What life is like for people using this service:

Natalie House was exceptionally well led. The organisation had clear aims and objectives of the service it provided and how this would be achieved with people’s involvement. People were supported in a caring and safe environment to work on individual goals around mental health recovery and independence.

The service worked in partnership with other professionals to achieve positive outcomes for people. There was a calm and positive atmosphere.

The service was clean and well maintained. People could enjoy communal areas such as the lounge, kitchen and garden or spend time in their rooms. Peoples choices and diversity were respected and promoted.

People’s medicines were managed and administered safely. People were supported to work towards managing their own medicines where appropriate. People were involved in the development and review of their care plans. People were supported in how they wished to spend their time. Activities were arranged within the service and facilitated in the community.

Feedback was sought from people and staff through meetings, questionnaires and engagement. People were encouraged to share their opinions and be involved in shaping the service’s development. Systems were in place to ensure regulatory requirements were met.

Rating at last inspection: Good (May 2016)

About the service: Natalie House provides fixed term accommodation and support for up to 10 people with mental health needs. At the time of the inspection there were six people living at the service.

Why we inspected: This was a planned inspection based on the previous rating. The service’s rating remained Good.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

We carried out this inspection on 04 & 10 March 2016. The inspection was unannounced. Natalie House provides accommodation and support for up to ten people with mental health needs requiring intense support for a year long period to learn and develop independent living skills. At the time of our inspection there were eight people living at the home.

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.

We received some outstanding feedback about the service without exception people and health professionals told us they were extremely happy with the care and support provided by Natalie House.

There was a very positive and welcoming atmosphere within the home and people were very much at the heart of the service. Everyone we spoke to told us they felt extremely safe living at Natalie House. The safety of people who used the service was taken very seriously and managers and staff were well aware of their responsibility to keep people safe.

Natalie House actively involved people in their assessment which enabled them to make choices about the support they needed to help them back to independence. People were supported to take informed risks. Risk assessments had been completed for the environment and safety checks were conducted regularly of gas and electric.

There was a strong focus on continually striving to improve. The registered manager sought feedback through the use of quality assurance questionnaire and used the results to improve the service. The registered manager had asked peoples relatives to carry out an audit in the home so people might be more open and honest.

The home was piloting a peer support group to support people living at the home manage their mental health by people with lived experience of mental health and recovery.People were empowered to raise awareness of mental health conditions to ensure they were at the heart of the service.

The home had provided two open days and invited health professionals and support organisation’s to assist in promoting awareness to improve people’s wellbeing. People were also empowered and supported to produce monthly newsletters to support people understand mental health conditions and improve their knowledge.

People’s health and wellbeing needs were closely monitored and staff worked closely with health professionals and regular reviews by health professionals took place with people working towards goals they had set for themselves. People were supported to receive their medicines safely from suitably trained staff and these were stored, administered and audited effectively.

People were given a choice of food gift cards weekly so they could buy their own food to encourage independence and staff were their to support people if needed. People could also attend cookery classes and attend group meals and a breakfast club.

The registered manager maintained a high level of communication with people through a range of newsletters and meetings. They consulted people about all aspects of the service and acted on their feedback. People were invited to service user involvement groups to feedback on provider policies and procedures, which the company valued.

Relevant recruitment checks were conducted before staff started working at Natalie House to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

People were cared for by a motivated and well trained staff team, who always out people first. Staff received regular support and received regular one to one sessions of supervision to discuss area

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe living at Natalie House. Each person had their own key to their room and a front door key. People told us they let staff know when they were going out and when they would be returning. Due to the vulnerability of some people they had agreed a time when staff would contact them if they were late back. One person said, “I don’t worry when I am out as I know staff are only a phone call away if I need help.”

Staff had completed training in the safeguarding of vulnerable adults. They could describe different types of abuse and how it could be determined if someone was being abused. All the staff we spoke with were knowledgeable about the home's safeguarding policy and local procedures for reporting suspected abuse and felt confident to use these. Risks to people’s health and safety had been assessed and management plans were in place to reduce these risks. Appropriate checks were carried out on staff before they began working with people.

Is the service effective?

People we spoke with told us they were involved in planning their care. We saw two people had written their own care plan goals. One person told us, “Staff give me the support I want and encourage me to do things for myself.” Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills to care for people living in the home. Where appropriate, the service sought advice from appropriate professionals to assist with the care provided for people.

Is the service caring?

People were supported by staff who were aware of their needs and how they wished to be supported. We observed staff speaking to people in a respectful way and encouraging them to be as independent as possible. One person told us, “The staff here are brilliant. They are so caring and encourage me to do things for myself.” Another person said, “I really can’t fault the staff. They always have time for me and praise me when I have done something by myself.”

Is the service responsive?

An assessment of needs was carried out before people moved to the service. The care records included details of how each person wished to be supported, including their personal preferences. We saw two people had written aspects of their own care plans and these were used by staff supporting them. People told us they could change any aspect of their care and they met regularly with their link worker to discuss this. We saw people were encouraged to suggest changes to the service. This had led to furniture being purchased in the main lounge and other items purchased that people had requested.

Is the service well-led?

Quality assurance systems were in place. A provider report was produced regularly which looked at the care and support people received along with checks on the maintenance of the home and staffing issues. We saw some people living in the home and their relatives, had completed an annual questionnaire about the quality of the service provided in the home. Comments from the survey were all positive. Where people had made suggestions or requests, the manager had contacted the respondents to inform them of changes that were made in response to their comments. Staff told us the management team were supportive and always available for advice and help. A list of staff tasks and responsibilities ensured all staff knew their duties on each shift and this was monitored by the manager and head of care. People living in the home were consulted about changes to the home, for example, the purchase of new furniture.

We spoke with three people who use the service, the registered manager, two members of staff and a visiting community psychiatric nurse.

One person told us "It's a lovely place, nice atmosphere and the staff are amazing." They also spoke about the progress they had made since coming to Natalie House and how secure they felt." Another person we spoke with remembered speaking to us before and was very pleased to tell us that they were moving into a supported independent flat in the next month.

The two staff we spoke with enjoyed working with the people who use the service. One of them said "It is so rewarding to see how much progress people made during their time in the service." Both staff highlighted the training was really helpful and they were able to put this into practice.

A visiting professional said, "I knew nothing of this service before my person came here. I have been impressed by the attitude and commitment of staff, they have really settled and helped the person."

We looked at care plans and saw how people were able to contribute towards them. We found there had been changes to the medication administration and recording systems in line with the services action plan, following previous non compliance in this area. Staff told us they felt supported and received suitable training.

During the visit we spoke with five of the seven people who were living at the service. We also spoke with two healthcare professionals, two relatives and the staff. People told us that staff treated them well and they were supported to make decisions about their care. They told us that the “staff were great” and supported them to be independent. A person told us that they were planning to go out shopping with staff's support that afternoon. People told us that their privacy and dignity were respected.

People told us they felt safe and said they would talk to staff if they had any concerns. People were confident that any concerns they raised would be taken seriously and staff would help them to resolve the issue. People who use the service understood the care and treatment choices available to them. People were offered clear choices and had contributed in the way that care would be provided. The care plans provided detailed, personalised information about the care and support people needed and how it should be provided. People who use the service were protected from the risk of abuse. There were some concerns about medicines' management for one person as their medicines were transferred from their original packaging into another box. This meant that people may be at risk due to secondary dispensing that may lead to errors. There were regular reviews of health and safety risks and audits.