staff. People were involved in planning their care and their views were sought and planned for as a central and important part of the process. The service regularly monitored people’s changing needs and involved them in discussions about any changes that needed to be made to their care plans.

Staff respected people’s privacy and treated them with respect and dignity.

Relatives and other visitors were made to feel welcome and told us they were free to visit people in the home.

People told us they were able to contribute to the assessment and care planning process of their care through a number of different ways that they found useful. This included Care Programme Approach (multi-disciplinary agency) meetings, key worker meetings and house therapy meetings. We saw evidence that care plans reflected what people had said they would like and how they would like their care to be delivered. Care plans included details of people’s social activities and of their engagement with the community. All care plans we inspected had been reviewed monthly to the date of this inspection.

People knew how to make a complaint or how to raise a concern if they needed to do so. The registered manager told us they reviewed all complaints that had been made to check if there were any trends emerging. None had been identified at the time of this inspection.

People and staff members gave positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions via feedback surveys. Action plans were developed where required to address areas that needed improvements. The management of all the home’s records such as care files and maintenance records was seen to be well ordered and effective.