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Inspection carried out on 5 March 2020

During a routine inspection

About the service

NAS House is a residential care home providing accommodation with personal care. The home accommodates up to 14 people in one house. At the time of our inspection 12 people were living at the home who had mental health conditions.

People’s experience of using this service and what we found

The provider carried out a range of health and safety checks of the premises. However, they had not identified window restrictors were not always suitable to reduce the risk of falls from height and that water safety was suitably managed. The responsible person told us they would immediately improve these two areas.

Staff supported people with their medicines safely. Risks to people, including those relating to their mental health conditions, were suitably managed. The provider carried out recruitment checks on staff to ensure they were suitable to work with people. There were enough staff to support people safely. Staff followed suitable infection control practices and received training to understand their responsibilities and the home was clean.

Staff received regular training and support to care for people with mental health conditions. People received their choice of food and were supported to maintain their health. The provider regularly assessed people’s needs to check they were meeting them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care from staff who knew them well as they had worked with them for many years. People liked staff and developed good relationships with them. Staff treated people with dignity and respect. People were involved people in their care and their care plans were based on their needs and preferences. Staff engaged people in activities they were interested in. The provider had a suitable process to respond to any concerns or complaints.

The service did not require a manager to be registered with the CQC. However, the director managed, and was responsible for, the service. The responsible person had good oversight of the service as they worked closely with people and staff each day. They understood their role and responsibilities, as did staff. People, relatives and staff told us the service was well-led and the manager engaged well with them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (report published September 2017).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 15 August 2017

During a routine inspection

NAS House provides accommodation, care and support to up to 14 people with mental health support needs. At the time of our inspection 10 people were using the service.

At our previous inspection on 8 July 2015 the service was rated good. At this inspection we found the service remained good.

People felt safe at the service. There were sufficient staff to meet people’s needs. Staff were aware of the risks to people’s safety and how to mitigate those risks. Staff adhered to their responsibilities to safeguard people from harm. People received their medicines as prescribed.

Staff continued to complete regular training to ensure they had the knowledge and skills to support people. They adhered to the principles of the Mental Capacity Act 2005 and there were no undue restrictions on people’s freedom. People were supported to have their nutritional and health needs met.

Staff respected people’s decisions and empowered them to make choices. Staff were respectful of people’s privacy and dignity and had built caring supportive relationships with people. People were encouraged to maintain relationships with friends and family.

Staff continued to provide people with personalised support which met their needs. Staff were aware of what support people required and detailed care records were maintained. Processes remained in place to record, investigate and respond to any complaints received.

There was clear leadership and management at the service. Staff said the provider was accessible and staff and people were encouraged to express their views and opinions about service delivery. Processes were in place to review the quality of service delivery. The provider adhered to the requirements of their registration with the Care Quality Commission (CQC).

Inspection carried out on 8 July 2015

During a routine inspection

This inspection took place on 8 July and was unannounced.

NAS House provides accommodation and personal support for up to fourteen adults who have past or present mental health needs.

We last inspected the service in July 2014. At that inspection we found the service was meeting all the regulations that we assessed.

The registered provider also manages the home on a day to day basis. The registered provider has 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 told us they felt safe using the service and trusted staff. Staff were trained in safeguarding adults and the service had policies and procedures in place to ensure that the service responded appropriately to allegations or suspicions of abuse. The service ensured that people’s human rights were respected and took action to assess and minimise risks to people.

People were supported with their mental health needs so that they could lead a fulfilling life. They were encouraged to be independent and to take part in interests that mattered to them in the home and the community.

People were supported by suitable numbers of qualified and experienced staff that provided them with the care they required. They were protected from the risks of unsafe and unsuitable staff being employed by the provider’s recruitment and staff selection procedures.

People’s rights were protected at the home. This was because there were systems in place to ensure that the Mental Capacity Act 2005 Code of practice and the Deprivation of Liberty Safeguards were followed if decisions needed to be made on their behalf.

People told us they were happy with the service and found staff kind and considerate. Staff felt supported and received the training needed to do their job effectively. This helped ensure staff cared for people in the way they preferred. Staff had a good knowledge about people’s diverse needs and there were suitable arrangements in place to meet them.

Staff monitored people’s physical health needs and supported them to stay healthy. The provider had appropriate arrangements in place to manage medicines safely. People were supported to integrate in the community and to develop independent living skills. They participated in a wide a range of activities in the community which met their individual needs and interests.

The service was well-led. The service promoted a positive culture that was open, inclusive and empowering. The service had effective systems in place to monitor the quality of the service, and to drive continuous service improvement. People were encouraged to make their views known about the service. Records were kept up to date, internal audits were completed of care and staff records.

Inspection carried out on 19 June 2014

During a routine inspection

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The summary is based on our observations during the inspection. Thirteen people were using the service at the time we visited and we met and spoke with six of them. We talked to staff on duty; they included a support worker and the manager. We reviewed the care records for people who use the service. We requested information from the provider which included quality assurance records, staff records and a business plan. We spoke with a community based mental health care professional and a social services care manager, both were involved in coordinating and reviewing the placements of people using the service.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us they felt reassured by staff who cared for them and this helped them feel safe in the home. All the people we spoke to told us that they felt safe living at NAS House and that they knew who to speak to if they were unhappy about something. People told us they went out independently but told staff of their plans and expected return times. They did this because although they felt they had become more independent and there were no restrictions they did not want staff to worry about them.

The home was well maintained and safe, and had annual programme in place for refurbishing the premises and furniture. Arrangements were in place for regular health and safety checks and the service and maintenance of equipment. The home had fire fighting equipment and a plan to evacuate the premises in the event of a fire.

People using the service had assessments of possible risks to their mental and physical health and these were reviewed every three months, with systems in place that staff were familiar with on how to manage these appropriately.

Is the service effective?

People�s diversity, values and human rights were respected. Care plans included details about the person's age, ethnicity, preferred faith and culture. Staff respected and effectively responded to individual needs. For example, Halal meat and vegetarian meals were included on the menus. One person told us they were always offered a vegetarian option.

Care arrangements provided people with the support they needed with their physical and mental health and with their social care needs, including managing their finances. People were supported by skilled staff who were familiar to them and who provided them with stability and consistent support.

People were supported in promoting their independence and community involvement. A local authority care manager told us they found that people using the service benefited from their placements, the home had successfully promoted their independence, and they received the support and encouragement they required to integrate into their local communities. Care records told of people's aims and ambitions, and how staff should support each person with their social interests and occupation.

Is the service caring?

People using the service told us they felt valued by staff who they described as kind and patient. We observed during the day how the support staff and the manager spent their time in conversations both indoors and in the garden. People found their views were acknowledged, they were offered choices and staff knew about and respected their preferences and daily routines. A person spoken with told of their life changing experiences since they came to this caring environment, they said, "I trust these people who work here; they are good to us and show us love and respect".

Staff were able to tell us how they focused on promoting the dignity of people in a tactful way, and told of everyday events such prompting people with taking an interest in their appearance.

Is the service responsive to people�s needs?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People told us they received on-going advice and treatment from health and social care professionals to ensure that they stayed as well as possible.

People were supported to access relevant mental health services. People regularly saw doctors and nurses from the community mental health teams. Where relevant people had their care needs reviewed at a Care Programme Meeting (CPA). There were additional contingency plans that guided staff on what action to take if a person experienced a relapse in their mental health and that ensured that they got the support they needed. This meant that the service worked with other professionals where necessary to deliver the care people required.

People who use the service were asked for their views about their care and support and they were acted on. All people we spoke with told of a manager who was approachable. They also told us that they were asked to complete satisfaction questionnaires about what they thought of the service they received and if there were areas that needed to be improved.

Is the service well-led?

People using the service benefited from the presence of an experienced and qualified manager who offered good leadership and promoted high standards of care and support. Staff told us they felt well supported by the manager and understood their roles and responsibilities.

The provider/manager had systems in place to monitor standards of care provided in the home, including regular quality audits and satisfaction surveys for people living in the home.

The home worked well with other health and social care agencies to make sure people received the care, treatment and support they needed.

Inspection carried out on 26 November 2013

During a routine inspection

We spoke with five people using services. We spoke with the registered provider and one staff member.

One person said they �like living here and it is a wonderful home.� Another person said staff are �very supportive, they accept each person has limitations and they support me in doing what I can.�

We observed the preparations for a visit to a supermarket. We saw people engaged in activities including colouring pictures and bingo. We heard staff supporting people to be independent in their activities.

People received the care and support that met their needs. We saw that the staff co-operated with other providers. We found that medicines were managed in a safe way. People were protected against the risk of unsafe or unsuitable premises. We saw that there were enough staff who respected people and involved them in making decisions.

Inspection carried out on 11 January 2013

During a routine inspection

At the time of our inspection there were fourteen people using the service, the majority of whom had lived at NAS House for over 15 years. We spoke with seven people, the owner/ manager and one member of staff.

People were positive about their experiences of the home. Comments included, �nice place, I love it�, �the staff are like friends� and �I like it here, the staff are good.�

People told us that staff listened to them and were approachable. Comments included, ��the staff are always available for a chat� and �they are alright and I get asked if I�m happy here.� A third person said, �the staff are the most helpful people I�ve ever known.�

There was a stable staff team who had worked at the home for many years and as a result they knew people well. People told us staff supported them in their daily lives and that they received the necessary treatment when they were not well.

People confirmed they felt safe and told us they would talk to their keyworker staff or the manager if they had any worries or concerns. One person commented, �I feel safe, the staff wouldn�t dare raise their voice.�

The provider also manages the home and made sure that they regularly monitored the care, facilities and support for people using the service.