Terrance House

Terrance House is a residential care home providing accommodation and personal care for 48 people living with long term mental health issues. At the time of the inspection there were 45 people living at the service.

Terrance house is also the office location for a supported living service for six people with mental health needs who can live more independently with staff support. The supported living property is attached to the main house. There were six people living at the supported living when we visited.

Not everyone who used these services received personal care. CQC only inspects where people receive personal care. This is tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of inspection 32 people in Terrance House and two people in the supported living needed staff support with their personal care.

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

People spoke positively about living at Terrance house. People within the supported living also commented positively about the support they received. People told us that they felt that staff understood how to support their differing mental health needs and showed kindness and respect towards them.

People were supported by staff who had been recruited safely. Staff received training necessary to give them the skills and knowledge to understand and support people with long term mental health conditions. People and staff told us that there were enough staff to be available to people when they needed support. The atmosphere was relaxed, and staff were able to spend time to sit and talk with people. Staff were mindful of how vulnerable people in Terrance house and the supported living service were, they understood how to protect people from the risks of abuse, discrimination and avoidable harm from others. Medicines were managed safely. Staff ensured people received their medicines regularly and on time to help maintain a stable mental health.

People told us that staff supported them with their health needs and helped them to access appointments. Staff monitored people’s health and sought advice from health professionals as needed. Care plans were personalised to reflect people’s specific needs and preferences, and these were kept updated when changes occurred. People were given a choice of meals and told us that they enjoyed these, there were opportunities for them to get regular drinks.

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 were treated with understanding and compassion. People told us that they able to express their concerns to preferred staff and that resident meetings were held at regular intervals. People told us they felt listened to. People had keys to their bedrooms and staff provided support for personal care discreetly to protect people’s privacy and dignity. Levels of motivation varied but where people showed interest staff supported them to develop skills and independence and a programme of activities was provided to aid stimulation and reduce isolation. People had access to all communal areas of the service and could go into the garden which included a smoking shelter which was important to people.

People and staff confidentiality were maintained. People were given important information in a format that suited them best, such as in larger print, pictorial or in a verbal form.

The registered manager promoted an open and inclusive culture where everyone was valued for their contribution There were systems and procedures in place to monitor service quality. People, relatives and professionals were invited to give feedback about the service which was used to inform future service development.

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 6 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Terrance House is a privately owned residential care home supporting up to 48 people with mental health issues. The premises comprise of seven terraced houses converted into one home. It is located in Margate. There were 46 people living at Terrance House when we inspected.

A registered manager was in post and assisted with our inspection. 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. The manager was supported by two deputy managers and they knew people well. They had a good understanding of people’s needs and led by example.

We previously carried out an unannounced comprehensive inspection of this service on 23 February 2016. Two breaches of regulations were found. We issued requirement notices relating to person centred care and safe care and treatment. We asked the provider to take action. They sent us an action plan telling us what action they would take to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the breaches in the regulations had been met.

At the previous inspection staff had not always taken the action needed to reduce risks to people to a minimum. Guidance was not always available to make sure all staff knew what action to take to keep people safe. At this inspection improvements had been made. Risks to people's safety were assessed and there was guidance for staff on how to keep risks to a minimum. The guidance was followed to make sure people were as safe as possible. Risk assessments identified people's specific needs, and showed how risks could be minimised without restricting people’s life styles and promoted their independence, privacy and dignity.

The registered manager and staff carried out other environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Accidents and incidents were recorded and were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively.

Emergency plans were in place so if an emergency happened, like a fire, staff knew what to do. There were regular fire drills and people knew how to leave the building safely.

At the previous inspection there were shortfalls in the care planning for people. There were shortfalls when people had specific needs like support to keep their skin healthy or with their behaviours. At this inspection improvements had been made. Each person's care plan was personal to them and recorded the information staff needed to care and support people in the safest way that suited them. Some care plans had not been fully updated to reflect peoples changing needs but staff were aware of the changes and were providing the care people needed.

People received their medicines safely and when they needed them. The staff monitored people's health needs and sought professional advice when it was required. If people were unwell or their health was deteriorating staff contacted their doctors or specialist services.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed. Staff were familiar with people's likes and dislikes, such as how they liked their food and drinks and the activities they enjoyed. People were given individual support to carry out their preferred hobbies and interests.

When complaints were raised they were listened to.

People felt safe using the service and were protected from the risk of abuse because staff knew the possible signs of abuse and how to alert the registered manager or the local authority safeguarding team.

People were supported by staff that were kind, caring and respectful and knew them well. Staff treated people with dignity and respect and understood people's needs well. Staff received the training and support they needed to carry out their role and meet people's individualised needs.

There were enough staff to support people safely and make sure their individual needs were met. Recruitment procedures ensured that only staff of a suitable character to care for people were employed.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance and had been approved.

The registered manager provided leadership to the staff and had oversight of all areas of the service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and senior staff.

People and staff told us they thought the service was well led. Staff told us that there was an open and inclusive culture within the service. They said they could talk to the registered and deputy managers about anything and they were always supportive.

There were effective systems in place to ensure that the quality of care provided to people was monitored. People had opportunities to provide feedback about the service they received. Feedback received had been positive.

The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Terrance House is a privately owned residential care home supporting up to 48 people with mental health issues. The premises comprises of seven terraced houses converted into one home and is located in Margate. There were 46 people living at Terrance House when we inspected.

A registered manager was in post and assisted with our inspection. 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. The manager was supported by two deputy managers and they all knew people well. They had a good understanding of people’s needs and led by example. Staff told us they felt supported and one staff said that the manager was the ‘best manager they had ever worked for.’

The registered manager provided leadership to the staff and had oversight of all areas of the service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and senior staff.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity. Staff told us the registered manager was approachable and they were confident they would not hesitate to raise any issues if they had any concerns. There was a feeling of unconditional positive regard for people by the staff. People were respected and treated with kindness and consideration.

Staff had completed safeguarding training and they knew what action to take if they suspected abuse, and who to report to, such as the local authority safeguarding team. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the registered manager, who would take appropriate action.

There were sufficient numbers of staff on duty. Staff were checked before they started to work at the service and regularly received training to ensure they had the skills and competencies to provide safe care. New staff were allocated a mentor, received induction training and shadowed established staff before they started to work on their own. Staff met with a senior staff member to discuss their role and practice, and to discuss their training and development needs.

Medicines were stored and administered safely. People had the support they needed to attend health appointments and to remain as well as possible. Staff responded to any changes in people’s health needs; people told us that staff always called their doctor if they felt unwell. People made positive comments about the food, there were daily choices and people took part in choosing the menu and food shopping. If people were not eating enough their food was monitored. If required a referral was made to a dietician or their doctor, and supplements were provided as necessary so that they maintained a healthy diet.

Potential risks to people were identified but staff had not acted in a timely way when some risks were identified. Guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. We did find that some areas concerning risks to people needed reviewing and action needed to be taken to make sure people were as safe as possible. The registered manager told us these would be addressed immediately. On the whole there was guidance in place for staff on how to care for people effectively and safely and keep most risks to minimum without restricting their activities or their life styles and promoting their independence, privacy and dignity.

The care and support needs of each person were different and each person’s care plan was personal to them. Parts of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way that suited them. However, there were shortfalls in the care planning when people had specific needs like needing support with their skin or their behaviours.

The complaints procedure was available but could have been more visible and accessible. People felt comfortable in complaining and when they did complain they were taken seriously and their complaints were looked into and action was taken to resolve them. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been very positive.

People had an allocated keyworker who was involved in their assessments and reviews. A key worker was a member of staff who takes a key role in co-ordinating a person’s care and support and promotes continuity. Throughout the inspection people were treated with kindness and respect. People told us the staff were kind, and respected their privacy and dignity. People were encouraged to be as independent as possible. Staff were attentive and the atmosphere in the service was calm, and people were comfortable in their surroundings. Staff encouraged and involved people in conversations as they went about their duties.

People were given individual support to carry out their preferred hobbies and interests. Staff were familiar with people’s likes and dislikes, such as how they liked their food and drinks and what activities they enjoyed. People were supported to make choices and decisions and staff followed the principles of the Mental Capacity Act 2005.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found the home to be clean and tidy and free from unpleasant odours. There was a system in place for infection control to protect people from the risk of infection.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. 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.

They said: "I like living here, I feel safe". "staff help you and care for you". 'They always knock and ask before they come into my room".

People told us, they were supported by the staff and that their wishes were respected and their privacy maintained. People said they felt listened to and were able to be as independent as they wanted to be, but still felt they received the care they needed.