The inspection took place on the 2 November 2016 and was unannounced.

Quayside is a small residential home which provides support and accommodation for up to eight people who have care needs associated with their mental health conditions. At the time of our visit the age range was that of older adults, between the ages of thirty and sixty-four. All bedrooms are for single occupancy and have en-suite, wet room facilities. People also have access to a large communal dining area and two lounges, a kitchen and laundry. There is also a private garden and limited parking next to the service. The home has 24 hour staffing and an on- call service. There is good public transport links nearby.

The service had 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.

The service provided good care and support to people enabling them to live fulfilled and meaningful lives. People told us they liked living at the service and that the staff were kind and supportive.

The registered provider’s philosophy was that staff support people to make decisions and encourage and develop them to achieve agreed goals. Through positive risk taking individuals were assisted to develop the skills required to live their lives in a less structured, more independent way. In conversation with staff, they confirmed this ethos and it was clear that they saw their role as supporting people to maintain as much independence and self-determination as possible.

People were assessed prior to admission to Quayside to make sure the home could meet their needs. Staff worked with other health and social care professionals to make sure people received the right levels of support and care.

The interactions we observed between people and staff during our visit were positive. We heard and saw people laughing, chatting and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with.

People’s health and well-being needs were continually monitored and adjustments made to care plans as required. The registered manager and staff responded promptly to any concerns in relation to people’s health and were knowledgeable about their medical history.

People had their medicines managed safely, and received their medicines in a way they chose and preferred.

People were fully involved in menu planning and the meals were varied and of a good standard.

People were supported to lead a full and active lifestyle and this varied according to individual choices. People’s daily routines were dependent on their particular choices and interests. People were supported to develop their skills and pursue their hobbies and interests.

People were supported to have their voices heard and staff engaged individually with everyone to make sure everyone was able to express their opinions. People were involved in the planning and reviewing of their care and support plans.

Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). At the time of our visit no one had a DoLS authorisation in place.

The management team provided good leadership and led by example. The registered manager had clear values and enthusiasm about how they wished the service to be provided. These values were shared with the staff team. Person centred care was a major key to the home’s philosophy and staff demonstrated they understood and practiced this by telling us about how they met people’s care and support needs. Staff spoke in an enthusiastic and compassionate way about the people they supported.

There we

We spoke with three of the five people who lived at Quayside. We also spoke with registered manager, regional director and three members of staff.

Through a process called pathway tracking we looked at the care records of three people who used the service. Some of the people who used the service had complex needs and challenging behaviour. We could not ask all of the people if they consented to their care and treatment because to have done so could have caused them distress and anxiety. At our inspection we observed how staff delivered care and treatment, looked at people’s care records and spoke with staff. We spoke with people who used the service who chose to speak to us about how capacity and consent was assessed for them.

We also used this inspection to answer our 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 and staff told us.

Is the service safe?

We spoke to people who used the service and they told us that risk from harm, abuse or exploitation was discussed with them regularly. One person who used the service told us they knew about risk of harm and how they could raise a concern if they felt they were at risk.

The care records we saw all contained a very detailed assessment of people's capacity in respect of the care and treatment they would consent too. There were also detailed assessments of people’s wishes and preferences and how the staff should verbally seek their consent prior to any care being delivered. The staff told us that they treated people with respect at all times and supported people to make their own decisions.

Staff told us that they recognised that the people they supported had the right to make unwise decisions but it was their role to talk with the people who they supported about the consequences of their decision making. The staff we spoke to told us that they had enough time to give people one to one support if they required it and this maintained people’s safety and welfare. The level of staffing had been assessed as appropriate and in line with the daily support structure the provider had developed and which support staff followed.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, the manager was able to describe the circumstances when an application should be made and knew how to submit one.

The provider had a risk management policy. We saw a service risk assessment which outlined actions that needed to be taken in specific situation; for example, flood, fire, extreme weather and power failure. There were emergency plans in place for people who used the service and fire evacuations were carried out routinely and in line with the company’s policy.

Is the service effective?

People who used the service were offered advocacy support. A person who used the service had engaged an independent advocacy service on a regular basis and the advocate was involved in specific situations where the person who used the service had requested this.

We saw that care plans were regularly reviewed and this included discussions with people’s representatives, general practitioners and clinical psychiatrist. The care plans included information about people's health conditions and any treatment options available to them.

There was a range of house and community activities on offer to people who used the service. We saw from the care records we looked at that people were given choices about what activities they liked or disliked what they preferred to take part in. People were encouraged to participate in general household duties, for example; planning menus, cooking and laundry. This meant that people’s independent living skills were being maximised as much as possible and people were being supported with a view to a more independent life.

Is the service caring?

The ethos of the provider is one of positive reinforcement and support to maximise independence, creating change and changing lives. From the care files we looked at we saw that supporting independence and maximising potential featured throughout assessment and support planning.

We observed that the staff knew people well and they were able to interpret people's non-verbal communication and were able to identify any signs that a person may wish to withhold their consent. We observed the staff offering people choices regarding their care and asking for people's agreement. We also observed staff talking with people about what activities they wanted to undertake on the day of our visit and what support they needed from staff to undertake that activity. Where people chose not to accept the support, the staff talked with people about how to undertake the activity safely by themselves.

A person who used the service told us “the staff are very kind, I am given choices about what I want to do”. Another person told us “I can go out and about any time I like and the staff will support me if I need their support”.

A health action plan was contained in the person’s care records; this helped to ensure staff in the hospital would be aware of the person’s needs and how they should be cared for. The plans were in easy read format so that the person concerned could understand them.

Is the service responsive?

All incidents within Quayside were recorded in people’s daily records. Any issues relating to the care and welfare of residents or aggression towards staff were recorded. Debriefing sessions followed to discuss any incidents and to explore if different interventions could be adopted to minimise the risk of further occurrences.

We saw that people who used the service were provided with a copy of the provider’s complaints policy. The complaints policy was in easy read format that people could understand. This meant people with limited reading skills were able to understand the policy and how to make a complaint. Complaints were responded to by the registered manager within seven days. Complaints forms were displayed in the hall of the premises. People were also given the option of complaining to the regional director.

We spoke with people who used the service and they told us the quality of care they received was good. People also told us they knew how to comment and offer suggestions and that their views on the service were welcomed by the provider.

Is the service well led?

The provider had a consistent and robust system for ongoing monitoring of the service provided at Quayside. Quality audits were carried out regularly and the outcome of them was discussed in staff team meetings. We found that the provider assessed risks and took timely action to address any risks identified. Complaints were dealt with robustly and the people who use the service had the complaints policy within their service user guide.

The provider supported staff to undertake national qualifications. Staff induction and ongoing training was provided and staff had confidence in the management arrangements. People who use the service told us that Quayside was well managed.

We spoke with two of the three people who lived at Quayside. Both told us that they were happy at the home and that the staff treated them well.

Comments included: “I get all the support I need,” and, “The staff are very good and give you help when you need it.”

One person told us “I have lived in a lot of different places and this is the best”.

We also spoke with a healthcare professional who told us that the home was proactive and would ask for advice and support if needed

We also spoke with two relatives of people and they told us that they were very happy with the care and support their relatives received. They said that they were consulted about the care their relatives received and that they were kept informed about any changes. Relatives told us that they knew how to make a complaint if they needed to and said they were confident that any complaints would be dealt with appropriately.

We spoke with two members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable