Archived: Jordangate

During the inspection we spoke with the provider, the administrator and two staff members. We also spoke with three of the people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the safeguarding policy and the whistle blowing policy. They were available in the office used by the staff. We spoke to the senior support worker and the support worker who were both aware of the policies and how to access them. There was also a copy of the local authority safeguarding procedure available. The senior support worker described to us a number of issues where the staff had developed strategies to manage concerns to minimize the risk of abusive incidents occurring.

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) are legal requirements that need to be followed to ensure decisions made about people who do not have capacity are made in their best interests. They are designed to ensure that people who are unable to give consent for certain aspects of their care and welfare receive the right type of support to make a decision in their best interest. We spoke with the senior support worker about their understanding of the MCA and DoLS and what they would do if a person was not able to give their consent. They were clear about the processes that would need to take place to support the person safely. They also explained to us how the people they supported had fluctuating capacity due to their mental health problems and how this sometimes meant that the Mental Health Act was used to support their care.

Is the service effective?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual support plan. We looked in some detail at the care and support provided to three people who used the service. These records included the person's support plan, risk assessments, and records about the support they had received from professional people outside of the service. We found the information in people's support plans was detailed and they clearly reflected people's individual wishes and choices. Support plans also included detailed pieces of information and guidance about particular aspects of people's care. We saw that some people had very clear wishes about how they wanted staff to support them in particular situations. We saw that this was documented and that staff were aware.

We saw that risks were very clearly identified and that risk management plans were discussed and agreed with the individual person. We saw that staff had drawn up an action plan in conjunction with the person to agree how the staff would support them during difficult periods. We saw that other health professionals had also been part of these discussions. We saw that the service worked very closely with a variety of health professionals including social workers and community psychiatric nurses.

Is the service caring?

We spoke to three people who used the service. Two of them in person and one on the telephone. They all told us that they were very happy with the support they received and the staff who provided it. One person said; "Hospitals are a very stressful environment. This is now my home and it feels like it. It's a good thing - getting the support you need." Another person said; "The staff are very supportive. They help me and they are aware of what I need."

From our discussions with staff and our observations it was evident that staff knew people well and were providing support based on people's individual needs and choices. Staff were able to tell us about how they communicated with people using the service and they were able to describe people's skills, needs, likes, dislikes and lifestyle choices.

Is the service responsive?

We looked at the audits that the service completed on a monthly basis and saw that regular checks were made to ensure that the buildings and environments were safely maintained. We looked at the quality assurance monitoring checks that the provider had put in place to ensure appropriate standards were maintained in all areas within the service. These checks were carried out every month by the staff and any issues were recorded and dealt with.

Upon reviewing records we noted that the provider had not always notified CQC of notifiable incidents. For example, we highlighted that we had not been notified of an incident when the police had been called to deal with a situation of concern. Failure to inform the Care Quality Commission of a notifiable incident is an offence under the Care Quality Commission (Registration) Regulations 2009 and may place the welfare of vulnerable people at risk. We discussed our concerns with the provider and they told us they would take immediate action to ensure that future incidents were correctly reported.

Is the service well led?

We looked at the training records and saw that all staff were receiving regular training. We also noted that training had been planned and booked for the coming year to ensure that all mandatory updates were completed and staff had been informed of the dates they need to attend in advance. We saw that specific training was provided for staff in order to meet the needs of the people they were supporting such as dealing with deliberate self harm, dual diagnosis and violence and aggression.

We were told by the administrator that senior support workers were also provided with clinical supervision every two months by a health care professional outside of the organisation to enable them to seek confidential support. We spoke to a senior support worker who confirmed this and said that the clinical supervision was supportive and useful and they felt that the manager and the provider worked hard to support the staff working in the service as they recognised that at times the work was stressful.