Mansard House

Updated 24 April 2018

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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We also looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This unannounced inspection was carried out on 15 February 2018 by two Adult Social Care inspectors from the Care Quality Commission, who were accompanied by an Expert by Experience. An Expert by Experience is a person who has experience of the type of service being inspected. This expert had experience in supporting family members to access health care facilities and had cared for an adult with mental health issues. They had also been an Independent Mental Health Advocate. An advocate is an independent person who supports people to make decisions, which are in their best interests. The role of an expert by experience during a CQC inspection is to find out what it is like to use the service. This was achieved through discussions with those who lived at Mansard House and staff members, as well as observation of the day-to-day activity.

At the time of our inspection there were ten people who lived at Mansard House. We were able to speak with eight of them. We looked at four care files and ‘pathway tracked’ the care of two people who lived at the home. This enabled us to determine if people received the support they needed in a person centred way and if any risks to people’s health and wellbeing were being appropriately managed. We were also able to speak with three members of the staff team and the registered manager of the home during our inspection.

We toured the premises, viewing with permission a number of bedrooms and all communal areas. We observed the day-to-day activity within the home. We also looked at a wide range of records, including the care files of four people who used the service and the personnel records of two members of staff. Other records we saw included a variety of policies and procedures, training records, medication records and quality monitoring systems.

Prior to this inspection we looked at the information we held about this service. We reviewed notifications of incidents the provider had sent us and we asked local commissioners for their views about the service. We also requested feedback from 14 community professionals, such as medical practitioners, community nurses, mental health teams and a dentist. We received seven responses, which all provided us with very positive information.

The Provider sent us their Provider Information Return (PIR). A PIR is a form that asks the provider to give us some key information about the service, what the service does well and improvements they plan to make.

We used a planning tool to collate all this evidence and information prior to visiting the home.

Updated 24 April 2018

The Inspection took place on 15 February 2018 and it was unannounced. At the last inspection on 22 June 2015, the service was rated good overall with an outstanding rating for responsive. At this inspection the service was rated as outstanding overall with all five domains also being rated as outstanding.

Mansard House is a 'care home'. People in care homes receive accommodation and or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service is registered to care for up to ten adults who have mental health conditions, a learning disability or autistic spectrum disorder. There were ten people who lived at Mansard House when we inspected, who had mental health conditions.

There was a registered manager in post, who was present at the time of 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.

Mansard House is a three storey dwelling located in a residential area of Preston close to the city centre. All bedrooms are of single occupancy with en-suite facilities. These are tastefully decorated and furnished to meet the needs and wishes of each individual who lives at the home. The communal areas are pleasant and well maintained. Public transport links are within easy reach and on road parking is permitted directly outside the home. A variety of amenities are within easy reach, such as pubs, shops, supermarkets, churches, a post office, leisure centre and newsagents.

The regulated activity for this service is accommodation for persons who require nursing or personal care. However, nursing care is not provided at Mansard House.

We found recruitment practices to be robust. In-depth induction programmes were provided for all new employees and a wide range of training modules were available for the staff team, many of which were essential components of individual learning and development plans. Training was also provided specifically around the needs of people who lived in Mansard House. Staff members we spoke with were knowledgeable about the needs of those in their care.

Records showed the staff team completed an exceptionally wide range of mandatory training modules and this was confirmed by staff members we spoke with. Regular supervision sessions and annual appraisals enabled members of the workforce to discuss their personal development and training needs with their line manager.

The home had introduced a well-researched and evidence based system for the planning of people’s support. This produced exceptionally detailed assessments of people’s needs, which had been completed before a placement was arranged. The planning of people’s care and support was extremely person centred, providing staff with clear guidance about people’s needs and how these needs were to be best met.

Records showed that individuals were empowered and fully involved in making decisions about how they wished to live. Risk assessments had been completed, which were detailed and outlined the best course of action, in order to reduce the level of potential risk. This helped to protect people from harm.

The home had introduced creative ways of supporting people with healthy eating and with learning independent living skills, such as meal planning, food shopping, cooking and computer skills. This helped those who lived at Mansard House to prepare for their future, when they were able to step down from residential care and support.

We found that people’s dignity was consistently promoted and their privacy was always respected. Staff members approached those who lived at Mansard House in an extremely kind, gentle and friendly manner. They were polite, compassionate and committed. People were supported to maintain their independence and were relaxed and comfortable in the presence of staff. They spoke extremely positively about the service and how staff had made them feel empowered and fully motivated to succeed in reaching their goals.

People were supported to express their views and supported to access advocacy services, should they wish to do so. An advocate is an independent person, who will act on behalf of those needing support to make decisions.

The staff team were confident in reporting any concerns about a person’s safety or wellbeing. Mental capacity assessments had been conducted for all those who lived at the home, which determined that no-one lacked the capacity to make any decisions and everyone was able to ‘come and go’ as they pleased, without any restrictions being placed on their freedom.

People had been 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.

Equality, diversity and human rights were consistently considered and strategies implemented to promote anti-discriminatory practices. We observed the daily routines and practices within the home and found people were treated equally and their human rights were constantly being respected.

People told us they felt safe living at Mansard House. Their human rights were properly recognised, respected and promoted. Accident records were appropriately maintained and these were kept in line with data protection guidelines. There was a detailed record of the actions taken and included lessons learned to reduce the potential of any future risks.

A contingency plan provided staff with clear guidance about what they needed to do in the event of an environmental emergency, such as power failure or severe weather conditions. Systems and equipment within the home had been serviced to ensure they were safe and fit for use.

People received their medicines in a safe manner. Detailed medication audits were in place and staff had completed training, as well as regular competency assessments.

Clinical waste was being disposed of appropriately and infection control practices were good. The home was found to be safe. People were involved in meal planning, shopping and cooking. They were able to eat whatever they preferred, although healthy eating was also encouraged. A range of bespoke individual activities were provided and outings to local places of interest were arranged.

We found that Mansard House was constantly striving to improve and to look for innovative and creative ways to move the service forward. We found many distinctive characteristics of ‘outstanding’ evident. This was echoed by the consistent positive comments from those who lived at the home, the staff team and external professionals, of which feedback was sought from a considerable number. Evidence was also available to show the home maintained sustainability over long periods of time and had continued to make positive developments in all domains.