The inspection took place on 20 February 2017 and was unannounced. Garden House provides accommodation and care to a maximum of 14 adults who may have complex mental health needs. On the day of the inspection 14 people lived in the home. Garden House is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in five other residential homes and one nursing home across the same site and in Polyphant village, near Launceston.

A registered manager was employed to manage the service. 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 inspection was undertaken in response to concerns raised by the local authority about the services run by Bowden Derra Park Limited.

The issues raised included staff turnover, staff working long hours, lack of staff training, and staff not seeking advice from external professionals or following guidance supplied. There were also concerns whether people were being kept safe, including from the risk of fire or those posed by other people’s behaviour. Concerns were also raised about people living with people that they were not compatible. We were told people were potentially not being supported according to their assessed needs, were having their choices restricted, particularly regarding food, drinks and activities. Also, people were carrying out work they were not paid for and being charged for facilities owned by the provider that should have been included in their fees.

People were supported by a sufficient number of staff. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant people’s needs were met in a timely manner. One staff members told us, “Staffing levels are good.” Staff and relatives told us they felt the staff team was consistent. The registered manager confirmed and rotas showed staffs’ working hours complied with working time regulations. Staff told us they did not work long hours and they had recently been consulted about shift times and patterns to see if any improvements could be made.

A comprehensive training programme was in place which included induction training, mandatory training and training to support people’s individual needs. Staff told us their training was updated regularly and they could request extra training they felt they would benefit from. One staff member told us, “I think the training here is brilliant.”

People, relatives and staff told us people were safe. Staff members commented, “I would definitely say people are safe” and “People are definitely safe. I would not be here if I felt there were any concerns” Risk assessments, guidelines, policies and procedures were all used to help ensure staff supported people’s safety. A fire risk assessment was in place and regular checks were carried out of fire equipment and staff knowledge of evacuation procedures. People had up to date personal emergency evacuation plans (PEEPs) in place.

The registered manager and staff told us before people moved into Garden House, their needs were assessed to help ensure the service could meet their needs and that other people already living in the service would not be adversely affected. If the person’s needs changed or they were not compatible with other people living there, the registered manager told us they contacted the local authority for support to find an alternative place for them to live.

People had personalised care plans in place. Staff and relatives confirmed people and their relatives were involved in ensuring records reflected people’s needs and wishes. Staff and relatives confirmed support was provided in line with people’s care plans. Comments from staff members included, “The car

On the day of our visit we were told that there were 14 people living at Garden House. We spoke to six people living at the home, spent time observing the care people were receiving, spoke to nine members of staff, which included the registered manager and looked at three people’s care files in detail.

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

We spent time talking to people who lived at Garden House and observing the interactions between them and staff. Comments included: “I like living here” and “The staff are nice and I feel happy here.” During our visit, we saw that people appeared relaxed and content.

Care plans that we saw reflected people’s health and social care needs and demonstrated that other health and social care professionals were involved.

Medicines were safely administered. We saw the medication recording records which were appropriately signed by staff when administering a person’s medication.

Staff confirmed that people’s needs were met in a timely manner and felt that there were sufficient staffing numbers.

People were made aware of the complaints system. This was provided in a format that met their needs.

We conducted an unannounced visit to Garden House on 11 July 2012 as part of a programme of scheduled inspections. We spoke to four people who used the service. Some people living at the home were unable to communicate verbally in a meaningful way so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We looked closely at the care of two people who used the service. This involved meeting them, talking to staff about their needs and reading records about their care. We also talked to three health care professionals who were visiting the home and a training instructor working with staff on the day. The registered manager was available and involved in the visit.

People told us, "I like it here"; "There is nothing I would change" and "I like to do my own cleaning of my room and staff help me if I ask". They said that if they were unhappy with anything they would tell the staff. A person's family said, "He likes it here so much" and that he had changed in a positive way since living at Garden House.

We saw that people were relaxed in staff company and talked to them without hesitation, indicating that the staff were kind to people and people felt safe with them.

We observed staff giving people information, asking their opinion and promoting their dignity and independence. One of several examples was staff explaining what we were doing. People's care records were detailed and provided staff with clear information on how the person's needs should be met.

We found that staff understood the complex needs of people using the service. For example, they knew how to respond to a person's anxieties or behaviour that might challenge others. Staff were fully trained and supported in their work.

People's health care needs were being met and community health care professionals were fully involved as necessary for people's welfare. The health care professionals told us that the home always followed their advice and worked in the person's best interest.

The home and organisation had good systems in place to monitor the service provided and ensure people's health, safety and well being.

The inspection took place on 19 and 21 October 2015 and was unannounced.Garden House provides accommodation and care to a maximum of 14 adults, who may have mental health needs, learning or physical disabilities. Garden House is part of a complex of residential accommodation.

On the day of the inspection 14 people were using the service.The service had 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 registered manager was also responsible for the other services on the same complex. Garden House had a team leader who oversaw the day to day running of the service. People and staff were relaxed throughout our inspection. There was a calm, friendly and homely atmosphere. People told us they enjoyed living in the home. Comments included, “The staff are all lovely, they look after me," and "I think it is lovely here."People’s records were personalised and gave people control over all aspects of their lives.

Staff responded quickly to people’s changing needs. People or where appropriate those who mattered to them, were involved in reviewing their needs and how they would like to be supported.

People’s preferences were identified and respected.Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and staff focused on people rather than on tasks.Staff were highly knowledgeable about the people they were supporting and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful and reflected people’s interests and individual hobbies.People’s medicines were managed safely. People received their medicines as prescribed, received them on time and were told what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.

People told us they felt safe and relatives confirmed this. Comments included, “I feel safe here. There are people here looking after me.” All staff had undertaken training on safeguarding vulnerable adults from abuse and demonstrated a good knowledge of how to identify and report any concerns. Staff described what action they would take to protect people from harm. Staff felt confident any incidents or allegations would be fully investigated.People were protected by safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Relatives and friends were made to feel welcome and people were supported to maintain relationships with those who mattered to them. People and those who mattered to them knew how to raise concerns and make complaints. Complaints had been recorded, investigated and the outcome fed back to the complainant.

Staff described the management as supportive and approachable. Staff talked passionately about their role. Comments included, “You make a difference to people" and "I really enjoy working with the guys, ensuring they have a nice day."

Staff received a comprehensive induction programme and there were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

Staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications were made and advice was sought to help safeguard people and respect their human rights.

There were effective quality assurance systems in place. The registered manager followed a monthly and annual cycle of quality assurance activities.