The inspection took place on 7 March 2017.

Mount Vernon is registered to accommodate up to 16 people and specialises in providing care and support for people who live with a mental health condition. At the time of the inspection there were 15 people using the service.

On the day of our inspection there was a registered manager in place. 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 previous inspection on 26 May 2016 we asked the provider to take action to improve the way the prevention and control of the spread of infection was managed at the service. At this inspection we found improvements had been made in this area and concerns dealt with appropriately.

People’s medicines were not always managed safely. Records showed one person had not received their medicine as prescribed. A weekly medicine audit did not identify this concern. Three members of staff had not completed medicine refresher training.

People were safe living at the service because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered manager would deal with any concerns that they reported. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. Staffing levels were adequate to meet people’s needs. Staff were recruited through safe recruitment practices.

Staff had opportunity to meet with the registered manager to review their work, training and development needs. The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. People received sufficient to eat and drink and they were involved in the planning of their meals however, we saw that their choices were limited on a day to day basis. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

Staff were kind, caring and respectful towards the people they supported. Staff were aware of people's support needs and their personal preferences. Information was available for people about how to access and receive support from an independent advocate. People were encouraged to be independent and make individual choices. People's independence privacy and dignity were promoted and respected by staff.

People received care and support that was personalised and responsive to their individual needs. Regular reviews of people's care and support needs took place. People were supported to participate in a variety of activities. The complaints policy was accessible for everyone.

The registered manager understood the responsibilities of their registration with the CQC. People were involved or had opportunities to be involved in the development of the service. Quality assurance and auditing processes were not always in place to ensure people who used the service, their relatives, staff and visitors were safe. However, the registered manager took action to ensure that these were implemented.

We carried out an unannounced inspection of the service on 26 May 2016. Mount Vernon is registered to accommodate up to 16 people and specialises in providing care and support for people who live with a mental health condition. At the time of the inspection there were 16 people using the service.

On the day of our inspection there was a registered manager in place. 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.

There were not sufficient processes in place to reduce the risk of the spread of infection. The risk to people’s safety was reduced because staff understood how to identify the signs of abuse and who to report concerns to. Risk assessments had been completed in areas where people’s safety could be at risk. People had the freedom to live their lives as they wanted to.

Staff were recruited in a safe way, there were enough staff to meet people’s needs and to keep them safe.

Accidents and incidents were investigated. Personal emergency evacuation plans (PEEPs) were not in place, but regular fire drills were carried out. People’s medicines were stored, handled and administered safely although there were not sufficient processes in place for the administration of ‘as needed’ medicines.

People were supported by staff who received an induction and supervision of their work, however some staff required refresher training in particular areas.

The registered manager was aware of the principle of the Mental Capacity Act (2005) and how to apply them if needed. Staff ensured people were given choices about their support needs and day to day life.

People spoke highly of the food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by the staff and external professionals. Clear guidance on how to support people living with diabetes was needed in people’s care records. Referrals to relevant health services were made where needed.

Staff supported people in a kind and caring way. Staff understood people’s needs and listened to and acted upon their views. Staff responded quickly to people who had become distressed.

People were able to contribute to decisions about their care and support needs. Information about how to contact an independent advocate was available for people. Staff understood how to maintain people’s dignity and people were encouraged to lead as independent a life as they wanted.. People’s friends and relatives were able to visit whenever they wanted to.

People’s care records were person centred and focused on what was important to them. People were involved with reviews of their care with staff and health and social professionals. People were encouraged to socialise with each other and others outside of the home. Staff had identified when people were at risk of social isolation and took positive action to address this. People were provided with the information they needed if they wished to make a complaint.

There was a positive atmosphere at the home. People and staff got on well together and they spoke highly of the registered manager. The registered manager understood their responsibilities and adhered to the terms of their registration with the CQC. People and staff felt able to contribute to the development of the service. People who used the service were encouraged to provide their feedback on how the service could be improved.

There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided. However, effective processes were not currently in place to ensure the risk of the spread of infection was reduced.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activitie

We carried out the inspection to check that the provider had met the compliance actions that we set at our previous inspection on 25 January 2013 regarding the safety and suitability of the premises and how the service supported staff.

We spoke with one person using the service. They said, “Nothing they [The service] could do better. They’ve [The service] done a lot for me.” They told us they felt safe and would speak to staff if they had any concerns.

They told us they received their medication when they needed it and they were happy with their room. They said, “My room is cosy and warm. It has everything I want in it.” They also said, “Staff treat you ok. They are a decent sort of people.”

We found that people experienced care, treatment and support that met their needs and protected their rights. We found that people were protected from the risk of abuse and medicines were appropriately stored and given. People were protected against the risks of unsafe or unsuitable premises and cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with one person using the service. They told us they felt safe and said, “People are treated like a family. People are very, very happy here.” They were happy with the levels of staff at the home.

They also told us they were receiving good care. They said, “Staff are caring, patient and understanding. I’ve never met anyone to equal the staff here.” They told us they would be happy to raise any issues if they needed to.

We found that people’s privacy and dignity were respected and they were involved in decisions about their care. We found that people were supported appropriately but people using the service, visitors and staff were not fully protected against the risk of unsafe premises.

We found that staff were recruited appropriately and there were enough qualified, skilled and experienced staff to meet people’s needs at all times.

We also found that people were cared for by staff who were not fully supported to deliver care and treatment safely and to an appropriate standard. However, we found that appropriate arrangements were in place to assess the quality of service provided.