Providence House and Moira House

Providence House is a residential care home providing personal and nursing care to up to 10 people. The service provides mental health support to young people aged between 13 and 18 years old. We are still looking at the registration status of this home as identified in the last inspection report (published) 7 Jul 2022.

Throughout the report we have used the term young people to represent those using the service. At the time of our inspection there were 8 young people using the service.

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

Young people told us this was the best placement they had experienced. However, young people also told us they did not feel safe all the time. We found some evidence of a closed culture in relation to the practice of some staff. We define a closed culture as - a poor culture that can lead to harm, including human rights breaches such as abuse.

Young people were supported by enough staff, who had been recruited safely.

Young people were supported to consider and understand risks. The provider followed comprehensive risk assessment and management procedures. However, we found not all decisions had been recorded in sufficient detail to evidence the decisions made.

Young people had been fully involved in decisions about how they were supported and praised the quality of their care plans which were written clearly.

Legal authorisations were in place where young people had restrictions on their liberty. Young people were aware of restrictions on their liberty and their views had been considered and recorded.

Management oversight had improved, however further improvements were needed to ensure the improvements had been fully embedded. The manager in post was committed to achieving optimum oversight of the service to help ensure consistent high-quality care.

Young people praised the impact the new manager had on the service and the changes they had started to make. Young people said they felt more confident about being listened to and feeling safe.

Staff felt well supported and valued by the manager and management team. Staff were proud to work in the home and were committed to the provider's values.

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 requires improvement, (published) 7 July 2022.

Why we inspected

This inspection was prompted due to concerns we had received about; the use of restraint with young people, some staff interactions with young people, adherence to risk management plans and the availability of food and drink. A decision was made for us to inspect and examine those risks. We looked at the key questions of Safe, Effective and Well-Led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Providence House on our website at www.cqc.org.uk.

The overall rating for this service has remained as requires improvement.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to; Safeguarding people from abuse, and Governance. We have also made a recommendation in relation to recording risk management decisions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Providence House is a residential care home providing personal and nursing care to up to 10 people. The service provides mental health support to young people aged between 13 and 18 years old. Throughout the report we have used the term young people to represent those using the service. At the time of our inspection there were six young people using the service.

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

Young 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.

Systems in place for audits and monitoring the quality of the service were not sufficiently robust. Electronic care plans did not contain person centred information or contain clear and measurable goals. Records of care provided were not always detailed or reflective of the actual good care and support young people had received. Where young people needed specific staff support when they were experiencing distress, positive behavioural support (PBS) plans were in place, but these were not written in a way that was easily accessible to the young people. Systems and processes currently used were mostly developed whilst providing service to adult’s further developments to young person focus was needed. New person centred, accessible and young person focussed care plans and PBS plans were being developed, but these had not yet been embedded

Young people received their medicines as prescribed. Some records were incomplete, and action required regarding room temperature and oxygen signage had not been taken. Staff had received training in safeguarding young people from abuse. Risks within the home, to young people and staff were identified and well managed. The required checks were completed before staff started to work at the service and there were sufficient staff to meet the young people’s needs. Risks associated with COVID-19 had been assessed and well managed.

Staff received the induction, training and support they needed to carry out their roles effectively. Young people were supported to eat and drink and maintain a balanced diet. They were supported to access a range of health care professionals from the providers own multi-disciplinary team including psychologist, psychiatrist, nurses and occupation therapist.

Staff knew the young people well and spoke respectfully about the young people they supported. Throughout the inspection staff were observed to have a kind and caring, unrushed approach. Young people were listened to and involved in decisions about their care. Everyone was positive about the staff and the support people received.

There was an activity timetable in place for each young person. People told us the activities had improved recently. There was a plan for this to be further developed to improve the range of individual and group activities. These developments had been designed by the Occupational therapy team and the young people. The service was following the Accessible Information Standard (AIS).

There was a recently appointed manager in place who was applying to register with CQC. People were very positive about the new manager. Everyone was positive about the recent changes and improvements. The management team in place had a clear commitment to continuing with improvements and providing safe, quality care. Staff morale was good. There was an appropriate system in place for the management and oversight of complaints, accidents and incidents and safeguarding’s.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 10 October 2020 and this is the first inspection.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to information we received from the provider regarding changes they had made to the type of service they provided. This involved the service changing from providing mental health support to adults, to a more medical model of support and treatment to young people aged 13-18 years old. As part of the inspection we reviewed the service being provided and we confirmed to the provider that the current registration was not reflective of the type of service and treatment being provided to young people. The provider has been transparent throughout this process.

We have advised the provider that they need to apply to CQC to request the appropriate changes to their registration. Failure to address this and ensure the service is appropriately registered may lead to the commission considering further action. CQC will contact Ofsted to inform them of the service being provided so they can determine if it needs to be registered with them.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.