This unannounced inspection took place on 28 June 2018. 5 Priory Drive was previously inspected in August 2015 when it was found to be 'Good' in all areas.

5 Priory Drive is a small care home that provides accommodation, personal care and support to a maximum of three people of working age who are experiencing severe and enduring mental health conditions. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

5 Priory Drive belongs to a group of homes owned by The Community of St Antony and St Elias. The homes all act as a community with group activities and group management meetings and oversight. At the time of the inspection the home was contracted to provide support to two people, one person was in hospital and was not available during this inspection.

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

We looked at the home’s quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided. Although some systems were working, others had not been effective, as they had not identified the concerns we found during this inspection.

People were not always protected from the risk of harm because the systems in place to manage/ mitigate risks were not always effective. For example, people were potentially exposed to the risk of avoidable harm, because where staff had been provided with guidance to help reduce or minimise risks, information was not known by staff or followed. Whilst some premises safety checks had been completed, risks to people's health and wellbeing had not always been identified, assessed or mitigated.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found that where a person’s capacity to make complex choices or decisions was in doubt, records did not show staff had assessed the person’s capacity. Where decisions had been made in a person’s best interests, these were not being recorded properly and it was not clear these were the least restrictive.

People were protected from the risk of abuse. Staff attended safeguarding training to enhance their understanding of how to protect people. People were involved in the planning of their care and were offered choices in how they wished their needs to be met.

People received their medicines when they needed them and in a safe way and had access healthcare services to maintain good health. Healthcare professionals spoke positively about the home and had confidence in the care provided.

People were involved in choosing, planning and preparing their own meals and records showed people's nutritional needs were identified and met. People could access the kitchen with staff support and were able to help themselves to snacks throughout the day and we saw tea, coffee and soft drinks were freely available.

People's individual living areas and bedrooms were personalised and reflected their individual tastes and interests. The home was set over two floors, on the lower/ground floor there was a bedroom, kitchen, laundry area and a lounge with a large flat screen television and comfortable leather sofa. This lead onto a conservatory which people used as a separate dining area. We saw throughout the inspection people making use of the garden to relax and socialise. Activities were seen as important to people's quality of life and staff ensured people had the opportunity to take part in one-to-one activities both in the home and the wider communi

5 Priory Drive is a small care home for people of working age who are experiencing severe and enduring mental health conditions. The home provides accommodation, personal care and support to a maximum of three people. The home only offers placements to women. The home belongs to a group of homes owned by The Community of St Antony and St Elias. The homes all act as a community with group activities and group management meetings and oversight.

This inspection took place on 19 August 2015 and was unannounced. There were three people living in the home at the time of our inspection. People had a range of needs with some requiring a high level of support with their physical care needs. All people had freedoms but some were restricted under the Mental Health Act. The service was last inspected in August 2013 and was found to be meeting all the regulations.

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

People who lived in 5 Priory Drive were supported towards independent living with care, dedication and understanding. People spoke very highly of the home and described how living there met their individual needs. People who lived in the home had complex mental health and emotional needs as well as physical needs. Staff ensured a great deal of planning and preparation was involved in their care. Staff had liaised and coordinated with people, their relatives, healthcare and social care professionals as well as relevant authorities in order to provide a support package and an environment which reflected people’s individual needs and preferences.

People’s relatives also praised the home, they said “I have always been impressed by the care” and “There is nothing negative I could say”. Healthcare professionals said “They are not like other providers, I find it excellent”, “I cannot fault anything that they do”, “There are very few settings that could manage as well as they do” and “They are an amazing place”.

People were confident about being safe and were comfortable about raising any concerns they may have to the management team. People’s relatives also stated they felt people were safe. One relative said “Her safety always comes into everything” and “A great deal of consideration is taken for her safety”. One healthcare professional said “I feel people are safe, they protect people and I find it excellent”. People were protected from risks and comprehensive risk assessments had been carried out. These had been highly personalised and extensive thought had gone in to identifying all potential risks and actions to avoid them happening. People had a very thorough assessment prior to moving into the home in order to identify their needs comprehensively as well as any potential risks to them or others. People’s safety was paramount and staff spent a lot of time understanding people. People were supported to be as independent as possible, taking responsibility for their medicines, finances and learning new skills. The staff ensured people were physically safe and that their mental wellbeing was prioritised. There were very detailed assessments of the risks to people’s mental health, the triggers that could lead to a relapse in their mental health, the signs that their health was deteriorating and the actions staff were to take. Steps were taken to minimise the risks of people suffering abuse and the home had a very open culture around complaints and raising concerns. People were protected against risks relating to medicines as very specific protocols and training were in place.

Staff were equipped with the skills, knowledge and understanding to be able to support people with diverse and complex needs. Staff told us they were happy with the training they had received and felt skilled to meet the needs of the people in their care. Staff told us people came first and their wellbeing was paramount to the work staff undertook. Staff were supported to develop individually and to share their thoughts and opinions in order to improve the home. Prior to staff being recruited, candidates were invited to spend a ‘taster day’ at the home. This involved the candidate spending a day in the home getting to know the people who lived there and ensure people living at the home felt comfortable with them. People, their relatives and healthcare professionals praised the staff at the home. One relative said “They must vet the staff really well, the calibre of staff is exceptional ”. One healthcare professional said “I feel staff are competent, I cannot fault anything that they do”.

Staff sought advice from health and social care agencies and acted on their recommendations and guidance in people’s best interests. A healthcare professional said “I can say unreservedly that I have never before worked in such a positive, therapeutic organisation, and I regard it a privilege to be able to use my skills in such an effective environment”.

People’s experience of their care and support was positive. People were involved in all aspects of their care, including planning and reviews, and took pride in being able to direct their care. People discussed and shaped the activities programme they wished to take part in and their feedback was listened to and their ideas were implemented. The home had a very comprehensive activities programme in place which people took advantage of. The service was well known and respected within the local town which helped people feel part of the local community. People took part in local social events as well as more individualised activities that met their needs and preferences. Staff supported people to make choices and decisions about their care and lifestyle. People’s care records were detailed and were written in a personalised way. It was clear people were consulted during the writing of their care records and were involved in reviewing these. People were included in decisions about their care and where people did not have the mental capacity to make a particular decision at a particular time, staff had involved the right people and professionals in making the decision. People confirmed their wishes and preferences were respected.

The service had a strong person centred culture which helped people to express their views and share their points of view. People were supported in a caring way which promoted their well-being and helped them to increase their self- esteem. For example, one person had been supported to express their feelings more in order to be understood and to understand themselves. This person had become more expressive and was able to make themselves more clearly understood.

Staff treated people with kindness, compassion, dignity and respect. Steps were taken to improve people’s relationships with their relatives and staff had organised regular day trips for one person to visit their relatives as they could no longer stay there overnight. People were always treated with dignity and respect. One relative said “They try very hard to respect her privacy, whilst still recognising how much help she needs”.

The community’s visions and values were embedded in every aspect of the home. People were treated as equals and were encouraged to take control of their lives as far as possible. Staff competence and behaviours were continuously monitored by management to ensure they were displaying the values of the community and the high level of competence expected.

The provider had a robust quality assurance system in place and regularly sought feedback from people, their relatives and health and social care professionals. The provider continually strived to deliver a very high quality service and always sought to improve. The management structure offered staff support and demonstrated a culture of openness. There was an out of hours management rota which ensured there was always a senior member of staff to contact for support and advice. People told us they felt comfortable sharing their feedback and complaints with the registered manager and the deputy manager.

When we visited the home we met one of the three people that lived there and talked with them. Two people chose not to talk with us. One person told us that they were very happy with the staff and the manager. They told us that the quality of the service was “fantastic”. This person told us that the staff “Know what they are doing. They do a darn good job”.

The service obtained people’s consent before they assisted them with their care and welfare needs. We saw staff respected people's privacy and dignity. Peoples' choices about their care were considered. We saw detailed daily records kept for each person and this related to the person centred and individualised care plans.

People that used the service were supported to use community facilities. The organisation provided an activity programme that was available to all the people that used its services. We saw that this programme included a wide range of activities and events. People could plan ahead and decide what activity or event they would like to attend.

We found that medicines were managed safely by the service. The home had systems were in place to protect people from unsafe medicines management.

People were protected from the risks associated with care workers who may be unsuitable to work with vulnerable people. This was because the provider had effective recruitment procedures in place.

The provider had systems in place to assess and monitor the quality of the service provided.

When we visited the home we met one of three people that lived there and spent time talking with them. We also talked with another person over the telephone. The person living at the home told us that they were very happy with the staff that were supporting them and also with the manager. They said that the quality of the service they were receiving was brilliant. One person told us that the home was the best support service that they had ever experienced.

Throughout our visit we saw staff respected people's privacy and dignity. Peoples' choices about their care were considered in the day to day activity of the home. We saw detailed daily records kept for each person and this related to the person centred and individualised care plans.

People that used the service were supported to use community facilities. The organisation provided an activity programme that was available to all the people that used its services throughout South Devon. We saw an activity programme which included a wide range of activities and events. People living at the home could plan ahead and decide what activity or event they would like to attend.

We saw that the home had been monitoring the quality of the service. However it was difficult to see what direct action had been taken in relation to specific identified trends or questionnaire responses because this information was kept at the head office. The Registered Manager was able to explain how they monitor and manage incidents and accidents.