We carried out this unannounced comprehensive inspection on 10 October 2017. At our previous inspection of 4 and 8 August 2016, we found the provider and registered manager were in breach of regulations relating to fit and proper persons employed and good governance. At this inspection, we checked on these issues and found that the provider had made improvements and now met all the relevant requirements.

Penberth House is a residential care home for up to three people with mental health needs. At the time of the inspection, three people were receiving care at the service.

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.

People were happy living at the service. Staff knew how to identify abuse and the safeguarding reporting procedures to protect people from potential harm.

People had risk assessments carried out on their well-being including their health, financial and social needs. Support plans contained sufficient guidance for staff about how to support people safely and to minimise the risk of harm. Staff supported positive risk taking which enabled people to live independently.

Staff were aware of the triggers to people’s behaviours and worked closely with healthcare professionals when required to support them safely.

People took their prescribed medicines and received the support they required to do so from competent staff. Staff managed people’s medicines appropriately in line with the provider’s policies and procedures.

The provider ensured the premises were safe and well-maintained. Staff knew how to minimise the risk of infection to people and followed good hygiene practices.

People received care from staff who had the knowledge and skills to meet their needs. Staff had attended the provider’s mandatory training and refresher courses to keep their knowledge and skills up to date. People were supported by staff who received regular supervision and an appraisal of their performance.

People’s care was provided in line with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent to care before they provided support.

People received sufficient food and drink at the service and were encouraged to eat healthily. People were supported to maintain their mental and physical health and to access healthcare services in a timely manner.

The registered manager assessed people’s needs and developed support plans that provided information to staff on how to deliver suitable care. People using the service, their relatives (where appropriate) and healthcare professionals were involved in planning their care. Staff met with people and regularly reviewed their needs and updated the support plans to reflect any changes.

People using the service and their relatives knew how to raise a complaint about the service. The provider sought people’s views about the service and acted on the feedback.

People and staff were happy with the leadership provided by the registered manager and the person centred culture at the service. Staff were clear about their roles and responsibilities and felt supported in their work.

People’s care and support was subject to regular checks and audits. The provider and registered manager ensured they carried out improvements when necessary. Maintenance, repairs and servicing of equipment and premises were carried out when required. There was coordinated working between the provider and external agencies to enable people to access high standards of care.

We carried out this unannounced comprehensive inspection on 10 October 2017. At our previous inspection of 4 and 8 August 2016, we found the provider and registered manager were in breach of regulations relating to fit and proper persons employed and good governance. At this inspection, we checked on these issues and found that the provider had made improvements and now met all the relevant requirements.

Penberth House is a residential care home for up to three people with mental health needs. At the time of the inspection, three people were receiving care at the service.

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.

People were happy living at the service. Staff knew how to identify abuse and the safeguarding reporting procedures to protect people from potential harm.

People had risk assessments carried out on their well-being including their health, financial and social needs. Support plans contained sufficient guidance for staff about how to support people safely and to minimise the risk of harm. Staff supported positive risk taking which enabled people to live independently.

Staff were aware of the triggers to people’s behaviours and worked closely with healthcare professionals when required to support them safely.

People took their prescribed medicines and received the support they required to do so from competent staff. Staff managed people’s medicines appropriately in line with the provider’s policies and procedures.

The provider ensured the premises were safe and well-maintained. Staff knew how to minimise the risk of infection to people and followed good hygiene practices.

People received care from staff who had the knowledge and skills to meet their needs. Staff had attended the provider’s mandatory training and refresher courses to keep their knowledge and skills up to date. People were supported by staff who received regular supervision and an appraisal of their performance.

People’s care was provided in line with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff sought people’s consent to care before they provided support.

People received sufficient food and drink at the service and were encouraged to eat healthily. People were supported to maintain their mental and physical health and to access healthcare services in a timely manner.

The registered manager assessed people’s needs and developed support plans that provided information to staff on how to deliver suitable care. People using the service, their relatives (where appropriate) and healthcare professionals were involved in planning their care. Staff met with people and regularly reviewed their needs and updated the support plans to reflect any changes.

People using the service and their relatives knew how to raise a complaint about the service. The provider sought people’s views about the service and acted on the feedback.

People and staff were happy with the leadership provided by the registered manager and the person centred culture at the service. Staff were clear about their roles and responsibilities and felt supported in their work.

People’s care and support was subject to regular checks and audits. The provider and registered manager ensured they carried out improvements when necessary. Maintenance, repairs and servicing of equipment and premises were carried out when required. There was coordinated working between the provider and external agencies to enable people to access high standards of care.

The inspection was carried out in order to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

When we last visited the service in January 2014 we found that unused medicines were not stored securely. This put people at risk of receiving medicines that were not prescribed for them. We asked for improvements to be made. On this inspection we found that all unused medicines were kept securely in a locked cupboard. Records showed that staff had recorded how they supported people to receive their medicines safely as prescribed.

Individual risks to people were assessed and plans were put in place to promote their safety. We saw that staff put into practice these risk management guidelines when working with people. There were arrangements in place to check the premises were safe and suitable for people.

Staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We confirmed that the service met legal requirements in relation to DoLS and there were no unauthorised deprivations of people's liberty.

Is the service effective?

People's needs and preferences had been assessed and they had an individual support plan which set out how the service supported them. A community psychiatric nurse told us that their community mental health team had found the service to be effective in supporting people with complex needs. They said the service had promoted people's independence and wellbeing.

Is the service caring?

People told us they were supported by kind and friendly staff. Staff knew about people's individual background, interests and preferences and used this information when communicating with people and offering support.

Is the service responsive?

People told us the support they received reflected their views. People were supported to follow their own interests and went out to a range of activities.

Is the service well-led?

The service has a registered manager who has been in post since 2011. Professionals told us that the service worked effectively in partnership with them to promote people's wellbeing. People, relatives and professionals had been asked to give their views of the service. The provider had made health and safety checks of the premises and ensured it was clean and well maintained.

We spoke to all three of the people using the service and asked them about the care being provided. One person using the service had recently returned from a hospital stay and told us that they "couldn't wait to get back here." They described the member of staff on duty as a "miracle worker." Another person told us that "It is a good place. I am happy here."

We saw that care was planned and delivered in a way that ensured people's safety and welfare. People using the service had individual support plans which identified their needs, any potential risks that might occur, and assessed their progress towards personal development goals. We saw that people were asked for their consent before they received any care or support, and the provider acted in accordance with their wishes. The provider also had systems in place to monitor the quality of service that people received.

There was some evidence that people were being protected against the risks associated with the use of medicines. Medicines were being administered safely and were stored in a locked office. However, we found evidence that there was some minor risk to the people using the service because medicines were not stored securely inside the office. Therefore these medicines could potentially be accessed by people other than the member of staff in charge, if they were invited into the office.

We spoke with the two people using the service at Penberth House. They confirmed that they received appropriate care and support, which met their needs. We observed good rapport between people using the service and the staff. People consented to the care and support they received.

The premises at Penberth House were well maintained. The provider had suitable arrangements in place to ensure the premises complied with legal requirements, such as health and safety, and fire regulations.

People with relevant qualifications, knowledge, skills and experience were employed to care for people at Penberth House. Robust recruitment and background checks were completed before new staff joined the service

Records were suitably maintained in the service

People we spoke with who used the service said they had been asked by the staff at Penberth House about the support they needed. They said the staff were aware of how to support them, and that they were good at listening to them. They said they knew there was a care plan for them, and that they were happy that we examined it as part of the inspection.

They told us they had been visited by the home’s management before deciding to move in, to ask them about their care needs. They were also able to visit the home before making a final decision. They said they were able to ask staff when they needed help or advice and staff listened to them.

People who used the service told us the staff were respectful, and they felt safe when being supported. People said staff were very helpful and always were quick to sort out any problems they had.

Overall the people we spoke with said they were very happy living at the home.