Felix House is a residential service which provides accommodation, personal and nursing care to a maximum of 11 adults with mental health needs. At the time of our inspection there were nine people living at Felix House. People can access areas on the ground and first floors of two adjoining Victorian properties and include communal, group and garden facilities.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated good:

Staff were respectful and caring and had a good understanding of how they could support people with a focus on their wellbeing and abilities. People had good relationships with staff. There were enough staff, and members of the team and the registered manager supported them in their roles.

People had personalised care plans. These supported staff to provide care that was responsive and effective. Care plans had information about people’s needs and how they liked to be supported. Staff knew what they should do to safeguard people from abuse. Risk assessments supported people’s safety in a range of areas while maintaining their independence as far as possible.

The provider had systems in place to ensure people were safe, including risk management, checks on the environment and safe recruitment processes.

Staff had received induction, and had effective training and supervision.

The provider had processes in place to ensure that medicines were stored safely and people received their medicines correctly.

People’s views were sought through house meetings, surveys and care reviews. Changes were made and actions taken as a result. There were systems in place to continually monitor and improve the quality of the service. Relatives felt involved and included in the service.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service support this practice.

Further information is in the detailed findings below.

This inspection took place over one day on 15 March 2016 and was unannounced. At our last inspection we found the provider met all standards that we inspected. Felix House is registered to provide accommodation, personal care and nursing for a maximum of 11 adults with mental health needs. On the day of inspection there were 11 people using the service.

There is 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.

The previous registered manager had left but the registered manager of a similar home run by the same provider had taken up the registration on a temporary basis. However, a new manager for Felix House had recently been appointed and was in the process of applying for registered manager status with the Care Quality Commission (CQC).

People told us that they felt safe within the home and well supported by staff. We saw positive and friendly interactions between staff and people.

Staff understood people’s individual needs in relation to their care. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place. Staff understood what to do and who to report to if people were at risk of harm.

Staff had an understanding of the legal requirements and systems in place to protect people who could not make decisions for themselves. When people were not able to have input in to decisions affecting aspects of their lives, there were records of Mental Capacity Act assessments and best interests meetings.

Care plans were person centred and reflected individual’s preferences. People were able to have regular meetings with designated staff to discuss their care. There were focused key working sessions that looked at specific aspects of an individual’s care. People were involved in writing their care plans and risk assessments and were able to express their care needs.

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. Medicines were administered safely and on time.

People’s views about how the service was run were listened to. There were regular residents meetings that allowed people to have their views and opinions heard.

Staff training was updated regularly and monitored by the manager. Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

People were supported to have enough to eat and drink. People were encouraged and supported to cook and plan some of their meals.

There was a complaints procedure in place as well as an accident and incident reporting. Where the need for improvements was identified, the manager used this as an opportunity for learning and to improve practices where necessary.

There were regular health and safety audits and monthly medicines audits. These allowed the provider to ensure that issues were identified and addressed. There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance issues.

There was an open atmosphere within the home. The management encouraged a culture of learning and staff development.

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?

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

Is the service safe?

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

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff told us they had been trained to understand when an application should be made, and in how to submit one. This meant people were safeguarded as required.

Staff rotas took into account people’s individual needs when determining the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Is the service effective?

There was information available about advocacy services. This meant people could access additional support if they needed too.

People’s health and care needs were assessed with them, and they were involved in developing their plans of care if they wanted to. People told us their care plan reflected their current needs.

Is the service caring?

People described the staff as “very good, I work with all of them.” Another person told us “staff are okay.” We saw care staff showed patience and gave encouragement when supporting people.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People were encouraged and supported by staff where necessary to be involved with their local community. This included shopping, attending appointments and by attending groups such as ‘FRIENDS.’

People knew how to make a complaint if they were unhappy. We saw complaints had been dealt with and responded to in a timely manner.

Is the service well-led?

The service worked in partnership with key organisations, such as the local authority.

People using the service had regular opportunities in a variety of formats to have their say about the service. For example; meetings and one to one time with their keyworker. Regular audits were completed and we saw any shortfalls had been addressed promptly. This meant the quality of the service was continuingly monitored and being improved.

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 people received a good quality of service at all times. All of the staff told us they would report poor practice if the witnessed it.

The home cared for people who required specialist mental health support. Since the home was purchased by Milestones Trust at the end of 2012 considerable changes had been made in how care was provided to people. The provider carried out a full audit of the service and put in place an action plan to change and improve the service offered. In response to a large number of identified shortfalls the provider took the step to close the home to admissions whilst working to improve the service. At the time of this inspection there were seven people living at the home.

On the day of the inspection some people appeared unkempt and dishevelled. This showed that staff were not spending time with people to support them with personal care. One person said “I would like someone to help me wash my hair but I don’t think they do that anymore.” This demonstrated the general confusion from staff and people who lived at the home about how people’s needs should be met.

Everyone told us that staff were always polite and friendly. We observed that staff spoke with people in a kind and respectful manner. Due to staff vacancies at the home many shifts were being covered by agency and bank staff. Staff spoken with said that there were usually enough staff to support people but not all had experience of working with the people who lived at the home. This meant that although there were adequate numbers of staff they did not always have the skills or experience to effectively meet people’s needs.