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

We are carrying out a review of quality at St Martins of Tours Housing - 158-162 New North Road. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 20 June 2019

During a routine inspection

About the service

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

Inspection carried out on 7 November 2016

During a routine inspection

St Martins of Tours provides residential care for men with forensic psychiatric histories and mental health problems. There are 18 rooms for people with mental health problems and/or substance misuse issues and a nearby three bedroom house for people who were transitioning to independent living. There were 16 people using the service at the time of this inspection.

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.

Inspection carried out on 27 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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."

Inspection carried out on 2 July 2013

During a routine inspection

We found that the staff team at 158-162 New North Road provided effective support to people who used the service. They demonstrated good knowledge of people's complex needs and spoke about them in a caring and non-judgemental way.

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'.

Inspection carried out on 13 April 2012

During a routine inspection

Two inspectors carried out this inspection over the course of a day on the 13th April 2012. We visited the home and spoke with five people who use the service, with staff and with other professionals visiting the home. We also looked at a range of records relating to the running of the service including the personal files of some people using the service and the personnel records of some staff. At the time of our inspection sixteen men were living at the home.

New North Road adjoins another service run by St Martin of Tours that provides a similar service and is also registered with the Care Quality Commission. We were told that activities sessions at New North Road were run jointly between these two services and that the garden area was shared. We were also told that staffing changes within the two services meant that staff on night duty provided shared cover between the two services.

We found that the service had a clear referral process that involved potential users of the service in an assessment to ensure that their needs could be met. Each person we spoke with confirmed that they had a current care plan. They told us that they had been involved in the development of this plan and felt that their views were taken into account when it was being developed and updated.

People we spoke with commented that they felt safe and comfortable within the home. They also told us that staff were approachable and listened to any concerns they might have, and were respectful to them.

The service had developed an activities programme aimed at supporting people who use the service to develop their independent living skills and to participate in the local community. People who use the service commented that they enjoyed the range of activities on offer.

People who use the service told us that their medication was always available at the times they needed it. Some people using the service were managing their own medication and they told us that they had a lockable space in their room to store their medication. However, we found that some medicines listed on records of people using the service were not available.

People who use the service benefitted from well maintained premises that provided a range of communal space. Each person had their own bedroom.

The provider had developed a comprehensive training programme for staff. People who use the service told us that there always seemed to be enough staff on duty, and that they had the right skills and experience for their role.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.