This inspection took place on 25 May 2017 and was unannounced. When the service was last inspected in March 2016 we found two breaches of the regulations of the Health and Social Care Act 2008. The breaches related to safe care and treatment and need for consent. These breaches were followed up as part of our inspection. The service was rated ‘requires improvement.’ in March 2016.

Cintre Severnoaks is registered to provide accommodation for up to seven people who have complex mental health needs. At the time of our inspection the service was providing support to five people.

A registered manager was in post at the time of inspection. 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 our previous inspection the provider was not fully adhering to the principles of the Mental Capacity Act (2005). Although some further work is required we found sufficient improvements had been made. We were advised that the kitchen and pool room were locked overnight. There was no evidence that people had consented to this restrictive practice. The registered manager agreed to review their protocol and ensure that the necessary consideration with people is taken forward as a matter of priority. Apart from this issue the service enabled people to make their own decisions and assisted them to understand the decision making process.

At our previous inspection the provider was not consistently managing medicines safely. We found sufficient improvements had been made.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff were supported to undertake training to enable them to fulfil the requirements of the role.

Risks to people were assessed and where required a risk management plan was in place to manage an identified risk and keep the person safe.

People were supported by a small experienced team. Enabling relationships had been established between staff and the people they supported. Support plans to enhance people’s independence were promoted by the service and staff members.

A care plan was written and agreed with individuals and other interested parties. At people’s requests some family members attend care plan meetings. Care plans were reviewed regularly and a formal review was held once a year and if people’s care needs changed.

People were supported to maintain good health and had access to external health care professionals when required.

Staff described the registered manager as supportive. Comments from people confirmed they were happy with the service and the support received.

There were systems in place to assess, monitor and improve the quality and safety of the service.

Further information is in the detailed findings below.

Severn Oaks provides accommodation for up to seven people who have complex needs including medical issues, learning disabilities, autism spectrum disorders and mental health. Most people living at the home have communication difficulties and find it difficult to speak with new people. On the day of inspection there were six people living at the home. The accommodation was arranged over three floors and a basement. On the ground floor there were a number of communal spaces including a pool room and lounge. In the basement there was a laundry room and woodwork workshop.

This inspection was unannounced and took place on 23 February and 1 March 2016.

The registered manager has been in post for nine-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 told us they felt safe but we found there were risks to their safety. There were concerns about the medication procedures in the home. Medicines taken “as required” rather than regularly did not have written protocols for staff to follow, medicines taken out of the home were not always signed back in and the provider did not have safe systems in place to ensure when people brought over the counter medicines into the home they were informed.

Staff told us there were enough staff to support people. Most staff had been working at the home for a long period of time. The recruitment process followed good practice and the registered manager was reviewing whether they would keep copies of staff files on site as well as in the head office so they were more accessible. Staff told us they had comprehensive induction and training and there was good understanding of how to support people using their training.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and had received training in safeguarding. Staff knew what action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home or the provider and they knew whom to contact externally. The registered manager understood when they were responsible for informing the local authority and CQC about safeguarding.

Staff and the registered manager had some understanding about people who lacked capacity to make decisions for themselves. Some people potentially had fluctuating capacity because of their diagnosis and complex needs but the Mental Capacity Act Code of Practice had not been followed when people’s capacity was in question.. The consultation process, when people lacked capacity, had not been clearly documented in care plans and the plans also weren’t clear if people had decision specific two part assessments. Staff understood about Deprivation of Liberty Safeguards and what process to follow if someone in the home required this.

There were some quality assurance procedures in place to keep people safe. When shortfalls had been identified by the local authority the home had rectified the concerns. However, the registered manager and provider only had some systems in place to identify shortfalls and demonstrate proactive management; these had not picked up all the concerns we found.

Staff supported people to see a wide range of health and social care professionals to help with their care; this was important because many people had complex needs. Staff supported and respected the choices made by people. People’s cultural and religious differences were respected.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. If people expressed they wanted to help with the cooking then this was supported. Staff encouraged people to follow a healthy diet in a caring and respectful wa

The inspection gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service well led? Is the service effective? Is the service safe? In the course of our inspection we spoke to people who use the service, relatives, staff and visiting professionals. We also looked at a variety of records and observed staff interactions with the people who live at Severn Oaks.

Below is a summary of what we found. If you want to see the evidence that supports our summary please read our full report.

Is the service safe?

We observed people being treated with respect and dignity. One person told us 'I told my keyworker that I wanted to see and agree to everything that is written about me and they agreed' We observed risk assessments that detailed the hazard and likely consequences and noted that these assessments are reviewed monthly and signed by the person they relate to. People made decisions about their care and activities.

Staff understood how to safeguard the people they supported and we observed an up to date training matrix indicating all staff had received mandatory and other training. People we spoke with told us they knew how to make a complaint if they needed to and we observed the complaints procedure in a prominent place in the house along with a suggestion box and leaflet inviting comments and suggestions from visitors.

We observed a contingency plan that would be used in the event of an emergency detailing alternative accommodation that would be used in the event of being unable to stay in the house.

Is the service effective?

Personalised care planning was in evidence with people actively involved in decisions about their care and treatment. Personal choice was respected. We spoke with a community worker who had supported a person throughout the preparation for independent living. This means there is a continuity for people and familiarity with the member of staff who will offer on going support when/if they move to independent living in the community.

Is the service caring?

We observed that staff had detailed knowledge of people's likes and dislikes. We spoke with people being supported by the service and people told us 'It's good here, very relaxed' 'Staff are respectful they have helped me a lot' 'I was involved in developing my care plan' 'They look after me quite well' 'The staff are thoughtful and respectful'

When listening to staff it was apparent that they really cared about the individuals they were supporting and they provided care and support in accordance with people's wishes, always promoting and supporting independence. Service satisfaction surveys were completed regularly for people living in the home, visiting professionals and family members and any issues identified were promptly dealt with.

Is the service responsive?

A visiting professional and family member both told us that communication is excellent. The family member told us 'I know I can ring them anytime, the work they have done is brilliant' The service ensured that they communicated with all the professionals involved with a person's care. All the people we spoke with knew how to make a complaint and told us who they would contact if they ever had any concerns.

Is the service well-led?

We observed a number of quality assurance systems, records and documentation that identified how the service responded to opportunities for improvement and development. The staff we spoke to all said they valued the way they were treated and supported by their manager. We saw that staff training records were all up to date ensuring that people were supported by informed staff who were aware of current legislation and regulations.

We observed a number of quality assurance audits including responses from service users, employees and visiting professionals. The responses that had been analysed were positive. This demonstrated that the manager actively seeks the views of people who use the service, staff and visitors in order to check the service is meeting standards.

People told us that they were able to do a lot of things for themselves. One person described the home as a “good base” for their activities and for going out into the community. People’s independence was being promoted; one person told us that there was a “step by step” approach.

People’s support was planned in a way which respected their rights and helped to ensure their safety and wellbeing. Staff assisted people with their medication and with accessing the healthcare services that they needed.

The home was being checked in a number of ways so that people received a service that was suitable for their needs. Meetings took place when people could pass on their views. People told us that they could also raise concerns more formally if needed.

On the day of our inspection there were four people permanently living in the home and one person was arriving that day for a short term placement. People we spoke with were happy with the service at Severn Oaks. Comments included; "I’m happy here and staff are great", " I help with the painting and decorating, we all picked the colours at our meeting".

Staff told us "people need to get something back for their hard work, if people help out around the home it’s rewarded, and the money earned helps them plan extra and more expensive activities". Other staff comments included; "we encourage people to be independent, modelling our care on empowerment and choice", "I feel uplifted working here, its not like a job", "we all work together for the people that live here" and “its the guy's home we work for them".

On the day of our visit people appeared relaxed and engaged in their own environment. For example, upon our arrival the door of the home was opened by a person who lived there, and then ensured a member of staff was alerted to our presence. Staff were observed engaging with people in a positive way, and were viewed sitting and discussing what people wished to do with their day.

Staff were knowledgeable about the needs of people living in the home, and told us that training was plentiful and relevant to the needs of people they were supporting.

The people who we met told us how well supported they are with their mental health needs by the staff team and the manager. Examples of the comments people made included, “the staff are all polite and helpful”, “it’s quite flexible here”, and “you should give the staff a good report”.

People are effectively supported at Severn Oaks to develop independence in their daily lives. The staff team work hard supporting people in building up their confidence in daily living skills. Each person is supported to cook food and to do household tasks at the home. People also take part in a variety of flexible activities that they enjoy in the home and in the community. Some people have part time employment and are being supported by staff in this.

People are involved in planning and agreeing what care and support they need. The care plan records explain what support people need clearly and are informative and based on what each person feels matters to them in their daily lives.

People are cared for by staff who have a good understanding of complex needs. This means people receive care from staff who understand how to support them to meet their needs.

Staff have not been consistently supervised in the work they do. This can impact on the wellbeing of people who use the service, if they are supported by staff who have not had the opportunity to discuss their work with their manager on a regular basis.

Health and safety audits are carried out, but actions to reduce identified risks are not routinely followed up. The service does not use information about adverse events to identify trends that may help to improve quality and reduce risks in the service.