Earlham House is a care home for eight people with mental health needs. At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

The home was kept clean and well maintained. Staff supported people with personal care and helped them to keep safe. People were supported to have choice and control of their lives with the exception that people were not allowed a key to the front door.

People said they were happy living in the home, felt that staff supported them well and were able to do the things they wanted to do. Comments included; “I like it here” and staff were “really good.” Staff had positive relationships with people living in the home.

Staff had regular training relevant to their role and said training and supervision were good and they felt well supported by the manager.

Staff gave people good support with their health needs including going to their medical appointments with them if required. People were involved in planning their care and were supported to lead the lifestyle they wanted.

The manager notified other authorities of any important event and ensured records were organised and accurate.

The previous inspection was a focused inspection to check on whether the provider had made improvements in health care plans, staff training and notifications. These improvements had all been made and the home was rated Good. The manager showed evidence of learning from incidents and acting on the feedback from other authorities to ensure continuous improvement in the quality of the service. The service met all relevant fundamental standards. Further information is in the detailed findings below.

This focused inspection took place on 8 March 2016 and was unannounced.

Earlham House is registered to provide accommodation and personal care to eight people who have mental health issues. The home has 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.

This inspection took place to check on legal requirements which were not being met at the last inspection in September 2015. These related to recording people's health needs in a care plan, staff training in First Aid and the Mental Capacity Act 20105 and informing us of important events in the home.

We found improvements had been made in all areas and people were happy with their service. Staff had completed training in First Aid so knew how to respond in the event of a medical emergency in the home. They had been trained to understand the implications of the Mental Capacity Act 2005 for people in the home and understood people's rights to make their own decisions and choices. The registered manager had updated herself on the legal requirements and has been sending notifications of events to us as required.

This inspection took place on 15 September 2015 and was unannounced. The last inspection of this home took place in July 2014. At that inspection we found the provider was not meeting the standards for staffing, staff training and supervision and monitoring the quality of care. At this inspection we found improvements in all of these areas.

Earlham House is a care home for up to 8 people who have mental health needs. There were 7 people living in the home at the time of this inspection.

There was 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.

The home was kept clean and well maintained. People living in the home said they were well looked after. Staff supported people with personal care and helped them to keep safe.

People said they were happy living in the home, had good relationships with staff and were able to do the things they wanted to do. Comments included; “I like it here,” “I don’t have any problems,”

and, “We all get on well together. This is my home and I’m happy.”

There had been some improvements in the service since our last inspection in 2014. These included more staff on duty, more training and supervision for staff and people being allowed to use the kitchen.

Staff did not have up to date training in first aid which meant there was a risk that they may not be able to provide emergency first aid support in an emergency.

Staff gave people support with their health needs and went to their appointments with them but care plans did not always detail the support people needed to maintain their health. This meant there was a risk that some health needs might not be identified and met.

There were three standards which were not being met which related to training, not having written health care plans and the provider not notifying the Care Quality Commission of events they are required to notify. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation that the service promotes independence and rehabilitation in people’s daily lives.

We spoke with two of the seven people using the service. We also spoke with one member of staff and the manager; and reviewed the records including care plans, risk assessments, the menu and the staff rota. Overall, people spoke positively about the service with one person saying, "staff are all right". Another person also said, "staff treat me well". We saw that people could talk and listened to by the staff. We noted people were involved in the review of their care plans and were encouraged to live as independently as possible.

We noted that allegations of abuse had been recorded but procedures were not followed to ensure these were reported and investigated by the local authority safeguarding team.

The home was clean and tidy and arrangements were in place to ensure that equipment and the facilities were maintained. Even though staff and people who used the service felt that the staffing level was sufficient, we have asked the provider to take note of the fact that at times there was only one member of staff working at the home.

We were only able to meet with one person using the service as one was in hospital and the others were out all day. The person did not wish to speak with us other than to say they were happy living at the home and that there were “no problems.”

We therefore contacted the care managers responsible for three of the people’s care. One of the managers said the home provided “good care.” Another said the home supported the person “brilliantly.” We also spoke with the home’s deputy manager and two members of staff.

The running of the home was taken over by the provider in May 2012, but most people had been living there for several years.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe in this home. Safeguarding procedures were in place, staff had been trained in safeguarding people from abuse and they had an understanding of how to recognise and act on any signs that somebody was being abused.

Is the service effective?

People's health and care needs were assessed. Staff encouraged and supported people to eat nutritious food. People said that they had not been involved in the care planning process and did not have copies of their care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare but improvements were needed with a programme of meaningful activities and in ensuring a risk assessment addressed all known risks to a person's safety. People received good support with their health care and personal care.

There was insufficient evidence to confirm that there were enough staff to meet people's needs at all times or that staff had enough support in the form of appropriate training and supervision to meet people's needs in the areas of mental health and medicines.

Is the service caring?

We were able to speak with four people living at Earlham House and observe the experience of another. The other two people did not wish to talk with us. One person living in the home told us, "they keep it clean, cook good meals and look after you" and "I would recommend this house to anybody who wants to stay here." Another said, "it's ok, it's a roof over your head" and "staff are ok. I don't have any problems here. They generally look after me alright." People said they were treated with respect by the staff. The four people we spoke to all said they could go to bed at any time they chose. One person said, "Sometimes I go to bed at 9 or 10. Sometimes I get up and watch TV in the night. I can do what I want. They treat me with respect." They told us they were satisfied with the care they received at this home.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Staff understand their needs and wishes well and people said they were satisfied with the service they were receiving. We judged that staff were not always responsive to the needs of one person who had more complex needs and had limited meaningful activities within the home.

Is the service well-led?

The Registered Manager had been employed for some years and had formed a good relationship with people living in the home. The office was well organised and records easy to find and understand. Staff were clear about their roles and responsibilities. People living in the home told us they would tell the manager if they had a problem. The provider did not have an effective system to regularly assess and monitor the quality of service that people receive or identify, assess and manage risks to the health, safety and welfare of people who use the service and others.