The service provides accommodation and support for up to 17 adults with mental health problems. The home does not provide nursing care. The property consists of two adjoining terraced houses that have been linked. On the day of the inspection there were 17 people living there.

Why the service is rated Good.

At the last inspection, the service was rated Good overall, although there was a breach of regulation because records relating to the care and treatment of people were not accurate or up to date. At this inspection we found records relating to the care and treatment of people were now accurate and up to date, and the service remained Good overall.

People remained safe at the home. Staff continued to manage risks to people living at the home, while supporting them to make choices and feel in control. People told us there were adequate numbers of suitable staff to keep them safe and make sure their needs were met. People received their medicines safely.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People’s healthcare needs were monitored by the staff and people said they had access to healthcare professionals according to their individual needs. A programme of refurbishment was underway to to make the environment safer, and improve the quality of life of the people living there. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home continued to provide a caring service to people. People told us, “The staff are awesome, really friendly” and, “Yea, they care about me, they’re a good bunch”. Staff had built trusting relationships with people, and worked with them to promote their independence while minimising risks. They ensured people, or their representatives, were fully involved in decisions about the care and support they received.

The service was fully responsive to people’s individual needs. Care and support was personalised to each person and reviewed to ensure it continued to meet people’s changing needs. Complaints were fully investigated and responded to.

The service continued to be well led. People and their relatives told us the management within the home were open and approachable. A relative said, “ [Manager’s name] is a good manager. I get on well with them. My family member warms to them. They are always willing to talk, always very warm and willing to chat”. The registered manager was now supported in their role by a senior carer which meant the home was effectively managed at all times. The registered manager and provider had an effective quality assurance system to ensure they continued to meet people’s needs safely and effectively. The service was proactive in seeking the views of people and their relatives, and using the feed back to identify areas for improvement.

Further information is in the detailed findings below.

This unannounced inspection took place on 12 November 2014. The home is registered to provide accommodation with personal care for up to 17 adults with mental health problems. The home does not provide nursing care. The property consists of two adjoining terraced houses that have been linked. On the day of our inspection visit there were 14 people living there.

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.

We last inspected this service on 19 and 22 November 2013 when we found they were not compliant with Regulation 15, safety and suitability of premises. There were insufficient safety measures in place to protect people from harm caused by people smoking in their bedrooms. After the inspection the provider told us about actions they had taken to minimise the risks. During this inspection we saw measures had been put in place to reduce the risks of harm from passive smoking and from fire.

People were not protected against the risks associated with inappropriate or unsafe care because there were no clear procedures in place to ensure that staff understood the principles of the Mental Capacity Act 2005. There was no guidance in place to show how staff had reviewed decision making for people who were unable to give their consent to care, treatment and support.

The care plans provided information on how to keep people safe, for example moving and handling practice, mental illness, behaviour and nutrition. However, many of the risk assessments were out of date and had not been regularly reviewed. The manager assured us that the risks had been informally reviewed but this could not be evidenced in the records. People told us they felt safe. Comments included us “I have no concerns. I can’t think of anything they could do better. I feel safe here.” A health professional told us the service gave people “A stable, settled, steady home” where “People feel safe”.

People lived in a safe environment. The building and equipment were generally well maintained. A few areas showed signs of wear and tear and the manager showed us evidence that they had plans in place to replace worn or broken furnishings and fittings. Medicines were stored and administered safely. Staff understood how to recognise signs of harm or abuse and how it should be reported.

People were involved and consulted about their health and personal care needs. The registered manager and staff understood people’s current needs, and told us they regularly reviewed the care plans with each person, although this could not be fully evidenced by the records. Relatives told us they felt welcomed, involved and regularly informed.

Menus were balanced and varied. People told us they enjoyed the meals. They were offered choices to suit their individual preferences and nutritional needs.

Staff were appropriately trained and skilled. Regular training was provided covering health and safety topics and also topics relevant to people’s health and personal care needs. People told us there was always enough staff on duty and assistance was provided promptly whenever they asked. People were treated with care and respect.

Staff told us the home was well managed and there were good communication systems in place. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and opportunities to request advice, support, or express views or concerns at any time.

There were systems in place to monitor the quality of care including questionnaires, a comments box, and regular resident’s meetings. People told us they knew how to make a complaint and were confident they could raise any concerns and these would be listened to and acted upon. The home had received no complaints in the last year.

There were a number of breaches under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full report.

There were 13 people living at the home on the day of our visit. We spoke with five people who lived there, one of the providers, the manager (recently appointed and not yet registered) and one care worker. We looked at four care plan files and tracked the care each person had received. We looked at the way medicines were stored and administered. We also checked staff recruitment procedures.

People told us they were happy living there and they were always treated with respect. Comments included “It’s a lovely home – it must be the best home in the country!” and “They are lovely staff – they are all angels!”

People told us how their views were sought and taken into account in the way the service was provided. Four people told us they had been consulted about their care plans and they had checked and agreed the content. They also told us they about monthly resident’s meetings where they could raise any issues about the home and the services they received. We heard about some of the things people enjoyed doing each week including swimming, shopping trips and visits to see family and friends.

The records we looked at showed that safe procedures had been followed before new staff began working in the home. This showed that the home had taken good care to make sure the applicants were suitable to work with vulnerable people.

Four people told us they knew how to make a complaint if they wanted to. However, they said they had never needed to.

On the day of our visit, we were told there were 14 people living at St James Road. We spoke with six people and overall they told us that they were very happy with the care and support they received.

People commented that they were fully involved and supported to make decisions about their care. For example, people were involved in reviewing their own care plans so that their needs and wishes could be taken into account. People said that they were encouraged to maintain their independence and felt fully involved in their care.

Staff had knowledge of privacy, dignity, independence and human rights. This included how to maintain privacy and dignity when assisting with personal care. They showed an understanding of the need to encourage people to be involved in their care, recognising the need to promote positive experiences for people to aid their wellbeing. They did this through offering a range of activities to partake in or spending one-to-one time chatting about a range of subjects appropriate for that person.

People we spoke with who lived at St James Road said that their care and welfare needs were being well met.

People we saw and spoke with confirmed that they felt safe and supported by staff at St James Road. They had no concerns about the ability of staff to respond to safeguarding concerns. They felt that their human rights were upheld and respected.

People we spoke to said that staff were supportive and helpful. Staff knew how to respond to specific health and social care needs and were observed to be competent with such. Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people’s health and wellbeing.

People we spoke with confirmed that St James Road sought their views about the quality of the service they received and that this information was sought by questionnaires and resident meetings. Questionnaires were also completed by family members and other health and social care professionals involved in people’s care. We were able to see that where improvements were needed they were followed up by the home.

This inspection took place on 16 and 17 November 2015 and was unannounced.

The service provides accommodation and support for up to 17 adults with mental health problems. The home does not provide nursing care. The property consists of two adjoining terraced houses that have been linked. On the day of the inspection there were 17 people living there.

The service had 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.

At the last inspection on 12 November 2014 we found there were breaches of legal requirements. We asked the provider to take action to make improvements to care records and ensure that people’s legal rights were protected under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We received a provider action plan stating the relevant legal requirements would be met by June 2015. At this inspection we judged the service was now acting in line with legislation to protect the rights of people who lacked capacity, however, some care plans and risk assessments were out of date.

Staff managed risks to people, while supporting them to make choices and feel in control. They did this by ensuring people were fully involved in risk assessments, and in agreement with any plans to keep them safe.

There were systems in place to ensure that medicines were managed safely.

Staff were proactive in monitoring the safety of people at the service. One person said,” If I was concerned I would talk to any of the staff. They are very good”

There were enough staff deployed to meet people’s complex needs. An induction, regular supervision, and a rolling training programme gave them the necessary skills and knowledge. Care plans contained clear information about people’s individual needs and the service guided staff to provide person centred care. We observed staff treated people with kindness, dignity and respect. One person told us, “The staff are super. Very kind and caring. Angels, they all are”.

The majority of people lived independently with support available as they needed it. They chose how and where they wanted to spend their time. The service was planning to develop its organised activity programme according to the wishes of the people living there.

People’s needs were responded to as they changed, and external health professionals were appropriately involved. One professional told us, “They were patient and supported people when they were mentally unwell”. Another professional told us how another person had become more independent;” They have done a really good residential support job and enabled him to move on to supported accommodation”.

Staff, people and their relatives spoke highly of the registered manager, describing him as, “a lovely man. Lovely natured, kind and caring”. The providers visited the home regularly and were proactive in supporting staff and the people living there.

The providers had a quality assurance system in place to ensure they continued to meet people’s needs effectively. A senior carer had been recently recruited to support the registered manager with this task and had begun to review and update people’s risk assessments.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.