This inspection took place on 29 March and 4 April 2017 and was unannounced.

St Christopher's House is a residential care home that provides accommodation and personal care for up to six people with mental health needs. At the time of our inspection five people were using 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.

Our previous inspection took place on 6 November 2015. Two breaches of the regulations were found. There was a concern about the cleanliness of one shower room where there was an infection control concern. Secondly, the service was not ensuring staff had an up to date Disclosure and Barring Service (DBS) check before they commenced employment. At this inspection, we found that both concerns had been addressed, the service was clean and well maintained and staff were recruited in a manner to ensure the safety of vulnerable adults.

In addition we had recommended that the provider consulted best practice guidance in providing person centred care. We found this had taken place and people’s care plans were person centred and reflected them well containing their history, aims and goals.

Staffing levels were assessed to meet the needs of the people using the service and staff told us they felt well supported by the registered manager and team leader. Each person had a keyworker, this is a staff member allocated specifically to the person who knows the person well and is a point of contact for the person, family and professionals. People told us staff were caring and the service was homely and welcoming.

We found a focus and strength of the service was supporting people to be as independent as possible. Staff supported people to learn new skills to become independent and where appropriate support was given to people to move to more independent living.

People told us they felt safe in the service and could go to staff for help if there was a problem. People had detailed and thorough risk assessments that managed risks to both themselves and to others.

Staff told us about people’s mental and physical health and the support they required to keep well. Staff supported people by administering their medicines in an appropriate manner and told us what steps they would take if they saw people’s mental or physical health was deteriorating. There was close liaison between the service and mental health professionals.

Staff received a thorough induction and subsequent training. Some newer staff had not received training to manage behaviour that might challenge the service however we saw these staff were identified to attend training to address this.

The service was well-led, the registered manager was well thought of by staff and people confirmed they felt able to raise concerns and these were addressed. The registered manager had an understanding of Mental Capacity Act 2005 legislation as did the staff. People were fully involved in their care planning and signed their care plans as they had the capacity to consent to their care and treatment.

The staff asked people for feedback on a regular basis in one to one meetings and the provider undertook a yearly survey. Audits and checks took place to ensure the quality of the care given.

The inspection took place on the 6 November 2015. It was an unannounced comprehensive inspection. At the last inspection on 04 October 2013 the service was found to meet the fundamental standards.

St Christopher's is a care home that offers a care service without nursing for up to six people with mental health needs. At the time of our inspection four people were using the service. There is 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 three storey house was situated in a residential street. People with reduced mobility lived on the ground floor. All communal areas were accessible including the lounge, kitchen and garden. People told us they felt safe at the service and that staff were good. Staff had received safeguarding adults from abuse training and demonstrated a good understanding of how to protect people from abuse. There were adequate numbers of staff to meet people's needs. Recruitment checks were made but some staff had been working unsupervised before Disclosure and Barring service criminal record checks had been received. The systems in place to manage safe recruitment were not being adhered to, putting people at risk of harm.

Staff had received training in infection control, food hygiene, and health and safety. The service was welcoming, well kept and clean, but there was a strong mal odour of urine in the ground floor shower room and toilet. The registered manager told us that measures taken to address the issue had not been successful and repair work would be required to eradicate the mal odour. We were concerned that this put people at risk of acquiring an infection.

We found staff were caring and respectful. There was effective care giving people support with their physical and mental health. Staff made appropriate referrals to medical services in a timely manner. Professionals spoken with described good communication from the registered manager and staff.

We found the service was good at promoting people’s independence. People were involved in their care planning, meeting with their key worker to discuss their support needs. Regular reviewing and updating of care plans occurred. People were encouraged to undertake individual activities however care plans did not address people’s diverse support needs.

The service was well led. There was an established registered manager who was knowledgeable about the people using the service. The registered manager recognised staff potential and encouraged staff to take greater responsibility in their role.

We made a recommendation around person centred care.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report

We spoke with four people who use the service and a visitor. Everyone praised the service and the support provided. Comments included, “it’s excellent” and “I’m happy here.” Everyone talked positively about the staff and manager. “All the staff are good, and are helpful to me”, one person said. Records and feedback from health professionals indicated that the service had a positive effect on people’s well-being.

We found that people were treated with respect and dignity, and were supported in promoting their independence and community involvement. People’s comments about this included, “they support me with cooking and give advice.”

People we spoke with told us they could talk to staff or the manager if they had concerns or complaints. “They’re always ready to help,” one person said. We found that comments and complaints were responded to appropriately.

People expressed satisfaction with the meals provided. Their comments included, “I like the food” and “it’s like being in a hotel.” We found that people were protected from the risks of inadequate nutrition and dehydration.

People we spoke with raised no concerns about standards of cleanliness in the service. Comments included, “it’s very clean” and “it’s not dirty.” We found that people were cared for in a clean, hygienic environment.

We spoke with three of the five people who were using the service at the time of the inspection. They all spoke positively about the services provided. Their comments included, “I’m happy here, it’s like a home,” and “it’s got lots of good points. It’s a nice place to live.”

People told us staff supported them where needed, to make decisions about their care and support, and to develop the skills needed to lead a more independent life. For example, each person took a turn to cook for everybody on a roster basis. Staff knew what sort of support each person needed for this.

Staff were respectful and friendly in their interactions with people, and understood people’s individual needs. They supported people to become more independent, and paid attention to people’s safety and welfare. Medication arrangements at the service were designed to safely enable people to take responsibility for their medicines.

Staff received appropriate professional development and support. There were effective systems to regularly assess and monitor the quality of service that people received, and to make service improvements where appropriate.