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Inspection carried out on 2 October 2018

During a routine inspection

We carried out this announced inspection on 2 and 3 October 2018. At the last inspection, in March 2016, the service was rated Good. At this inspection we found the service remained Good.

Calton House Ltd provides personal care to people living in their own homes in the community. Services are provided mainly in west Cornwall to people with a learning disability or a mental health condition. At the time of our inspection the service was providing a supported living service and personal care for 35 people. The number of hours provided for each person ranged from short visits at key times of the day to 24 hour care. These services were funded either privately, through Cornwall Council or NHS funding.

A supported living service is one where people live in their own home and receive care and support to enable people to live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

People we spoke with told us they felt safe using the service and they trusted the staff who supported them. People told us they received a reliable service and had regular staff who visited them. They had agreed the times of their visits and were usually kept informed of any changes. Comments included, “I feel safe because I've known the same staff a long time" and "I've been with the agency for 19 years, I wouldn't be with them that long if I wasn't happy."

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. People said they were treated respectfully and staff asked how they wanted their care and support to be provided. People who needed help taking their medicines were appropriately supported by staff.

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. People were aware of their care plans and most people had a copy in their homes. Some people had requested that a copy of their care plan was not kept in their home. There were suitable arrangements to inform staff, about how to provide the agreed care for people, where a care plan was not available in the person’s home.

Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff were aware of the reporting process for any accidents or incidents that occurred and there was a system in place to record incidents. Records showed that appropriate action had been taken and where necessary changes had been made to reduce the risk of a re-occurrence of the incident.

The service acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

The service had robust recruitment practices, which meant staff were suitable to work with vulnerable people. Training records showed staff had been provided with all the necessary training, which had been refreshed regularly. Staff told us they found the training to be beneficial to their role and said they were encouraged to attend training to develop their skil

Inspection carried out on 8 March 2016

During a routine inspection

Calton House is a community service that provides care and support to adults who have learning disabilities, mental health needs, people on the autistic spectrum, sensory disabilities and elderly people in their own homes, or group settings managed by a housing association. The service provides help with people’s personal care needs primarily in Camborne, Redruth and surrounding areas. The service provides personal care for people in short visits at key times of the day, as well as longer visits and 24 hour care.

At the time of our inspection 48 people were receiving a personal care service. These services were funded either privately, through Cornwall Council or NHS funding.

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run.

We carried out this announced inspection on 8 and 10 March 2016. The service was last inspected in March 2014 and was found to be meeting the regulations.

People we spoke with told us they were positive about the support they received from the service. They said the service was, “Fantastic, top marks”, “Very good,” and “Excellent”. A health professional told us the service was, “Very accommodating and flexible.” A survey was completed to find out the views of people, their relatives, staff, and professionals who worked with the service. This showed a significant majority of respondents were very happy with the service.

People told us they felt safe. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

There were enough suitably qualified staff available to meet people’s needs. The service was flexible and responded to people’s changing needs. People told us they had a team of regular staff and their visits were at the agreed times. People told us they had never experienced a missed care visit.

People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke well of staff and comments included; “the staff are more than OK”, “The staff are friendly, respectful and polite”, “They are lovely people” and “Polite and well mannered”.

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed.

Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.

The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions

for themselves had their legal rights protected.

Staff told us there was good communication with the management of the service. Staff said management were, “Approachable”, and “Very good.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Where the provider had identified areas that needed improvement, actions had been promptly taken to improve the quality of the service provided.

Inspection carried out on 28 March 2014

During an inspection looking at part of the service

Calton House provided a service to approximately 50 people. At the time of the inspection people had variable amounts of staff support for example from 2 hours per week to 24 hour support. People either lived in their own homes, or in shared houses.

The purpose of this inspection was to check suitable action had been taken following the three compliance actions which were issued to the registered persons as a consequence of our inspection on 18 and 19 November 2013.

At this inspection we judged suitable actions had been taken regarding record keeping regarding medication, improving staff training and supervision systems, and ensuring further safeguards were in place regarding the management of people�s finances.

At this inspection we did not speak with people who used the service or the staff who worked with them. However when we inspected the service in November the vast majority of people were very happy with the service provided. The reader is referred to our report dated 18 and 19 November 2013. We will inspect the service again by 31 March 2015.

Inspection carried out on 18, 19 November 2013

During a routine inspection

At the time of the inspection Calton House provided a service to 45 people. People had variable amounts of staff support for example from 2 hours per week to 24 hour support. People either lived in their own homes, or in shared houses.

We were able to speak with six of the people who used the service. The majority of the people we spoke with were happy with the service provided. For example comments we received included �Everything is all in order�the staff are supportive,� and �It is alright�they (the staff) are very good people.� One person raised concerns about their support, although we acknowledged from the registered provider�s perspective, there were a complex range of issues. We had some concerns regarding how the medication system operated.

Although an appropriate safeguarding procedure was in place, we were concerned about the arrangements in place to support people with their finances. We were also concerned where restrictions were in place there was no evidence a �best interests� process had been followed.

Staff recruitment checks and staffing levels were satisfactory. There was some evidence of staff training and supervision although this did not meet regulatory standards. For example, there were some gaps in the delivery of training which limited staff knowledge and skills to support people who used the service.

Inspection carried out on 4 March 2013

During a routine inspection

We spoke with five people who received care from Calton House. Everyone we spoke with was generally positive about the care they received and told us the care staff, were �very good and very caring�. One person told us,�They are good, they come on time and they are very nice people�.

The service had suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and support provided.

People told us and we saw evidence of pre-care assessments of peoples' needs to ensure the agency could provide the required level of care. The care plans we looked at were sufficiently detailed to direct and inform staff as to how care was to be provided. We saw evidence of regular reviews of care to ensure the care provided took account of any changes that had occurred.

People were protected from abuse, or the risk of abuse, and their human rights were respected and upheld because the provider had effective policies and procedures in place to ensure peoples� safety and welfare were paramount.

The agency undertook regular quality assurance checks to ensure they were aware of peoples� feelings about the service and adapted their policies and procedures accordingly to reflect required changes which had been identified.