Arundel House is a large Victorian building which consists of two housed joined together. It is situated in Barnstaple, close to the centre of the main town. The service provides personal care for up to 17 people with a mental health illness. At the time of our visit, there were 14 people living at the home.

At the last inspection on 23 March, 2015 the service was rated Good.

At this inspection on 21 April, 2017, we found the service remained Good.

People felt safe and cared for in the home. There was a homely, welcoming atmosphere with laughter and chatter. Staff were very clear it is the person’s home and they respected this. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People chose how they wished to spend their days based on their preferences and staff always respected this. Staff treated people with respect and dignity at all times and positive interactions had been developed. People were encouraged to maintain their independence.

People were supported by sufficient numbers of skilled, knowledgeable and trained staff who were safely recruited. Staff felt supported in their roles, received regular supervision and felt listened to. They enjoyed their work and put residents first.

Each person had an assessment, support plan and risk assessments in place. These were monitored and reviewed regularly. Staff had good working relationships with local health and social care professionals. Advice was sought when necessary and their advice acted upon.

People were protected from the risk of abuse as staff understood and knew what to do if they had concerns. People received their medicines safely and on time.

People were supported to have a balanced and varied diet which included their personal food choices. People were able to help themselves to drinks and snacks throughout the day.

People enjoyed individual activities and hobbies suitable to their needs and wishes both in the home and in the local community. People were enthusiastic about choosing a suitable pet for the home.

People knew how to make a complaint and who to address their concerns to. All complaints were investigated appropriately. The service had a suggestion box which people and visitors used regularly. Any comments were acted upon. Regular feedback was sought from people and staff through meetings and surveys.

There was a strong management team who knew people and staff well. Staff felt part of the team.

There were quality assurance systems in place to monitor the service and regular checks took place. Not all the information legally required had always been sent to the Care Quality Commission.

Some of the areas of the home were in the process of being decorated and painted. Other areas had also been highlighted as in need of updating.

Further information is in the detailed findings.

A single inspector carried out this inspection and it was completed in one day. We saw all of the people who lived at the home and spoke with eight people to gain their experiences of the service.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us they felt safe. The systems in place for safeguarding people were not fully robust. Some staff understood their role in safeguarding the people they supported. The management team were not fully aware of the correct safeguarding reporting procedures and the correct action to take which meant that some people were put at risk.

There was no system in place to ensure that the manager and staff learnt from events such as accidents, incidents, complaints and concerns. This increased the risk of harm to people and failed to ensure that lessons are learnt from mistakes.

The manager completed the staff rotas, which took into account people's support needs when making decisions about the numbers, qualifications, skills and experience required. The manager had highlighted any shortfalls in staff provision. This helps to ensure that people's needs are always met.

Systems for the safe administration of all medicines were not in place. This puts people at unnecessary risk of harm of receiving the incorrect medicine at incorrect times.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding, handling of medicines, complaints investigations and learning from incidents and accidents

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Staff had an understanding of when an application should be made and how to submit one.

Is the service effective?

People told us they were happy with the care/support they received and felt their needs had been met. People told us "they look after you properly" and "feel well looked after".

People's health, care and support needs were assessed but they were not always involved in reviewing their care/support plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff interacted well and showed patience when supporting people. People were complimentary of the staff and told us "there's enough staff on duty" and "it's difficult for staff but they do a good job". Relatives had commented about the service "X is being looked after with such kindness and dignity" and "staff get to know X".

Is the service responsive?

People's needs had been assessed before they moved into the home. Records showed that people's preferences, choices and needs had been recorded and support plans had been provided that met their needs. People had access to activities that were important to them and these were undertaken in the local community.

The service involved outside agencies when necessary to make sure people received appropriate care.

Is the service well-led?

The service did not have a quality assurance system in place. Records seen by us, for example those relating to medication administration, showed that shortfalls had not been identified and addressed. People were not regularly asked for their feedback on the service or treatment they received.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance.

When we last inspected this service in September 2013 we found people’s personal records were not always accurate and fit for purpose. Care plans had not been updated to reflect people's changing needs. We gave the service a compliance action for records. We asked the provider to send us an action plan to show how they intended to be fully compliant in this outcome. The action plan gave details about how the care plans were to be reviewed and a follow up telephone call to the manager confirmed they were fully compliant by the end of November 2013.

We visited the service on the 24 January 2014 to review some of the care plans and risk assessments to check compliance had been achieved. We looked at four care plans and care files. We saw they had been updated and reviewed with the individual concerned. We also saw the manager had implemented a system for regular reviewing for care files to ensure they remained accurate and up to date. We concluded the records were now accurate and fit for purpose. This helped to protect people using the service as it meant staff had the right information available to plan and deliver care and support.

During this inspection we spoke with seven people who lived at the home about their experiences. We also spoke with four staff and following the inspection we spoke with a care coordinator who had reviewed people's placements at the home. We spent time looking at key documents including care plans, daily records, staff meeting minutes, house meeting minutes and medication records. We observed how the medication were administered at lunchtime.

People told us they felt ''safe, comfortable and well cared for.'' One person who was newer to the service was able to explain how they had come to visit prior to moving in and another person told us ''The staff here couldn't be kinder. We have had a lot of staff changes so I am getting used to the new ones, but they seem very nice.''

We saw daily records gave a good overview of how staff monitored people's physical and emotional well being, however we found improvements were needed in ensuring the care planning process was kept up to date.

The home had good systems in place for the safe recording, storing and administering of medications. People told us they received their medications on time. We saw staff liaised with community psychiatric nurses and doctors where medications needed to be reviewed.

There was a formal complaints process in place, people were given opportunities to voice their opinions, suggestions and concerns via house meetings and in one to one discussions with their key worker.

We carried out this unannounced inspection during one day, speaking with eight people who live at the home, three staff and the registered manager. We spent time observing how care and support was delivered and had lunch with people. We also looked at some key records, these included care plans, staff recruitment files, risk assessments and minutes of meetings. This helped us to make a judgement about how well the home was being run.

We found that people’s care was being well planned. People were involved in making decisions about their care and treatment. People we spoke with said that they were happy with their care and support. Comments included ‘’When staff know I am upset, they talk to me. They are very good, they know me well.’’ Another person said ‘’we are very well cared for.’’

We saw that the service ensured that any new staff had the right checks in place to ensure they were fit to work with vulnerable people, before they commenced employment.

We saw that the home was clean and infection control was taken seriously.

The home had developed systems and checks to ensure that they reviewed and monitored the quality of care provided. This included involving and listening to people who lived at the home as well as staff.

The inspection took place on 23 March 2015 and was unannounced. At the last inspection on 30 April 2014, we asked the provider to take action to make improvements for the safeguarding of people, the management of medicines and the assessing and the monitoring of the quality of the service. We asked for, and received, an action plan. This outlined how the improvements would be made and included timescales saying when they intended to be fully compliant. During this inspection, there had been improvements in all three areas and the actions had been completed.

Arundel House provides care and accommodation for up to 18 younger people living with a mental health illness. The home does not provide nursing care. On the day of inspection there were 14 people living in the home, but one person was away for the day.

The service had a registered manager. A registered manager is a person who is 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 and associated regulations about how the service is run.

On the day of our inspection there was a homely and friendly atmosphere at Arundel House. People were relaxed and comfortable. People, their relatives and health care professionals all spoke highly about the care and support provided. One person said “I enjoy living here. I have lots of friends.” A health care professional felt “(the home) is a consistently good home.”

People said they felt safe. Staff undertook training to ensure they understood how to recognise and report abuse. All the staff said they would not hesitate to raise any concerns. People’s risks were managed and monitored.

Care and support plans were accurate and up to date. They contained information about how people wished to be supported. People’s risks were managed, monitored and reviewed to help keep them safe. People had choice and control over their lives and were supported to take part in activities both inside the home and outside in the community. Activities were meaningful and reflected individual interests and hobbies. One person said “I can do what I want.”

The service followed the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who were not able to make important decisions themselves. The registered manager was organising enhanced MCA training for two senior members of staff.

People had their medicines managed safely and received them on time. Staff knew people well; there were systems in place to recognise changes in people’s health and prompt action was taken when required. Good communication and partnership working had been made with health and social care professionals. One health care professional said “management and staff are receptive and welcome our input” and “will always ring or email”.

People enjoyed the food and comments included “food is lovely” and “love the food.” People received balanced and nutritious meals. They chose what they wanted to eat.

A safe recruitment procedure ensured only suitable staff were employed. Staff were caring and compassionate towards people. They respected people’s privacy and dignity. People were complimentary of the staff. Comments included “staff are kind”, “staff are very good, caring” and “they (the staff) listen to you.” One relative said the “the level of care is absolutely amazing.” A health care professional said “it is a well staffed home and genuinely cares for its residents.”

Staff undertook training to help them develop their skills. They received regular supervision in their work and felt valued and listened to. People commented “the staff know what they are doing” and “you can do as much as you can for yourself.”

People and staff were able to speak with the registered manager and deputy manager about any concerns they had and were confident they would be dealt with. Staff felt supported and valued. A senior member of staff was always on call for advice and guidance.

There were effective quality assurance systems in place that monitored people’s satisfaction and improve the quality of the service. Investigations following incidents and accidents were recorded and audited so that any learning for future practice could be considered.

The premises, services and equipment were well maintained and serviced in accordance with the relevant legislation.