This inspection took place on 1 March 2017. The inspection was unannounced. At our previous inspection during November 2014 the provider was meeting all the regulations we checked, but we saw that some improvements were needed. This was because the provider did not have robust recruitment procedures to ensure that new staff were suitable to work with people at the service. People who had been prescribed medicines on a when required basis were not given these in a consistent way. Where it was identified a person lacked capacity, there was no mental capacity assessment in place ensuring people were supported in the least restrictive way, whilst protecting their rights. We also found the service was not well-led as the provider did not have effective procedures for monitoring the quality of the service. At this inspection we found improvements had been made.

Annefield House Limited is registered to provide residential care and support for 17 people with mental health needs. At the time of our inspection there were 16 people using the service. The service is located within a residential area of Derby, which provides accommodation over two floors.

There was a registered manager in post. 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 who used the service were positive about the support they received and praised the quality of the staff and management. People told us they felt safe at the service. We saw staff interacting with people in a relaxed and friendly manner.

Staff we spoke with understood their responsibility in protecting people from the risk of harm. Recruitment procedures still needed further improvements so that they were thorough to ensure suitable staff were employed to work with people who used the service. Staff told us they had received training and an induction that had helped them to understand and support people.

Risk assessments and care plans had been developed where possible with the involvement of people and their representatives. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way. People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act (MCA) 2005. Some people were subject to restrictions on their freedom and the provider had identified where their support needed to be reviewed. This provided assurance the principles of the MCA 2005 were followed.

Staff understood the needs of the people they were supporting. People told us staff provided support with kindness and compassion. People were treated with dignity and respect by staff and encouraged to express their views. The delivery of care was tailored to meet people’s individual needs and preferences. People were supported to maintain a diet that met their dietary needs. People were supported to use healthcare services.

People were supported to maintain relationships which were important to them. People were able to access local community facilities and supported by staff to pursue their individual hobbies and interests.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People told us they felt if they raised any concerns these would be taken seriously and would be addressed by the registered manager.

People found the staff and management approachable. Staff felt supported by the management team. The registered manager was viewed as being approachable and involved in the day to day management of the service

A quality assurance system was in place which included audi

The inspection took place on 26 November 2014 and was unannounced.

Annefield House Limited is situated close to Derby City Centre. It provides a residential care service to 17 adults with mental health needs. At the time of this inspection there were 16 people living at the service and one person was in hospital.

The previous registered manager left the service in June 2013; however their registration was not cancelled until April 2014. At the time of this inspection the acting manager had submitted a registered manager’s application to us. 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 the last inspection on 17 December 2013, we asked the provider to take action to make improvements. We asked them to review the number of staff on duty to ensure people’s needs were being met. Improvements were also required with the recruitment procedures as the provider had not taken effective steps to ensure people were protected from abuse. The maintenance and the repairs of the home were not sufficient to protect people against unsafe or unsuitable premises.

The provider sent us an action plan outlining the improvements they would make.

At this inspection we found that action had been taken and improvements had been made.

The provider’s recruitment procedures had improved. The provider had recruited more staff and they were waiting for the relevant pre-employment checks to be received before they could start work.

People who lived at the service told us they felt safe and were happy living at the service.

The provider had taken steps in recruiting additional staff, so that there will be enough staff available at the service to safely support people with their care and interests.

Medicines were safely administered and most people received medicines when they needed them.

The acting manager and staff demonstrated an awareness of the basic principles of the Mental Capacity Act (MCA) 2005. However, the necessary documentation was not in place where it was identified that people may not have capacity. This did not ensure people were being supportive protecting their rights.

Staff told us that they had received training that was relevant in supporting the people using the service.

People told us they enjoyed living at Annefield House Limited and that the staff were caring and understanding.

People were able to take part in interests and hobbies that generally suited them.

The provider did not have a system in place to manage complaints. However, people we spoke with felt able to speak to staff should they have any concerns. Audits to monitor the quality of the service were being developed.

>

In this report the name of a registered manager, Mr Kamaljit Singh Johal, appears. He was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this report.

All of the people we spoke with told us that staff respected their privacy and dignity. We saw positive interactions between staff and people that lived at the service.

We saw that people's needs were assessed, and care plans were in place. This meant they received support in a way they prefer.

We found that risk assessments were in place, however these were not comprehensive. The assessment’s identified area’s of risk but did not contain clear action plans to demonstrate how these areas of risk were to be managed to ensure people were supported in a safe way.

People said they felt safe living at the service, and were able to report any concerns they may have to staff or the manager.

People we spoke with told us they liked the staff and got on well with them. Comments included “the staff are friendly,” “the staff understand my needs” and “we are fortunate here, as the staff are good, they work well together.”

We found that there were systems in place to monitor the quality of the service, and make improvements where required.

During the inspection visit we observed that staff were responsive to people’s needs and wishes. The care plans seen reflected people’s individual needs and took into account equality and diversity issues including dietary needs.

People we spoke with told us they were happy with the care and support they received. Comments from people included, “The care and service are very good" and “I am happy with the service, because I feel safe and cared for."

People told us they enjoyed the meals and they always had a choice.

People were generally protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People who use the service, staff and visitors were not protected against the risks of unsafe or suitable premises.

The provider did not have effective recruitment procedures in place to ensure that people are cared for by suitably qualified, skilled and experienced staff.

Due to the possibility of unexpected changing circumstances, the provider did not have arrangements to ensure there were always enough staff available to meet people's needs.

In this report the name of a registered manager, Miss Lisa McIntyre, appears. She was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this report.