The inspection took place on 23 and 29 March 2017 and was unannounced on the first day.

Maria Skobtsova is a small residential home providing care, rehabilitation and support for eight people with mental health and physical needs. Some

people are detained under the Mental Health Act and are under supervision in the community. Maria Skobstova House is affiliated to an organisation called St Anthony-St Elias also known as “the Community”.

At this inspection there were eight people living at the service (one person was in hospital and one person transferred to a different service during the inspection).

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

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.

On the day of the inspection staff were relaxed, and there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive .

People were comfortable with staff supporting them and we observed positive interactions. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly 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 practice was person focused and not task led. Staff had 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. Staff were motivated, and creative in finding ways to overcome obstacles that restricted people’s independence.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers, occupational therapists and physiotherapists.

People we observed were safe. The environment was uncluttered and clear for people to move freely around the home. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. The service followed the processes which were in place which protected people’s human rights and liberty.

People were supported by a staff team that had received a comprehensive induction programme, tailored training for mental health conditions and ongoing support.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

The service had a policy and procedure in place for dealing with any concerns or complaints.

No written complaints had been made to the service in the past twelve months.

People and staff all described the management to be excellent, supportive and approachable. Staff talked po

We spoke to five of the seven people living at Maria Skobstova House on the day of our visit, looked at four care records, met with five staff and looked at four staff files. People told us they were happy at the home and felt safe. We observed the interactions between staff and people at the home to be open and relaxed.

We found that people’s needs were assessed and there were individual, person-centred care plans in place reflecting people’s needs, likes and dislikes.

We found people were given a healthy, varied diet. People were supported with special dietary requirements they had and the staff knew people’s individual dietary needs well.

Staff knew how to protect vulnerable people and they were aware of the processes to be followed if a safeguarding issue arose. People told us they felt safe at the home and we saw clear plans in place to protect people where necessary.

There was an effective recruitment policy in place, staff had the necessary checks required to ensure they were of good character and safe to work with people at Maria Skobstova House.

There was a complaints policy in place, people had access to the policy and information available to them should they wish to make a formal complaint.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

We found that people's care was reviewed regularly and their needs were met. People contributed to the development of their own care records and were central to any care review. One person told us, “I keep my own records, so I know what it’s all about and what’s been agreed."

People using the service were able to participate in activities in the community with support where needed. People told us they were able to join in local activities according to their interests.

We saw that staff treated people with respect and dignity and people told us they were happy with the support provided. One person told us, “I can’t commend the staff enough. They really are excellent.”

We saw that people were cared for, or supported by skilled and experienced staff. This meant that people were kept safe because they received care from appropriately trained people.

People were protected from the risks of unsafe or inappropriate care, support and treatment because accurate and appropriate records were maintained.

When we visited the home we met some of the people that lived there. We spent time talking with and having lunch with them. They told us that they were very happy with the staff and the management of the home. They said that the quality of the service they were receiving was very good and one person told us that the staff were ‘genuine people and nice’.

Throughout our visit we saw the staff talking respectfully with people and using people’s preferred names. All of the conversation was friendly and peoples’ first names were usually used. People’s privacy and dignity was respected.

We saw many occasions when staff supported people to make choices and used their knowledge of peoples’ likes and dislikes to judge people’s wishes.

We saw the staff helping to prepare and deliver lunch at the kitchen’s large dining table for the one person that was present in the home at the time. This person had their preferred option of pizza. The household sat and had lunch and chatted together in a relaxed atmosphere. Peoples’ food preferences and choices were respected by the service.

Peoples’ choices about their care were considered in the day to day activity of the home. We were told that most of the organisation of peoples’ support took place at the handover meetings between periods of support.

People that use the service were supported to actively use community facilities.

The organisation provided an activity programme that was available to all the people that used its services throughout South Devon. For example one person took part in the Community’s allotment scheme each week. We were told that the organisation’s approach was to support people to be ‘busy and active’ thus supporting their mental health and wellbeing.

Other activities apart from those that took place routinely through the ‘Activity Programme’ were suggested individually to people each day and then the staff worked to support peoples’ choices.

We were told about each person’s individual lifestyles and activity choices. Multley Plain shopping area is close to the home and these shops and cafes were routinely used by the people that lived at the home.

Peoples’ care planning was not holistic or comprehensive and did not show how all of each person’s needs were being met by the service. Every person was restricted in some areas of their personal freedoms in order to keep them safe and well. For example most of the people in the home did not manage their own medication or their own personal money. These arrangements were not documented to show that the person was in agreement with each of these restrictions.

People’s needs were being met by competent and trained staff who were supervised by the management of the home. However, staff were not receiving some important training, for example understanding mental health conditions. These additional areas of training would support the staff’s delivery of good quality care.

The inspection took place on 15 and 19 January 2015 and was unannounced.

Maria Skobstova House is a small residential home providing care, rehabilitation and support for eight people with mental health and physical needs. Some people are detained under the Mental Health Act and are under supervision in the community. Maria Skobstova House is affiliated to an organisation called St Anthony-St Elias also known as “the Community”. Maria Skobstova House 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.

During the inspection people and staff were relaxed, there was a calm and pleasant atmosphere. Comments included; “The staff help me a lot, they give me advice, it’s the best thing that has ever happened to me”; “They (the staff) always think of us in a good way, nothings too hard for them”; “They (the staff) are always there for people, they help me with my paperwork”; “I like all the help and TLC here, I couldn’t cope on my own”; “ Staff are caring, kind and understand me”; “They have an exceptional way of making it feel like a home rather than just a house.”

People spoke highly about the care and support they received and professionals we spoke with confirmed this. Staff went the extra mile to ensure personalised care. One doctor we spoke to confirmed care was personalised, “..a lot of common sense and human respect.” Care records were individualised and gave people control over how they liked to receive their care and treatment. Staff responded quickly to people’s change in needs. People were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected.

People’s risks were managed well and monitored. People were encouraged to live full and active lives and were supported to participate in community life. Activities were varied and reflected people’s interests and individual hobbies.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, occupational therapist and district nurses.

People told us they felt safe. Comments included “Staff treat me with dignity and respect”; “I can do what I want, I feel safe here”; “If I was worried about something I’d talk to staff, they’d listen, no problem there”; “Staff help to keep me safe, they listen to you…it’s the best place.” Staff understood how to protect people’s human and legal rights. Applications were made and advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

Staff described the management to be very open, supportive and approachable. People told us the manager was “Efficient and friendly.” Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. One staff member said, “I had a week long training induction, very thorough, and since then updates on physical intervention, breakaway, Asperger’s…..it (the induction) gives additional skills and is tailored to the people who live here.”

There were effective quality assurance systems in place. Incidents were appropriately recorded, investigated and action taken to reduce the likelihood of reoccurrence. Feedback from people, friends, relatives and staff was encouraged and positive. Learning from incidents and concerns raised were used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the home.