The inspection took place on 3 and 7 October 2016 and was unannounced.

The service provides accommodation and personal care for up to five people with mental health support needs. There are currently five people receiving support, four people live in the main house, one person has their own separate accommodation on site. Downstairs there is a lounge, dining room, laundry room, kitchen and conservatory with access to the garden. Upstairs there are bedrooms and bathrooms, one person had their own toilet.

There is a registered manager employed at the service. 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 said they felt safe, there were audits completed to identify environmental risks. Not everyone had a personal emergency evacuation plan in case of a fire. Following the inspection the registered manager gave us further information about how risks were reduced and managed which was not seen during the inspection visit.

Medicines were managed safely and people were encouraged to be involved. Staff worked closely with health professionals and advice about people’s health needs was sought when needed.

Staff had safeguarding training and understood how to report abuse. People were supported to speak out if they felt unsafe. There were enough staff, with the necessary skills to meet people’s needs. Recruitment systems were in place to check staff were of good character and suitable for their role. Staff had an induction and training to meet people’s needs, staff told us they were well supported by the management team.

There were good relationships between people and staff. Staff treated people with dignity and respect. People were encouraged and supported to express their views and be involved in planning their own care. People’s hobbies and interests were supported. Staff showed good knowledge of people’s needs and preferences. These were reflected in their care plans that people were involved in writing. People had enough to eat and drink; they could make choices about what they ate and took part in preparing the meals.

When complaints were received they were investigated and responded to. People’s confidentiality was respected and records were stored securely. Staff had a good understanding of Mental Capacity Act (MCA) and how this worked alongside the Mental Health Act (MHA). The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty

Safeguards (DoLS). No one at the service needed a DoLS authorisation.

There was an open and person centred culture. Staff were aware of the vision and values of the service. These were to support people to live as independently as possible and to deliver person centred care. The registered manager was accessible to people and staff and had support from an area manager who knew the service well.

Views were sought from people, relatives and professionals and were acted on. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

United Response – 1 St Alphege Road is a care home provides accommodation and personal care for five people who need support with their mental health. Four people live in the main house and one person has separate accommodation in the grounds of the service.

This was an unannounced inspection. The service met all of the regulations we inspected against at our last inspection on 27 November 2013. During this visit, we met all of the people who used the service and were able to have conversations with four of them. We spoke with three care staff, the registered manager and a specialist nurse who was visiting the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.. After the inspection we spoke with a relative and received information from other community specialists who were involved in supporting the people using the service.

We observed people as they engaged in activities and relaxed at the service. Staff supported people in a discreet, friendly and reassuring manner. Staff knocked on people’s doors before entering their rooms and had understanding of people’s needs. Some people were preparing and cooking their own meals and some were supported by staff in the kitchen.

People had an allocated keyworker who were involved in their assessments and reviews. A key worker was a member of staff who co-ordinates a person’s care and support and promotes continuity. Potential risks to people were identified and managed. Throughout the inspection people were treated with kindness and respect. Everyone told us their privacy was respected and they were able to make choices about their day to day lives.

Safeguarding procedures keep people safe from harm. All of the people told us they felt safe in the home; and if they had any concerns, they were confident these would be quickly addressed by their key-worker or by the registered manager.

There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. A satisfactory system of recruitment was in place to ensure that the staff employed to support people were fit to do so. Staff were appropriately trained and skilled and provided care in a safe environment. The staff also completed extra training when people’s needs changed to ensure that they were up to date. The care provided to people was safe and effective and met peoples’ needs.

People received their medicines safely and when they needed them and they were monitored for any side effects. At the time of the inspection the service was not monitoring the temperature at which drugs were stored. The registered manager immediately rectified this.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under Act and the Safeguards (DoLS). The registered manager told us that they had not found it necessary to apply for a Deprivation of Liberty Safeguards authorisation for anyone to date.

Each person who used the service had a care plan which was personal to them and that they been involved in writing. We looked at four care plans. Two of the care plans we looked at did not record all the up to date information needed to make sure staff had guidance and information to care and support people in the way that suited them best. Some information had been removed from the plans and was not easily assessible.

People felt that they were listened to and were involved in planning all aspects of their care and support. Meetings were organised for people so that they had the opportunity to communicate what mattered to them. They were supported by a stable and consistent staff team who knew them well. Local community health and social care specialists had regular meetings comprising of people who use the service and care staff so that people’s care and support could be reviewed.

People were offered and received a balanced and healthy diet. They were able to choose what they wanted to eat and when they wanted to eat it. People’s rooms were personalised and furnished with their own things.

The registered manager and the area manager assessed and monitored the quality of care consistently. The service encouraged feedback from people and families, which they used to make improvements to the service.

People who used the service told us they were satisfied with the care and support 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 felt respected and involved in their care and running of the service.

People told us they felt safe living at the service. We found the provider had taken steps to ensure people were protected from the risk of abuse and staff had undertaken safeguarding training.

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 home and spoke to people who used the service the registered manager and staff.

We spent time with the people and observed interactions between the people and the staff. People were able to talk with us and tell us about their experiences at the home. The three people we spoke with gave us positive feedback about the service. They said, "I like it here the staff are very caring and gentle." "I love it here, I don't want to go anywhere else." "Feels good living here better then other places."

People told us that they were treated with respect by the staff that supported them and that their privacy was maintained. They felt listened to and supported to make decisions about their care. They said that they received the health and personal care they needed and that they were comfortable. They said that their likes and dislikes were taken into consideration.

People who use services said that staff treated them with respect, acknowledged their individuality and promoted their independence. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, 'Staff are pretty good to me here and I'm happy with how things are for me. They help me okay and do things for me'.