Powys House is a privately run care home registered to provide accommodation for up to 18 people, including people living with a learning disability, autism or a mental health need. At the time of our inspection there were 16 people living in the home.

The inspection was unannounced and was carried out on 26 April 2017 and 4 May 2017.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our last inspection, in February 2016, we identified breaches of two regulations; legislation designed to protect people’s rights was not always followed; people did not always receive personalised care; and care plans were not always up to date and reflective of people’s current needs. At this inspection we found action had been taken and there were no longer any breaches of regulation.

People told us and indicated they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider's safeguarding policy and explain the action they would take if they identified any concerns.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring. Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

Staff developed caring and positive relationships with people and were sensitive to their individual communication styles and choices. They treated them with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided both informally and through ‘house meetings’ and an annual survey. They were also supported to raise complaints should they wish to.

People told us and indicated that they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The directors of the company were fully engaged in running the home and provided regular support to the registered manager. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

This inspection took place on 23 February 2016 and was unannounced. The home provides accommodation for up to 18 people with a learning disability, mental health needs or dementia care needs. There were 17 people living at the home when we visited. The home consisted of three floors connected by staircases with a central lift to all floors. There was also a basement which contained the kitchen, laundry room, offices and a staff room. There was a good choice of communal spaces where people are able to socialise, and most bedrooms had en-suite facilities.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

Staff did not always respond promptly and consistently to people’s needs. Care plans were not always up to date or did not support the delivery of personalised care. A new care planning system was being introduced but had not been completed.

People were satisfied with the care and support they received from staff, who were knowledgeable about their physical and personal care needs. However, staff did not always demonstrate a good understanding of how to support people’s mental health needs. They had not been trained to communicate with people who had limited verbal communication and they did not have access to non-verbal prompts, such as pictures or symbols.

Staff did not always follow legislation designed to protect people’s rights, so were unable to demonstrate that they always acted in the best interests of people.

Whilst most people received a nutritious diet, people were not always able to make choices about the food they received and alternatives were not always offered. The manager described the way meals were served as “institutional” and was taking steps to make it more centred on people’s individual needs.

The provider did not have a clear vision or a set of values for staff to follow. A comprehensive auditing system was in place, although the manager recognised that this was not fully embedded in practice and was taking steps to improve it.

We observed positive interactions between people and staff and staff clearly knew people well. People were supported to build and maintain caring relationships. Their privacy and dignity were protected at all times and they were involved in planning their care.

People felt the home was run well. Management supported staff in their work and were described as “approachable” and “supportive”. Staff who understood their roles, were motivated, and worked well as a team. There was an open culture where visitors were welcomed and links with the community had been developed.

People told us they felt safe at the home. Staff knew how to identify, prevent and report abuse, and the provider responded appropriately to allegations of abuse. Where necessary, risk assessments and behavioural support plans were put in place to help protect people from harm.

Staff minimised risks to people without compromising their independence. Where people were not able to recognise or manage risks themselves, staff supported them appropriately.

Staffing levels had recently increased during the day and people told us there were enough staff to meet their needs. The process used to recruit staff helped make sure that only suitable staff were employed. Clear systems were in place for managing medicines and people received their medicines when they needed them.

Environmental risks were managed safely and a suitable system was in place to assess and analyse accidents and incidents across the home. There were arrangements in place to keep people safe

We spoke with seven people who used the service and with the families of three others. They all said they were very happy with the level of care provided and staff understood their needs. One of the people we spoke with said “I am happy here, the staff are nice. Staff help me when I need them”. A family member said their relative was “not easy but the staff know them and know what they need”. They added their relative had “blossomed since he has been there”.

We looked at six care plans and saw they were individualised and included the necessary details to inform staff as to the specific care people required. We saw these were reviewed on a monthly basis. We observed care in the communal areas of the home and saw staff were not rushed and interacted with people in a positive way.

We saw the home had effective systems in place to protect people from abuse. One of the people we spoke with said staff “look after me and make sure I am safe”. There was a duty roster system, which detailed the planned cover for the home. We looked at the duty roster and saw there were arrangements in place to manage short term absences. One member of staff said “it is nice. The level of staff we have means you do get time to sit down with people and they get quality time to talk to you”.

We found the provider had an effective quality assurance system in place and sought the views of people who use the service and their families through regular surveys.

We spoke with 10 of the 17 people who were living at the home. They told us they were very happy living at Powys House. People told us they were involved in day to day decisions such as what they wanted to eat and what activities they wanted to take part in. We were told staff were available when they needed them and at night "we have a call bell if we need any help".

People told us that they felt "safe and happy" at the home. Most people we spoke with had lived at the home for many years and clearly viewed it as their home. People also told us they had chosen the colours for when their bedrooms had been redecorated and that they each had their own room. We spoke with two visiting health professionals who were complimentary about the home and stated "the manager and staff clearly knew the people they looked after". Health professionals were complimentary about how a person with increasing needs was being cared for.

We viewed care plans and related records for two people. These were individual, and showed that people were receiving the care and support they required. Nutritional needs were appropriately met and there were safe systems in place for the management of medicines. The environment was homely and well maintained. All necessary records were available and stored securely.

We spent some time in the home’s communal lounge observing people and staff. Interactions we observed were warm and friendly with staff clearly having a good knowledge about the people they were caring for.

We spoke with people and they were all happy living at Powys House. They said that their privacy was ensured when staff helped them with any personal care. They also said that staff were very nice and friendly. People said staff were usually the same ones and people were able to name their key workers. People also told us that they could choose what time they got up or went to bed and one person told us they had a lie in if they wanted this. People said they felt safe at Powys House and would recommend it as a place to live.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met.