Saivi House is a care home that provides accommodation and care to a maximum of five people who have a learning disability, a mental health issue or a dual diagnosis. On the day of the inspection there were four people residing at the home.

At the last inspection on 4 November 2015 the home was overall rated Good.

At this inspection we found the home remained Good.

People in the home had complex needs and some people were unable to provide us with verbal feedback. On the day of our inspection, we spoke with two people. Following the inspection we spoke with one relative and one social care professional to obtain their feedback about the service. They told us they were confident people were safe in the presence of care workers and in the home.

During the inspection we observed people were treated with kindness and compassion. It was evident that positive caring relationships had developed between people who lived in the home and staff.

People who used the service spoke positively about staff and the care provided at the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm. Staff were knowledgeable about people's individual care needs and were aware of the triggers and warning signs which indicated when people were upset and how to support people appropriately.

There were enough staff to meet people's individual care needs and this was confirmed by staff we spoke with. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. People who used the service told us that staff always had time to speak with them. The registered manager explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

There were arrangements for the recording of medicines received into the home and for their storage, administration and disposal. However, we found that medicines were not always stored at the appropriate temperature and we made a recommendation in respect of this.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Staff demonstrated that they had the knowledge and skills they needed to perform their roles. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, basic life support aid and moving and handling. We noted that staff had received some supervision sessions. However, we noted that these had not taken place consistently since our previous inspection and raised this with management. The registered manager explained that they had recently employed a care supervisor who would be responsible for ensuring these were carried out consistently.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people's needs changed.

The registered manager explained to us that they encouraged people to be independent as much as possible but provided support where necessary.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005).

The CQC is required by law to monitor the operation of the De

This inspection took place on 4 November 2015 and was unannounced. At our last inspection in October 2014 the service met all the standards we looked at.

Saivi House is a care home that provides accommodation and care to a maximum of five people who have a learning disability, a mental health issue or a dual diagnosis. On the day of the inspection there were four people residing at the home.

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 and their relatives told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful. They said they were satisfied with the numbers of staff on duty at the home.

Staff had the necessary knowledge, skills and management support in order to carry out their role properly.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks should be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People told us they enjoyed the food and staff knew about any special diets people required either as a result of a clinical need or a personal preference.

People using the service, their relatives and staff were positive about the registered manager and his management of the home. They confirmed that they were asked about the quality of the service and had made comments about this. People felt the registered manager took their views into account in order to improve service delivery and they told us they were happy to raise any concerns they had with the staff and management of the home.

During our inspection on 21 May 2014, we found that the service was not meeting essential standards relating to care and welfare of people who use services, safeguarding people from abuse, and assessing and monitoring the quality of service provision. The provider submitted an action plan detailing what they would do to meet the standards. During this visit, on 17 September 2014, we checked whether the provider had carried out the actions and whether the standards were now being met.

We found that the provider had a system in place to protect people who used the service from abuse, and incidents were recorded and monitored so that appropriate action could be taken to protect people from harm. People who used the service told us they felt safe at Saivi House. One person said, "The staff look after us very well, and the police come sometimes to make sure we are safe."

We found that the registered manager had implemented a system to collect and respond to feedback about the service, and had undertaken a series of spot checks to ensure people received a good quality service that met their needs.

A single inspector carried out this inspection. The purpose of our inspection was to answer five questions: is the service safe, responsive, effective, caring, and well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We found the service did not always respond appropriately when supporting people who sometimes exhibit challenging behaviours which left people at risk of harm.

Is the service effective?

Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded, and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

We found there were arrangements in place to deal with foreseeable emergencies.

Is the service caring?

We observed staff treating people respectfully, with kindness, patience and gave encouragement when supporting them. People were also offered choices about the way their care was delivered. We found people were encouraged to be as independent as possible.

We saw that individual care plans were person centred. Care plans were updated each day with each person’s daily activities and information about their mood and behaviour.

We found people did not always receive care and support that reflected their individual needs.

Is the service responsive?

We found people’s needs had been assessed before they moved into the home and a care plan developed to help support their individual needs.

We found that people’s care plans were not always reviewed and updated quickly in response to a change in their care and support needs.

Is the service well-led?

We found that people living at Saivi House were regularly consulted about their care and treatment; however, it was unclear whether or not their concerns were always listened to or any appropriate action taken. We found the provider took account of comments and concerns from staff; however, it was unclear if action points identified at staff meetings were always acted upon. We saw the provider had some systems in place to assess and monitor the quality of their service.

We did not speak with people who use the service at this inspection as we visited the service to follow up on a compliance action on Outcome 9, Management of Medicines, in relation to the recording and safe administration of medicines.

We found that the provider had taken action following our last inspection. Checks we carried out on medicines provided evidence that medicines could now be accounted for, improvements had been made to medicines records, and protocols were now in place to provide staff with sufficient instructions to administer medicines safely. Therefore medicines were now being managed safely for the protection of people who use the service.

We spoke with three people who use the service and two relatives. Most people praised the service and the care provided. Comments included, “I’m happy here.” Staff were described as “kind”, “polite” and “nice.” “There’s lots of staff interaction here,” one relative told us. People were provided with individualised support to lead active lifestyles.

We found that staff and the management team knew people as individuals, and responded to people's care and support needs. Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We also found that the service liaised well with healthcare professionals to help meet people’s individual needs.

People told us they were happy with the maintenance and cleanliness of the care home. We found that people were protected from the risk of infection. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

However, we found that people were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements for the recording and safe administration of medicines were not in place. In particular, the service could not account for some stock shortfalls with many as-needed medicines, and there were no up-to-date individual protocols in place for supporting people with as-needed medicines.

The three people spoken to told us that they were consulted about their care. One person summed this up when they said, "Staff treat me alright". We saw that staff understood people’s needs. They were treated respectfully and spoken to in an appropriate manner. People were able to choose what they would like to eat at lunch time.

People said to us that staff were available to help them. We saw that staff knew how to communicate with people. They maintained confidentiality when doing this by not sharing information when other people were present.

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with them, by using pictures, sign language and symbols to do this. We saw that staff understood their needs. They were treated respectfully and spoken to in an appropriate manner. We saw that staff knew how to support people and asked their opinion about things that mattered to them.