The Care Quality Commission
  • Residential substance misuse service

Archived: St Clements Court

Falcon Street, Oldham, Greater Manchester, OL8 1NG (0161) 633 4205

Provided and run by:
Community Mediation Housing Limited

All Inspections

5, 6 and 12 December 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found multiple breaches of regulations. We used our enforcement powers to take urgent action and prevent the provider from admitting any more people to the service. We did this to ensure that people received safe care and treatment. We also required the provider to send us a weekly summary of the care and treatment provided to people using the services.

Full information about our regulatory response to the concerns we have described in this report will be added to a final version of this report we will publish in due course.

We found the following areas of concern:

  • Risks were not managed safely. There were no fire safety risk assessments and personal emergency evacuation plans, despite several clients having mobility difficulties and two wheelchair users. There was no assessment of ligature points, despite the service admitting clients who were intoxicated and with little risk history available. Staff were not following the infection control policy. Medicines management was unsafe. Staff did not report incidents and there was no policy or procedure for incidents to guide them.
  • Staffing levels were unsafe and not sufficient for the service. The provider did not follow recruitment procedures in terms of disclosure and barring checks and obtaining references prior to employing staff. Staff had not received mandatory training. Staff and managers had no awareness of safeguarding and policies were poor. Staff did not receive supervision or appraisals. There were no male support staff employed despite the service being for male clients.
  • Record keeping was poor. The service did not maintain individual contemporaneous records. We found no care plans in the records we reviewed. There was little information about the reason why clients were admitted. There were no physical health plans or information for staff, despite several clients having physical health conditions which required monitoring.
  • There was no structured alcohol treatment programme and no policies, procedures or guidance relating to alcohol treatment. Staff were not correctly totalling alcohol or reviewing the total daily quantities being received for the client undergoing a reduction. There was no use of recognised assessment tools or withdrawal scales. Staff had not received training in alcohol misuse or treatment.
  • Staff had no awareness of the Mental Capacity Act. There was no Mental Capacity Act training available to staff. The Mental Capacity Act policy was undated and did not contain practical guidance for staff. There were no assessments of client’s capacity undertaken, for example, in relation to medication.
  • One client reported that a previous member of staff had shouted at him, the provider had not investigated this or referred it to safeguarding. Two clients expressed concerns about financial arrangements. The registered manager had written a derogatory comment in the day book and spoke in a derogatory manner about clients at interview.
  • There was no structured activity programme. There was no information displayed about local services, client’s rights, how to complain, CQC registration or information about the service. The complaints policy was not followed. There was no interpreter provision for one client who did not speak English.
  • The overall governance and management of this service was poor. The provider failed to provide information we requested before the inspection. Managers had not registered the service with organisations such as the environmental health department and the information commissioner’s office. Managers did not display knowledge of relevant legislation, for example the Mental Capacity Act. Safeguarding procedures were not in place and staff and managers did not understand safeguarding. All policies and procedures had been written in 2013/14 and had not been reviewed. They provided no guidance to staff. Overall, the service had a task based approach to care, with several recording books serving as the only continuous records of the day to day life of clients residing there.

However, we also found the following areas of good practice:

  • The overall building was clean and tidy and the kitchen where the chef prepared food for clients was well maintained.
  • Clients described staff as positive, helpful and supportive and a carer was positive about the care their relative was receiving.
  • The provider offered support to clients with housing applications and resettlement plans.
  • There was a small gym available for clients and two computers were available so clients could access the internet.

26 August 2014

During a routine inspection

St Clements Court is a building offering accommodation and support for up to 26 people, all in single apartments. At the time of our visit there were 18 people living at the home. St Clements Court is known to commissioners and people living there as 'The Willows'. St Clements Court did not accept referrals from members of the public.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke to the registered manager and observed staff interactions with people using the service. We looked at records and talked in private with three people using the service and two members of staff. We also talked on the phone to two social care professionals from different agencies who commissioned services.

The full report contains the evidence to support this summary.

Is the service safe?

Overall the people we spoke to at the inspection visit were positive about the care provided by the service. People told us they felt safe.

Staff who we spoke with told us they believed people using the service were protected from abuse or exploitation. They also demonstrated an awareness of their responsibility to 'whistle blow' if poor practice was not addressed by the service provider.

We undertook a quick tour of the building. This included communal areas and two people living at St Clements Court each showed us their apartment. No obvious hazards to people's health and safety were seen. Staff did not undertake any physical personal care with people living at the home.

Recruitment procedures had been strengthened to help ensure only suitable people were employed.

The registered manager assessed each person referred to the service. This included a risk assessment.

Is the service effective?

A support plan was developed with each person at the service. This was regularly reviewed by support workers with the person. The service is intended to assist people regain their independence and has a focus on alcohol reduction. The service was intended to be relatively short term for each person. This involved a stay of around six months, although there was flexibility around the length of stay dependent on the specific needs of the individual.

People talked positively about the support they had received, their progress and their increased ability to function independently. One person said 'I'm looking forward to standing on my own two feet'.

Service commissioners were very positive about the effectiveness of the care provided. Comments included: '[I am] very impressed [with the service]'; '[they have] empowered individuals to find their way to recovery' and the service had 'a proven track record of working with very hard to reach people'.

Is the service caring?

People we spoke with during the inspection visit were complimentary about the approach and attitude of the staff. Comments included: '[staff are] honest and they do care about people'; 'all the staff are really nice'; 'never seen them [staff] nasty' and '[staff are] very helpful'.

Interactions which we observed during our visit were calm and relaxed.

Staff told us there was a 'very caring' environment. They also talked to us about the importance of treating people with respect. One member of staff when asked what the best thing about the home was said 'kindness and treating people like a human being'.

Commissioners were positive about the caring attitude of the service. One said 'clients are at the centre of care planning'.

Is the service responsive?

We did not look specifically at the service's complaints procedure. However, people who we asked during our visit said they believed they would be listened to if they had a complaint.

One member of staff told us managers were 'good at making changes and will implement good suggestions'.

There were systems in place to monitor the quality and the safety of the service that people received. This meant that the service was able to identify and respond to any shortfalls in the service, as well as recognising the strengths of the service people received.

Is the service well led?

The registered manager of the service was also the service provider and the service had a very flat hierarchy. This enabled the leadership to be in very close contact with all staff as well as the people who were being supported.

One commissioner mentioned the 'very dedicated and experienced staff team' who they found to be 'passionate and well skilled'.

Staff spoke positively about the management. One staff member said 'management would always help me'. Staff also told us that management knew the people being supported 'inside out'. One member of staff told us that they were motivated, by management, to 'make positive changes with people'.

25, 28 June 2013

During an inspection looking at part of the service

This follow up inspection was to check whether the provider of the service had taken action to address the one area of concern we identified at our previous inspection in January 2013. We received an action plan telling us how and when records of staff training and support would be in place. At this inspection we found that records of this were available.

At this visit we spoke with two people who were receiving support, the manager, the service manager and one support worker.

Both people we spoke with were very positive about their experiences of living at St Clements Courts. They told us that they were involved in all the decisions that affected their health and wellbeing. We saw that people had signed agreements to the support and accommodation they received.

People described the staff as 'brilliant' and 'very helpful'.

The atmosphere at the service was relaxed and peaceful. The accommodation was clean, tidy and well maintained.

One social care professional told us 'They [St Clements Court] provide really quality care to people who are incredibly hard to provide care to'.

People's records were up to date and held securely. However recruitment procedures were not sufficiently robust.

22 January 2013

During a routine inspection

At the time of our unannounced visit, 18 people were resident at St Clements Court. We spoke with three men who used the service, the Registered Manager and the two support workers on duty.

People who used the service spoke positively about the support they received and the improvements in their health and wellbeing. People told us 'It's brilliant' and 'If it wasn't for these here [staff] I wouldn't be alive or I'd be locked up".

People told us about the new skills they had acquired and the activities they enjoyed. They said they discussed and agreed their support plan with staff. We heard that each person had their own specific '1-2-1' time each week where they discussed their progress and planned next steps in their recovery. One person said 'Staff listen to you. I talk to them everyday'. Another person said 'I work with staff. I feel like they are my friends'.

We saw that people had a written support plan, which was reviewed regularly and updated.

People told us they felt safe at St Clements Court. The staff we spoke with had a good understanding of safeguarding vulnerable people.

People told us that the staff were 'supportive and friendly' and 'knew what they were doing'. Staff had received some training however, records of this training were not available.

The service had a complaints procedure. People told us that they were able to raise any issue or concern with the manager or staff.