The inspection took place on 17 August 2018 and was announced. The service was last inspected in December 2015 when it was rated Good.

Foxlands House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Foxlands House is a purpose built care home in a complex of supported housing services for people with mental health needs. It has six en-suite bedrooms and a number of shared living and dining spaces. At the time of our inspection six people were living in the home.

There was a registered manger 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 registered manager had identified issues with the quality and safety of the service including maintenance checks and record keeping issues. However, actions taken had not been effective in improving the quality of information within the service. Staff confidence in the provider’s systems varied, and it was not always easy for staff to locate the most up to date information about people’s needs. People, relatives and staff all spoke highly of the management team in the service. The registered manager was introducing improvements.

People were protected from abuse and avoidable harm. Staff were knowledgeable about safeguarding adults and knew how to escalate concerns about abuse. Risks people faced in their lives had been identified and risk assessments were updated during the inspection to ensure this information was readily available to staff. There were enough staff on duty to ensure people’s needs were met. Due to a misinterpretation of the provider’s policy the service had not maintained complete recruitment records, but they were able to demonstrate safe recruitment practice was followed. We have made a recommendation about recruitment records. People were supported to take their medicines as prescribed. The home was clean and free from malodour. Staff took appropriate action in response to incidents.

People were involved in the needs assessment process and set their own goals for their support. People told us they liked the food, and we saw people’s religious and health needs were respected in terms of the food. Staff received the training and support they needed to perform their roles. Staff worked with other organisations and healthcare services to ensure people’s needs were met. People’s bedrooms were personalised and the building was suitable for people’s needs. Staff worked within the principles of the Mental Capacity Act 2005 and ensured people were supported to make their own choices.

People told us staff were kind. Staff demonstrated they understood the importance of responding to people’s emotional needs and providing appropriate support. People were supported to maintain their friendships and relationships. People’s religious beliefs and cultural background were taken into consideration when their care choices were established. The service endeavoured to provide a safe environment where people could disclose their sexual and gender identity if they wished. Staff treated people with respect and dignity.

People were supported to attend a range of in-house and community-based activities. People were involved in regular reviews of their care. However, records of support and meetings did not reflect the detail of the support provided or progress made towards achieving goals. People knew how to make complaints and these were responded to in line with the provider’s policy. There were systems in place to ensure people would receive appropriate end of life care should the need arise.

We

We carried out an unannounced comprehensive inspection on 17 December 2015.

Foxlands House provides accommodation and care services to people with mental health needs. The service provides a step down service to prepare people for independence and enable them to move on to more independent accommodation. All rooms are single occupancy and have en-suite facilities. At the time of our visit there were six people using the service.

People were treated with dignity and respect by staff who were supportive and caring. We observed that staff interacted with people in a respectful manner and people responded positively. We saw that there was a system in place for managing medicines safely and ensuring that people received their medicines as prescribed. People were protected from the risk of abuse because staff knew what action to take if they suspected that anyone was suffering abuse. Consent to care and treatment was sought in line with the Mental Capacity Act 2005 legislation and staff understood the requirements of this.

People’s nutritional needs were met by the service and we observed that people prepared their own meals and were given support where this was necessary. People’s risks were assessed and reviewed and risk management plans were in place.

People received care and support that was exceptionally responsive to their needs. Care plans provided detailed information about people so staff knew exactly how they wished to be cared for and supported in a personalised way. People received strong encouragement to pursue their own interests and hobbies. People received one to one support through a key working system. This allowed staff to work with individual people on a one to one basis and meant people had a named staff member to talk about their needs at any time. People told us they found the key working sessions helpful and this enabled them to discuss how they felt and to feedback on the support they received from the service.

People were actively involved in developing the service and interviewed and met with new staff. Residents’ meetings were held to encourage people to give their views about the service and make suggestions for improvement. They were involved in making decisions about the environment, such as choosing the colour of paint to decorate communal and personal bedroom areas.

The service was well run by a team of experienced and qualified staff who understood the needs of people using the service. The home had a vision and values which were incorporated into the way the service was run and helped to deliver quality support in line with people’s individual requirements.

Staff were well supported to perform their role and encouraged their personal development encouraged. Staff had received recent training in areas such as, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, safeguarding, medicine management, assessment of risk and support planning.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of our visit the people and three staff were going on holiday. Before they left we were able to speak with three residents, three staff and the registered manager who had come to facilitate the inspection.

Below is a summary of what we found.

Is the service safe?

People told us they felt reassured by staff who supported them and this helped them feel safe in the home. People we spoke to told us that they felt safe living at Foxlands House and that they knew who to speak to if they were unhappy about something. The home was well maintained and safe. Arrangements were in place for regular health and safety checks and maintenance of equipment. There were emergency procedures in place for the staff to follow.

People using the service had assessments of possible risks to their mental and physical health and these were reviewed every three months, with systems in place for staff to manage these risks.

Is the service effective?

People's diversity, values and human rights were respected. Care plans included details about the person's age, ethnicity, preferred faith and culture. Staff respected and effectively responded to individual needs.

Care arrangements provided people with the support they needed with their physical and mental health and with their social care needs, including managing their finances. People were supported by skilled staff who were familiar to them. People who lived at the home said they felt staff helped them be more independent and the received the support and encouragement they required to integrate into their local community. Care records told of people's aims and ambitions, and how staff should people with their social interests and occupation.

Is the service caring?

People using the service told us they felt valued by staff who they described as kind and helpful. We observed during the morning how staff and the manager spent their time in conversations with people. People found their views were acknowledged, they were offered choices and staff knew about and respected their preferences and daily routines. A person who spoke with said, "I trust these people who work here. They are good show us respect".

We observed staff promoting the dignity of people in a tactful way, prompting people with taking an interest in their appearance.

Is the service responsive to people's needs?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People told us they received on-going advice and treatment from health and social care professionals to ensure they stayed as well as possible. People were supported to access relevant mental health services and regularly saw doctors and nurses from the health teams. People had their care needs reviewed at a care plan review meetings and when changes were required.

People who used the service were asked for their views about their care and support and they were acted on. People we spoke with told of the manager as approachable. They told us they were asked to complete questionnaires about what they thought of the service they received and if there were areas that needed to be improved.

Is the service well-led?

People using the service benefited from the presence of an experienced and qualified manager who offered good leadership and promoted high standards of care and support. Staff told us they felt supported by the manager and understood their roles and responsibilities. There were systems in place to monitor standards of care provided in the home, including regular quality audits and satisfaction surveys for people living in the home.

We saw from the records we checked and from speaking to people who used the service that they were able to express their views and make choices about where they lived and how their care and treatment was provided.

We saw that people's views had been taken into account when discussing their placement and plans for the future. There were emergency procedures in place to protect people who used the service from harm.

People who used the service said they felt safe and could speak to staff if they had any concerns. We found there was clear information about the organisations complaints policy and information about abuse which helped staff and people who used the service to understand what abuse was and how they should report it.

Medicines were managed safely and people were supported to self-medicate when this was appropriate.

The provider had effective systems for assessing and monitoring the service they provided.

We spoke with three people who use the service. Everyone told us they were happy with the service provided. People felt supported by staff. One person’s comments were typical of others when they said, “staff are always there for you”. People told us they took part in a range of activities both in the service and in the wider community. An art group which was held regularly was described as “inspiring”.

People we spoke with knew why they were using the service and what they were hoping to achieve with the support of staff. One person said, “I am making progress and looking forward to the future”. They were satisfied with the environment in which they received care. For example, one person said, “I like my room” and another person commented, “we keep it quite tidy between us.”

Staff received appropriate training and support to enable them to deliver the care to people that they needed. Complaints about the service were managed effectively.

We spoke to some of the people who used the service and they told us they were happy with the care and support provided to them. They said they got on well with staff and met regularly with their keyworker. People said they felt safe living in the home and took part in a number of activities including going to football matches and to cafes. There were weekly meetings of the people who used the service and staff at which people were able to plan meals for the week ahead and raise any concerns they had.