This unannounced inspection took place on 31 January 2017.

Terrance House is a privately owned residential care home supporting up to 48 people with mental health issues. The premises comprise of seven terraced houses converted into one home. It is located in Margate. There were 46 people living at Terrance House when we inspected.

A registered manager was in post and assisted with our inspection. 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 manager was supported by two deputy managers and they knew people well. They had a good understanding of people’s needs and led by example.

We previously carried out an unannounced comprehensive inspection of this service on 23 February 2016. Two breaches of regulations were found. We issued requirement notices relating to person centred care and safe care and treatment. We asked the provider to take action. They sent us an action plan telling us what action they would take to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the breaches in the regulations had been met.

At the previous inspection staff had not always taken the action needed to reduce risks to people to a minimum. Guidance was not always available to make sure all staff knew what action to take to keep people safe. At this inspection improvements had been made. Risks to people's safety were assessed and there was guidance for staff on how to keep risks to a minimum. The guidance was followed to make sure people were as safe as possible. Risk assessments identified people's specific needs, and showed how risks could be minimised without restricting people’s life styles and promoted their independence, privacy and dignity.

The registered manager and staff carried out other environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Accidents and incidents were recorded and were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively.

Emergency plans were in place so if an emergency happened, like a fire, staff knew what to do. There were regular fire drills and people knew how to leave the building safely.

At the previous inspection there were shortfalls in the care planning for people. There were shortfalls when people had specific needs like support to keep their skin healthy or with their behaviours. At this inspection improvements had been made. Each person's care plan was personal to them and recorded the information staff needed to care and support people in the safest way that suited them. Some care plans had not been fully updated to reflect peoples changing needs but staff were aware of the changes and were providing the care people needed.

People received their medicines safely and when they needed them. The staff monitored people's health needs and sought professional advice when it was required. If people were unwell or their health was deteriorating staff contacted their doctors or specialist services.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed. Staff were familiar with people's likes and dislikes, such as how they liked their food and drinks and the activities they enjoyed. People were given individual support to carry out their preferred hobbies and interests.

When complaints were raised they were listened to.

People felt safe using the service and were protected from the risk of abuse because staff knew the possible signs of abuse and how to alert the registered manager or the local

This unannounced inspection took place on 23 February 2016 and was carried out by three inspectors.

Terrance House is a privately owned residential care home supporting up to 48 people with mental health issues. The premises comprises of seven terraced houses converted into one home and is located in Margate. There were 46 people living at Terrance House when we inspected.

A registered manager was in post and assisted with our inspection. 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 manager was supported by two deputy managers and they all knew people well. They had a good understanding of people’s needs and led by example. Staff told us they felt supported and one staff said that the manager was the ‘best manager they had ever worked for.’

The registered manager provided leadership to the staff and had oversight of all areas of the service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and senior staff.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity. Staff told us the registered manager was approachable and they were confident they would not hesitate to raise any issues if they had any concerns. There was a feeling of unconditional positive regard for people by the staff. People were respected and treated with kindness and consideration.

Staff had completed safeguarding training and they knew what action to take if they suspected abuse, and who to report to, such as the local authority safeguarding team. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the registered manager, who would take appropriate action.

There were sufficient numbers of staff on duty. Staff were checked before they started to work at the service and regularly received training to ensure they had the skills and competencies to provide safe care. New staff were allocated a mentor, received induction training and shadowed established staff before they started to work on their own. Staff met with a senior staff member to discuss their role and practice, and to discuss their training and development needs.

Medicines were stored and administered safely. People had the support they needed to attend health appointments and to remain as well as possible. Staff responded to any changes in people’s health needs; people told us that staff always called their doctor if they felt unwell. People made positive comments about the food, there were daily choices and people took part in choosing the menu and food shopping. If people were not eating enough their food was monitored. If required a referral was made to a dietician or their doctor, and supplements were provided as necessary so that they maintained a healthy diet.

Potential risks to people were identified but staff had not acted in a timely way when some risks were identified. Guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. We did find that some areas concerning risks to people needed reviewing and action needed to be taken to make sure people were as safe as possible. The registered manager told us these would be addressed immediately. On the whole there was guidance in place for staff on how to care for people effectively and safely and keep most risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity.

The care and support needs of

People who used the service told us they were satisfied with the service they received. We found that staff took time to explain where possible the options available and supported people to make choices. People told us that they were asked for consent before any care or treatment took place and their wishes respected.

We found the home to be clean and tidy and free from unpleasant odours. There was a system in place for infection control to protect people from the risk of infection.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

We made an unannounced visit to the service and spoke with people who use the service, the registered manager and to staff members. We spent time with people and observed interactions between people using the service and the staff. The three people we spoke with gave us positive feedback about the service.

They said: "I like living here, I feel safe". "staff help you and care for you". “They always knock and ask before they come into my room".

People told us, they were supported by the staff and that their wishes were respected and their privacy maintained. People said they felt listened to and were able to be as independent as they wanted to be, but still felt they received the care they needed.

People said that they were treated with respect and that they received the personal and medical care they needed. They were satisfied with the vocational and social activities they could do and they liked their meals. People said they felt safe. They were confident that any complaints would be acted upon and that they could have a say on improvements to their care and home.