Welcome House - The Cedars is registered to provide accommodation and personal care for up to 26 people with mental health needs who do not require nursing care. Accommodation is provided in a detached House near to Rainham. There are local shops, a café and local bus routes close by. At the time we visited there were 11 people living at the home.

At the last Care Quality Commission (CQC) inspection on 05 August 2014, the service was rated Good in all domains and overall.

At this inspection we found the service remained Good.

People continued to be safe at Welcome House - The Cedars. People were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained, particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The registered manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

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.

The inspection took place 05 August 2014 and it was unannounced. Welcome House - The Cedars is registered to provide accommodation and personal care for up to 26 people with mental health needs. People were able to communicate with us.

There was 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 and associated Regulations about how the service is run.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. There was a safeguarding policy in place, which detailed what actions the provider must take to help keep people safe. Staff gave clear explanations of the different types of abuse to be aware of; they explained that they knew the action to take if they suspected any.

Training records showed that all of the staff had been trained on Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), managing challenging behaviour and safeguarding adults. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, we found that the manager understood when an application should be made and how to submit one.

There were enough qualified, skilled and experienced staff to meet people's needs and people were protected by a robust recruitment system.

Risk assessments clearly detailed the support needs, views, likes, dislikes and routines of people. The risk assessments in place clearly identify risks that may occur when meeting people’s needs.

One to one supervisions were carried out monthly and yearly appraisals had been done. Yearly appraisals identified current employee performance, their strength, weakness/growth opportunities, development & training needs and it also identified task to be carried out with timescale.

We observed that people were supported to eat and drink sufficient amounts to meet their needs and people were provided with a choice of suitable and nutritious food and drink. People's care records contained information about their food likes and dislikes.

People's care needs were assessed before they moved to Welcome House – The Cedars. Care records contained individual’s profiles, details of people's mental health needs and how they were met as well as individual specific risks and how they were managed. People were registered with the GP and there were records of regular contact with their GPs, dentists, chiropodists and an ophthalmologist where appropriate.

People were supported by caring and attentive staff. People told us that they had been treated with respect and dignity in the home. People also said that staff were approachable, spoke with them in a respectful manner and offered them choices. Staff were knowledgeable about how to support each person in ways that were right for them. The staff spoken with on the day of the visit were able to discuss the needs of people and the ways in which individuals were supported.

Information about people was treated confidentially and records were stored securely. Staff were discreet in their conversations with one another and with people who were in communal areas of the home. Staff were careful to protect people’s privacy and dignity.

People were encouraged and supported to take part in a variety of appropriate activities inside and outside the home. Each person had an individual weekly activity plan. Staff confirmed that people were encouraged to attend all their planned activities unless they chose not to. One person said, “I would be interested in doing an Art course or some voluntary work and staff are supporting me with this”.

People were made aware of the complaints system. This was provided in a format that met their needs and people had their comments and complaints listened to and acted upon without the fear that they would be discriminated against for making a complaint.

Staff said they felt the home was well led. Staff commented favourably about the positive atmosphere in the home, and the positive team spirit that motivated the staff. The registered manager worked well with other agencies, such as Skills for Care and local authorities to make sure people received their care in a joined up way.

We looked at records and found that people, their representatives and staff were asked for their views about care and treatment in December 2013 and these were acted upon. The survey result stated that people were happy with the service provided. We saw comments from families such as ‘Staff are great with my father’ and ‘We think the carers are doing a good job’.

The provider had systems in place for monitoring and auditing the home. This included weekly and monthly audits for different aspects of the work.

There were twelve people living in the home. We were accompanied by an Expert by Experience during our inspection visit who spoke with seven of the people who lived at The Cedars. People told us they were happy living at the home and that staff looked after them well. We saw that people were comfortable with the manager and staff who were supporting them. The atmosphere in the home was calm and relaxed.

People were treated with respect and their privacy and dignity was upheld. People were involved in planning the kind of support they needed.

People received support that was well planned and sensitively delivered.

People received the medicines they needed, when they needed them.

Robust recruitment and selection procedures ensured that people were supported by suitable staff.

Effective quality assurance systems ensured that people were provided with a good service.

Overall we found that this service was safe, effective, caring, responsive and well-led and had achieved compliance.

There were 12 people living in the home at the time of our visit. There was 24 hour support provided. People told us they were happy living in the home. They said, “All the staff help us, I like it here.” “The food is very good, there is always a choice.” “I make my own decisions about what I want to do.” “I would talk to the staff or the manager if I was worried about anything, they would sort it out.” “I always feel safe here.”

The service made sure people were able to make their own decisions about their care and treatment. We found that the care and support that people received was well planned and sensitively delivered. People were supported to eat a balanced and healthy diet, they were given choice and had their preferences taken into account. The home was clean throughout. Staff were given appropriate professional development to enable them to understand people’s needs and provide appropriate care and support.

People told us that the care and support they received from staff was very good and they liked living in the home.