St Martins of Tours Housing - 158-162 New North Road

St Martins of Tours Housing -158-162 New North Road Is a residential care home providing support to people living with enduring mental health difficulties and a history of illegal substance and / or alcohol abuse issues. There were fifteen rooms for people situated across three floors. There were eleven people using the service at the time of this inspection.

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

A person who spoke with us told us that the service was much improved. They had used this service before and since returning they felt it was a very different place to live, they felt much safer and thought their recovery would be greatly helped by this.

Much had improved at the service over the last two years. Oversight and management was thorough and there was transparency in sharing information with people using the service and stakeholders.

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.

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

Rating at last inspection and update

The last rating for this service was Unrated (Published 04/11/2020) but previously had been rated as Requires Improvement. At this inspection the rating has changed to Good.

Why we inspected

This inspection was prompted by a review of the information we held about this service to verify if improvements had been made. We also 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. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins of Tours Housing - 158-162 New North Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Martins of Tours Housing -158-162 New North Road Is a residential care home providing support to men living with enduring mental health difficulties and a history of illegal substance and / or alcohol abuse issues. There were eighteen rooms for people situated across three floors, although we were informed by the registered manager that the service was looking to reducing their maximum total occupancy to 15 people in the near future. There were eleven people using the service at the time of this inspection.

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

Rating at last inspection:

The last rating for this service was requires improvement (published 28 November 2019).

We have not awarded a rating to the service on this occasion.

Why we inspected:

We undertook this targeted inspection to check whether previous concerns about responding to people’s safety, not least around drug use and anti-social behaviour were being addressed. There had also been concern about management not always reporting to commissioning and regulatory professionals in a timely manner. There were no breaches of regulations reported as a result of the previous comprehensive inspection although due to the concerns we wanted to check if the oversight and performance of the service had improved.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Martins of Tours Housing – 158-162 New North Road on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect.

St Martins of Tours Housing -158-162 New North Road Is a residential care home providing support to men difficult to place because of enduring mental health needs, forensic backgrounds and/or substance misuse issues. There are 18 rooms for people situated across three floors, each with shared communal facilities. The service includes a nearby three bedroomed house for people who are transitioning to independent living. There were 16 people using the service at the time of this inspection.

Following the first two days of this inspection we were informed about safeguarding concerns. A decision was made to return for an extra day of inspection to examine those risks.

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

People spoke positively of the support they received from staff. Two people told us about the support that they were receiving to move on to live in their own independent accommodation.

However, although we found that steps had been taken to address the safeguarding matter our judgement was that the provider had not effectively addressed anti-social behaviour issues at the service either from current or past service users and that people using the service had been placed at risk as a result. This was not helped by the fact that the provider had not communicated incidents fully with the CQC in recent months.

This service provides care for a challenging group of people. There are many positive aspects of care provision such as co-production work and a good level of success for helping people to move on. However, a number of people using the service have particularly challenging needs and it can mean that there are times when the placement breaks down and people either return to hospital or may need to be evicted. This is a challenge for the provider. It was not clear to us that the provider had effective systems in place to manage anti-social behaviour and the impact of this on other people using the service and the local community. Or that the provider had effectively learnt lessons about this as anti-social behaviour had been a factor at this service for some time.

In addition, we found that the quality assurance initiatives, although good and effective at day-today matters, had not been able to assess, monitor and mitigate the risks to people using the service, particularly safeguarding risks.

Other aspects of the service were running smoothly. The home was clean and safely maintained although there needed to be improvement to the management of people's individual fridges and food cupboards. Some of these were not hygienic and risk assessments for this were needed.

The manager was new and showed some effective leadership. Staff told us they felt well supported. People spoke positively about the management of the home.

People’s individual support plans and risk assessments were detailed and up to date. These included guidance for staff Information on the support that people required. The plans and risk assessments included information about signs of mental health crises, and information about the risk of drug and alcohol misuse. People had regular key worker meetings with staff where concerns and plans were discussed.

People’s medicines were stored and administered safely. Where people self-administered their own prescribed medicines, this was monitored by staff.

Staff members received regular training to support them in carrying out their roles. They also received regular supervision from their manager to enable them to discuss practice in effectively supporting people.

Systems were in place to assess and monitor the quality and delivery of care to people. Regular monitoring of safety and practice had taken place although, as above, the monitoring needed to be extended to cover the anti-social behaviour challenges faced at the service.

People’s views of the support provided by the home had been sought. People also had the opportunity to express their views during house meetings and co-production events designed to seek feedback on policies and procedures and changes to the home.

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.

Staff were caring and treated people with dignity. People’s differences including cultural and religious needs were understood and respected by staff.

Staff understood the importance of social interaction. People were supported to maintain the relationships they wanted. A regular activity programme took place based on needs and interests. People were encouraged to participate in regular meal clubs where they were supported to cook nutritious meals and socialise around the table. People were also encouraged to participate in group or individual sessions in relation to their wellbeing and progress. For example, sessions had taken place to assist people to prepare for and seek working opportunities. A training course around understanding and skills in using a person-centred recovery model of support was due to take place and some people had signed up for this.

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 (published 9 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 7 November 2016 and was unannounced. Our previous inspection in May 2014 found that the service was meeting all of the legal requirements that we looked at during that inspection.

At the time of our inspection a registered manager was employed at the service. 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.

We saw that risks assessments were in place and were regularly being reviewed. The risk assessments encompassed potential risks associated with people’s day to day support needs, mental healthcare support, other healthcare conditions and risks associated with daily living and activities. Staff demonstrated that they were aware of how to mitigate risks and instructions were clear and informed staff about action to be taken to reduce risks and how to respond if new risks emerged.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA appropriately. Physical restrictions under DoLS were not applied for at the service as some people using the service was subject to a community treatment order. This would mean that if they did not comply with their treatment in the community they could be recalled to undergo treatment in a secure hospital ward.

We found that people’s health care needs were assessed and the service had begun developing specific health action plans to ensure that these assessments improved the range of potential health care needs assessed, whether previously known about or not. Recovery action plans were also being developed. Care was planned and delivered in a consistent way and the service had regular contact with community mental health services and other health and social care professionals. Information and guidance provided to staff about what was expected of them and the procedures used at the service were clear.

The service complied with the provider’s procedures to carry out regular audits of all aspects of the service. The provider carried out regular reviews of the service and sought people’s feedback on how the service operated. The four people using the service who spoke with us all said they were consulted and that their views were listened to.

At this inspection we found that the service met all of the regulations we looked at.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. We also spoke with a forensic Community Psychiatric Nurse, a forensic Consultant Psychiatrist and a forensic Social Worker.

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

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. The accommodation had been well maintained and was clean. A Consultant forensic Psychiatrist told us how "The fabric of the building is pretty good since it was refurbished." A member of the management team was available on call in case of emergencies. A care worker told us how 'There is always an on-call manager, which gives me comfort.'

Staff training records showed that staff had undertaken training relevant to their role. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. A forensic Community Psychiatric Nurse whom we spoke with told us how "Staff have a very good awareness of forensic issues, which is essential for the client and their safety."

Staff demonstrated an extensive knowledge of the policies and procedures of the home and how they would respond to different emergencies. There was an effective security system installed which meant that staff were able to monitor people coming and going from the building.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was evident from what we saw, and from speaking with staff, that they understood people's care and support needs and they had developed a trusting relationship with them. One person using the service told us that 'Staff are wonderful and helpful.' Staff had received training to meet the needs of the people living at the home and were equipped to deal with the complexities of behaviours presented. A forensic Community Psychiatric Nurse told us how staff had done joint training with their team in order to expand their knowledge of how to work with a certain individual. A forensic Social Worker told us how 'There is a shared knowledge amongst the support team about all those who use the service.'

Is the service caring?

We saw that care workers were patient and gave encouragement when supporting people. We observed how staff engaged with those who used the service and treated them with respect. One person told us 'The staff are really good, they listen to me.' Another told us how 'Staff are very caring and always check with me how I am feeling.'

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they met with their key workers every week to discuss what was important to them. We were also told that 'I can speak to any member of staff at any time.' Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their needs. People had access to activities that were important to them. One person who used the service told us how 'Staff will help me to find an activity if there is one I particularly want to do.' We saw how a person had been supported to maintain an important family relationship. A forensic Social Worker we spoke with told us how 'I get a very prompt response to any queries I may have. Staff anticipate a lot of issues before they become major ones.'

Is the service well-led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. People told us they were asked for their views on the service they received and we saw that they had completed a Service User Survey, with support from a person who was not a member of staff. Staff told us they were clear about their roles and responsibilities. They attributed this to "a good induction schedule, a robust training programme and a management team that was always available to lend support and advice.' They said someone from the senior management team was always on call and that the manager was very 'hands-on and approachable at all times.' We were told how it was 'Comforting to feel part of a team which responds so well to the needs of our people and which takes collective responsibility.' A Consultant forensic Psychiatrist we spoke with told us how "The manager is very consistent, which lends stability to the unit."

There was close working with healthcare providers in order to meet people's needs and the staff team benefitted from regular team meetings and opportunities for clinical supervision. This enhanced their knowledge of their own and others' services and the individuals using the service.

People using the service were complementary about the support they received. One told us 'the staff check - are you OK?' We saw that people were encouraged to make decisions about their care, although sometimes these were limited by legal restrictions. They also had the opportunity to get involved in some aspects of running the service if they so wished, for example, developing policies and procedures.

Medicines were well managed, if medicines had been missed, the reason was recorded. The Medication Administration Records (MAR) were accurate and easy to follow. All the records we saw relating to people who used the service were well maintained and gave a good overview of the person's needs and any risks associated with them.

The premises were being refurbished to a high standard and were kept very clean. Former office accommodation had been converted to provide 'move on' accommodation in response to people's needs. One person told us this was 'very nice'.