This unannounced inspection took place on 12 November 2018. Priors Piece is a small care home that provides accommodation, personal care and support to a maximum of four people who are experiencing severe and enduring mental health conditions.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both were looked at during this inspection. At the time of the inspection there were four people living at the home. Priors Piece belongs to a group of homes owned by The Community of St Antony and St Elias. The homes act as a community with group activities and group management meetings and oversight.

At our last inspection in March 2016 we rated Priors Piece overall as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

The home had a registered manager in post. 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.

People told us they were well cared for and said they felt safe living at the home. The registered manager and staff were aware of how to keep people safe. Staff had received safeguarding training and could describe signs that may indicate someone was at risk of abuse or harm.

Risks had been appropriately assessed and staff had been provided with information on how to support people safely. People’s medicines were managed, stored and administered safely and appropriately, by staff who had been trained and assessed as competent, to do so.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people's needs. Staff told us they felt supported and we saw evidence staff had received induction, training and ongoing supervision.

People's healthcare needs were monitored by staff and people said they had access to

healthcare professionals according to their individual needs. 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 home supported this practice.

The home remained responsive to people's individual needs. Care and support was personalised to each person which ensured they could make choices about their day to day lives. People knew how to make a complaint and felt confident they would be listened to if they needed to raise

concerns.

People benefitted from a home that was well led by a manager who was open and approachable. The provider had systems in place to review, monitor and improve the quality of service provided. This included a programme of audits and checks, reviewing medicines management, quality of care records, support to staff and environmental health and safety checks.

The home was clean, maintained and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

Further information is in the detailed findings below.

Priors Piece is a small care home for people who are experiencing severe and enduring mental health conditions. The home provides accommodation, personal care and support for a maximum of three people. The home belongs to a group of homes owned by The Community of St Antony and St Elias (The Community). The homes all act as a community with group activities and group management meetings and oversight.

The home has 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection took place on 22 March 2016 and was unannounced. At the time of our inspection there were three people using the service. People had a range of needs with some people being more independent and others requiring more support with their care.

We had carried out a previous inspection of Priors Piece on 29 January 2014 and found them to be meeting the regulations we inspected.

People who lived at Priors Piece received effective support which met their individual needs. The Community held values which revolved around people being seen as individuals and being supported to lead more independent lives through activities and proactive support. Staff at Priors Piece believed in these values and demonstrated these through their practice.

Each person’s care needs were assessed on a regular basis and risks were identified and acted upon. Clear and detailed management plans were in place in relation to each person’s needs. These gave staff information about each person’s specific needs, how these presented themselves, and how to ensure people’s wellbeing was maintained. People were encouraged to become as independent as possible and were supported to develop their skills. People’s skills were reviewed yearly in order to ascertain how people had progressed and which areas they needed to gain further skills in. Healthcare professionals spoke highly of the home and told us people’s abilities grew when they lived in Priors Piece. One healthcare professional said “I cannot speak highly enough about Prior’s Piece. They have turned the life around of one of my service users”.

Staff at Priors Piece had great respect for the people they supported and valued their dignity and self-esteem. Where staff provided people with support this was done in the most discreet way possible and staff were highly aware of not wanting to pressure people or underestimate their intelligence. Staff spoke very highly of the people in Priors Piece and spoke of their great intellect and abilities. Staff knew people well and were knowledgeable and confident when they spoke about people’s support needs. Staff knew people’s histories, their likes, dislikes, interests and preferences. Priors Piece had a very homely atmosphere and throughout the day we observed positive interactions between people and staff as well as laughter, joking and chatting. People’s privacy was paramount and each person had a key to their room. Staff did not enter people’s rooms without permission.

Staff had received training in, and understood, the principles of the Mental Capacity Act 2005 and the presumption that people could make their own decisions about their care and treatment. Some people who lived in Priors Piece did not have the capacity to make specific decisions at specific times. Where this was the case staff had followed the principles of the MCA, the Mental Health Act and decisions had been made in the person’s best interest. The registered manager had a good understanding of the laws regarding the Deprivation of Liberty Safeguards and had made one application to the local authority which had been authorised.

People felt safe at Priors Piece and staff had received training in safeguarding peopl

Prior's Piece is a bungalow providing a home for three gentlemen with mental health issues and learning disabilities.

People received good quality of care and support at this service. People's choices were promoted at all times and staff understood each person's support needs.

Staff made the service as homely as possible. People told us they were happy. One person told us "It's nice here, really nice". Another person said the service was "the best place I've been in. I do lots of things, when I want to".

One person showed us their room. They explained to us that they had the room as they wanted it and were very happy at this service. They told us "I do not want to move. Ever"

There were procedures in place to keep people safe. Staff were knowledgeable about safeguarding and people told us they felt safe. One person said "I'd be more than happy to talk to anyone here if I really had to".

The service had a quality assurance system that monitored standards and looked to improve where possible.

Priors Piece is a bungalow providing a home for three gentlemen with mental health and learning disabilities. The home was furnished to reflect the interests of the people who live there. For example one person enjoyed spontaneous drawing and on the side board there was drawing paper and felt-pens. Another was keen on film and the bookshelf was full of DVDs and videos.

We found that the people who lived at the home were supported by enough staff all of whom had been trained to understand and meet their needs. There were procedures in place to help safeguard people from harm. We noted that some of the policies and procedures were in need of revision. And likewise some staff training was overdue for refreshing.

The people who lived there described a sense of ownership. One person told us "oh I have been here years now. It's fine. I like it here. It makes me happy." A member of staff explained "We try and fill every day with as much as we can do". We were told "family can visit whenever....it is nice cos it's like a homely place to visit."

We saw that people were encouraged to take pride in their home. While we were there we saw one person helping with lunch preparation. Later another person laid the table for tea. We saw that the people who lived at Priors Piece, and the staff who worked there, all knew each other well. There was a sense of mutual affection and respect.