Lindsay House is registered to provide a supported living service for people with a mental health diagnosis. The service can support 15 people who require personal care support; at the time of our inspection four people were using the service. At the last inspection, in May 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care. Staff were appropriately recruited and there were enough staff to provide care and support to meet people’s needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on-going professional development that they required to carry out their roles. People were supported to maintain good health and nutrition.

People developed positive relationships with the staff; who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and the provider had effective systems in place to manage any complaints that they may receive.

The service had a positive ethos and an open culture. The registered manager and deputy manager were positive role models in the service. People and other professionals told us that they had confidence in the manager’s ability to provide consistently high quality managerial oversight and leadership to the service.

This unannounced inspection took place on 12 May 2015 Lindsay House is a supported living home, registered to provide personal care for up to 15 people with enduring mental illness. At the time of our inspection one person living at the home was receiving personal care. Another person who also received personal care had been admitted to hospital.

There was 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. At the time of the inspection the registered manager was on maternity leave and suitable interim management arrangements had been put in place.

People were protected from receiving unsafe care. The recruitment procedures carried out at the home protected people from being cared for by staff that were unsuitable to the work in a caring environment. The staff were appropriately trained and had the knowledge and experience to meet people’s needs.

The staff had a good understanding of what constituted abuse and were knowledgeable of the safeguarding reporting procedures.

Safe systems were in place for obtaining, storing, administering and disposing of medicines.

Staff followed strict protocols when giving medicines to people prescribed to be given when required (PRN).

The managers and staff where knowledgeable about the codes of practice relating to the Mental Health Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People received a varied, healthy and nutritious diet and people at risk of not receiving adequate nutrition where encouraged by staff to follow a healthy diet. Relevant healthcare professionals were also involved in promoting good health and wellbeing.

People’s care plans reflected their needs and choices about how they preferred their care and support to be provided. The care staff were attentive and responded in a timely way to people’s requests. They understood their duties and carried them out effectively. Their manner was friendly and they encouraged people to retain as much independence as their capabilities allowed.

People were supported to engage in occupational and recreational activities of their choice.

Suitable systems were in place to continually monitor the quality of the service, although the actions taken to address areas requiring improvement were not formally recorded.

Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary.

During our inspection of Lindsay House we set out to answer our five 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.

Is the service safe?

We found that people's needs had been appropriately assessed before they were provided with care and support. We saw documentary evidence of this in the two files we looked at. This meant that staff had the information they needed about people’s care and support needs and were able to support people in their recovery safely.

Is the service effective?

We saw that individualised care plans and risk assessments were in place which ensured people were supported in an effective way. It was clear from our observations and from speaking with staff that they had a good understanding of the individual care and support needs that people required.

Is the service caring?

We observed staff responding to people with patience and gave them time to be as independent as possible. We saw that people were supported by knowledgeable and approachable staff. We heard staff speak to people in an encouraging and sensitive way which evidenced their knowledge of people’s individual needs. We found that whenever possible people had been involved in the planning of their care and support requirements so that their wishes were respected. A relative told us “the staff here have been fantastic”.

Is the service responsive?

We found that people’s needs had been reviewed and changes made to staffing levels in order to respond to the change in one person’s requirements. We also found that assessments had included identifying any risks to people and detailing how staff should promptly care for people to support their safety and well-being. We read that when people had become unwell clinical professionals had been contacted promptly so that assessment or treatment could be given.

Is the service well led?

The staff we spoke with had a good understanding of the ethos of Lyndsay House and their individual part they played to ensure that people were well supported in all of their day to day activities. The manager provided us with evidence that supported our findings that the service was well managed.

We went back to review the improvements the provider had made following an inspection visit during October 2012. We found that the provider had made changes to the service in line with local commissioning requirements. This meant that the service provided people with more support which enabled them to live as independently as possible.

We spoke with two people who used the service. We also spoke with two members of staff and the registered manager. We reviewed the support records of three people and looked at staff training and development records. We also looked at the systems in place to assess and monitor the quality of service provided.

People told us they were happy living at Lindsay House and that staff supported them to live an independent life. One person told us they had not been very well and the staff were supporting them to take their medicines. They also told us that they would like a hand rail put in place to make sure they could use their shower in a safe way. During our inspection visit, we observed that people looked well cared for and staff provided support in a relaxed and friendly way.

We found that most people received care that met their needs. However, we had some concerns that support plans had not been put in place to meet one person’s individual needs. We also found that staff were well supported and trained to do their jobs. We found that the provider had a system of quality assurance in place and that records were stored safely and securely.

We reviewed the improvements that the provider had made to the arrangements for cleanliness and infection control and the safety and suitability of the premises. We found that significant improvements and refurbishments had been made to people’s bedrooms, bathrooms and living spaces. We also found that new cleaning and maintenance checks had been introduced by the manager and that the levels of cleanliness and infection control had improved at the premises.

We spoke with three people living at Lindsay House. They all told us that they were pleased with the improvements that had been made to the premises. One person said that they liked the new living room because it was clean and had new furniture. Another person told us that their bedroom had been recently re-decorated and that they had been given new curtains, which they were happy with.

The people also told us that they received regular staff support with the cleaning of their bedrooms and bathrooms. This helped them to make sure that their personal space was kept clean and tidy.

We spoke with eight people living at Lindsay House. Most of the people we spoke with told us that they were happy living at the home and staff were caring about their needs. They told us that they enjoyed the meals served by staff and they had a choice of food they wanted to eat.

A few people told us that the staff weighed them and checked their blood pressure on a regular basis to make sure they were healthy. Another person told us that they had discussed their care plan with a member of staff and they had signed the plan to agree with their care. Some people told us that the staff were busy working and did not have much time to spend with them. A few people told us that they wanted to be supported by staff to do more activities such as; going swimming, making their own breakfast and going on a holiday.

We had concerns about the service people received at Lindsay House. This was because people’s individual needs were not been reviewed by staff. We also found that the home was in a poor state of repair and was in need of cleaning, because certain areas in the home were dirty. One person told us that their shower did not work and that their curtains were in need of cleaning. Another person told us that the living room looked “nice” because it had been recently re-painted. They also told us that their bedroom was in need of re-decoration and that “the cushions and settees need replacing” in the lounge.

We spoke with four residents. All spoke highly of the staff and the care they received. One person told us that the staff “give us everything we need.” All told us that they did not have to wait too long if they needed staff assistance. One person told us, “There is always someone about.”

One person told us that staff had spent time talking to them when they were writing their care plans.

Two people told us that they had completed a satisfaction survey to give feedback on the service that they receive at Lindsay House. Another person told us that they attended residents meetings to discuss the running of the home. All four people told us that if they had any concerns they would talk to the staff or the manager.