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Inspection carried out on 7 February 2018

During a routine inspection

Azalea House 1 is a residential care home, registered to provide care and support for up to five people with mental health needs and learning disabilities. The home is located next door to its sister home, Azalea House 2. Both homes share facilities which include the garden and communal areas. People living in both homes also move freely from each location and staff also support each other. The homes are currently registered as two separate locations although they work as one. For the purpose of this report we will be focusing on Azalea House 1.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people’s individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met. 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.

People were supported by caring, friendly and respectful staff. Staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing.

Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns.

The service was well managed and the provider’s quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

Inspection carried out on 8 February 2016

During a routine inspection

This inspection took place on 8 February 2016 and was unannounced.

Azalea House 1 is registered to provide care and support for up to five people who are living with a mental health or learning disability illness. There were four people living at the service when we visited.

The service has 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 service is run.

Staff had been trained to recognise signs of potential abuse and how to report them. People reported feeling safe in the company of staff.

There were processes in place to manage identifiable risks. People had risk assessments in place to enable them to maintain their independence.

The provider carried out recruitment checks on new staff to make sure they were suitable to work at the service.

There were suitable and sufficient staff available to support people with their needs.

There was a system in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with induction and ongoing essential training to keep their skills up to date. They were also provided with regular supervision and appraisal.

Staff ensured that people’s consent was gained before providing them with support.

People were supported to make decisions about their care and support needs; and this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported to maintain a balanced diet and were able to make choices on what they wished to eat and drink.

If required, people were supported by staff to access healthcare facilities and were registered with a GP.

Positive and caring relationships had been developed between people and staff.

There were processes in place to ensure that people’s views were acted on; and staff provided care and support to people in a meaningful way.

Where possible people were encouraged to maintain their independence and make decisions. Staff ensured their privacy and dignity were promoted.

Pre-admission assessments were carried out before people moved into the service. This was to ensure that their identified needs would be met.

A complaints procedure had been developed to enable people to raise concerns if they needed to.

There was an open and inclusive culture at the service; and the leadership was transparent and visible, which inspired staff to provide a quality service.

Effective quality assurance systems were in place to monitor the quality of the service provided and to drive continuous improvements.

Inspection carried out on 13 November 2014

During a routine inspection

Azalea House 1 is registered to provide personal care and accommodation for up to five people with mental health needs and learning disability. On the day of our inspection there were five people living at the service.

The inspection was unannounced and took place on the 13 November 2014.

There was no registered manager in post at the time of this inspection. The previous registered manager left the service in September 2014. The provider had recruited a new manager, who had been in post for approximately two months. They have applied to become the registered manager for the service and their application was being processed. 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.

At the last inspection on 23 June 2014, we asked the provider to take action and to make sure suitable arrangements were in place to ensure that the premises were adequately maintained. Following the inspection the provider sent us an action plan detailing the improvements they were going to make and stated that improvements would be achieved by September 2014.

During this inspection we found that improvements had been achieved. The redecoration to areas of the premises had been undertaken and cracked window panes had been replaced. This meant that people were now living in suitable premises to promote their safety.

People told us that they felt safe living at Azalea House 1. We found staff had undertaken training to support them to recognise and report abuse and to maintain people’s safety. They were knowledgeable of the different types of abuse and the action to take if they suspected abuse had occurred or was at risk of occurring.

Where people were at risk of harm, risk management plans were put in place to promote their safety. There were adequate numbers of staff with the required skill mix to support and promote people’s safety. There was a recruitment process in place to ensure that only staff who were suitable were employed. People’s medicines were administered, handled and stored safely.

Staff received training to meet people’s needs; and the training was updated on a regular basis. There was a supervision and appraisal framework in place to support staff with their personal and professional development.

People’s consent was sought before care and support was provided; however, there was a potential risk that some people’s liberty maybe restricted as mental capacity assessment had not been undertaken. People chose what to eat and drink and were able to prepare their own drinks and snacks. People had access to health care services and other health professionals to make sure they received the support they required to maintain good health.

Positive interactions were observed between people and staff. We found that staff knew people very well and promoted their privacy and dignity.

People’s care plans contained were personalised and contained information about their health and social needs. They were reviewed on a regular basis and as and when needs changed. The provider ensured that complaints made were used to improve on the quality of the care provided.

There was a system in place to monitor the quality of the service provision and safety aspects of the service. Regular audits were undertaken; however, the frequency of safety checks undertaken was not consistently followed and adhered to in line with the provider’s policy.

Inspection carried out on 23 June 2014

During a routine inspection

Our inspection was carried out by one adult social care inspector who visited the service unannounced. At the time of our inspection five people lived at the service. We spoke with three people who used the service, the registered manager and three members of the care staff. We reviewed records relating to the management of the home which included, care plans, daily care records and records relating to the monitoring and assessment of the quality of the service. We also carried out a partial tour of the premises, which included one person�s bedroom.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Regular checks of the environment were made to identify any cleaning or maintenance requirements. We saw that staff carried out checks to make sure the premises were safe. However some parts of the premises were poorly maintained. For example some windows and doors were in poor decorative order and some window frames were rotten. Broken furniture had been left waiting removal for at least several weeks.

People who used the service told us that they felt safe and that they had no concerns about how staff treated them. They told us that they had people they could speak with if they had any concerns. Staff received training to ensure they understood their responsibilities in relation to safeguarding the vulnerable adults in their care. Staff also knew who to contact to report any suspicions of abuse.

Is the service effective?

People who used the service told us that they received the care and support that they needed. We saw that people�s needs had been assessed and care plans developed according to their needs, wishes and aspirations.

It was clear from what we saw and from speaking with people who used the service, that staff understood people�s care and support needs and knew them well.

Is the service caring?

Conversations were calm and relaxed and staff treated people with dignity and respect. People told us that all staff always treated them with respect.

Through discussion with staff, people who used the service and looking at records, we found that staff took account of people�s individual needs. One person said, �I can�t fault the staff.�

Is the service responsive?

People�s care needs were reviewed regularly which helped to ensure that people continued to receive care that was appropriate and effective. We found that staff were aware of indicators that may trigger deterioration in mental or physical health. Records showed that staff responded to changes in mental or physical health, reviewing risks, and providing additional support where necessary.

Is the service well-led?

We found the service was well managed. The registered manager and staff were experienced and had a good understanding of the ethos of the home. Staff received training appropriate to meeting the needs of people who used the service.

We saw that people who used the service and staff were provided with opportunities to give their views on the service. Quality assurance processes were in place to assess and monitor the quality of care and support. We saw that where issues were identified most of these had been acted on. However we found that arrangements for maintenance and the upkeep of the premises did not ensure issues were addressed in a timely manner.

Inspection carried out on 15 October 2013

During a routine inspection

We spoke with three people who use the service, two staff members and the registered manager.

People said that they were happy with the care provided. We observed that staff treated people with respect and dignity. Interactions between staff and people were positive. People were encouraged to make personal choices in relation to the care and support they received and were enabled to express their views.

We found that people were asked for their consent to be supported and the provider acted in accordance with their wishes.

The home had procedures in place to ensure that people were protected against the risk of acquiring a health care associated infection.

We found that the home had effective recruitment procedures to ensure that appropriate checks were undertaken before staff commenced work.

The home was adequately staffed to meet people�s needs. A person who used the service said, �The staff are very good. They have helped me to change my life. I would be in� if I did not have them. I can�t thank them enough for helping me.�

We found that records relating to the care and treatment of people and other records were appropriately maintained and stored securely.

Inspection carried out on 31 May 2012

During an inspection to make sure that the improvements required had been made

Due to the shared facilities and management of Azalea House 1&2, we spoke with three people out of six living at both the houses who told us they enjoyed living there and the staff were very caring and attentive.

People told us they were able to make decisions about what they did during the day, were able to contribute to the weekly menu planning, and were involved in decisions relating to their care.

Following a recent change of resident within the home, people told us the atmosphere was now much more relaxed and enjoyable.

Inspection carried out on 22 November 2011

During a routine inspection

The three people who spoke with us said that they could choose how they spent their time and that they had choices about other issues such as when they got up and went to bed.

One person told us that they knew that they had a care plan as they went to the reviews but that they didn�t want to ask staff for a copy of it, �In case staff think I�m nosy�.

People told us about a range of activities that they took part in, including adult education classes, day centres, shopping, music groups and other leisure pursuits. They also said that the staff provided good support to them.

One of the people who spoke with us said that they liked living there but that they did not like the restrictions placed on everyone in the house due to the behaviour of one person who lived there.

People said that they were happy with the staff who were providing support to them.

People who spoke with us said that they would talk to the staff or the manager if they were not happy with something. However, they did say that they had told people that they did not like the restrictions that were in place within the house and that these were still there.

Reports under our old system of regulation (including those from before CQC was created)