Scott House

Scott House is a residential care home that was providing personal care for up to 19 people living with long term mental health needs. There were 14 people using the service at the time of our visit.

People's experience of using this service

• People were happy living at Scott House, they told us they felt safe and liked the staff who supported them. Relatives were also happy with the service and they felt welcomed when they visited and said that staff maintained contact to inform them of any changes. Staff said they were proud to be working at the service and enjoyed their jobs.

• People, relatives, staff and health and social care professionals said the registered manager and the staff team were approachable and supportive. There were enough staff to meet people's needs. There was a robust recruitment process so the provider knew they only employed suitable staff.

• The provider had systems in place to keep people safe from identified risks. Staff knew to report any concerns that arose. Risks were managed to keep people as safe as possible. Staff received the training they required so they had the knowledge and skills to do their job and meet people's needs.

• Staff gave people their prescribed medicines safely. They followed good practice guidelines to help prevent the spread of infection. People had access to the healthcare services they required.

• People and their relatives told us they enjoyed their meals. There was a variety of healthy meals based on people's choices and nutritional needs.

• People were encouraged to make choices in all aspects of their lives. Staff knew each person well, including their likes and dislikes and their preferences about how they wanted staff to care for them.

• Staff respected people's privacy and dignity and encouraged people to be as independent as possible.

• People and their relatives told us they knew how to complain and were confident that the registered manager would resolve their complaints.

• There were effective quality monitoring processes in place including seeking the views and feedback of people who used the service and their relatives. Scott House was homely and staff did everything they could to make people's lives as comfortable and fulfilling as possible.

We found the service met the characteristics of a "Good" rating in all areas

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

Rating at last inspection: At the last inspection the service was rated as Requires Improvement [report published on 30 May 2018].

Why we inspected: This was a planned inspection based on the rating at the last inspection. The rating has improved to Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Scott House provides care and support for up to 21 adults living with long term mental health needs. There were 14 people living at the service when we inspected it.

Scott House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager. 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.

Our inspection of the home’s environment identified the need for redecoration and refurbishment in a number of different areas of the home because of the potential for infection and the potential risk to people and to their mental well-being. The provider told us they had identified the need for significant refurbishment of the home and had implemented a plan to carry out appropriate works designed to address these needs. We saw evidence of the work already started in the home. A number of improvements were noted. One shower room on the ground floor was refurbished as well as one bedroom on the same floor and the dining room was in the process of refurbishment. The registered manager and the regional manager told us the plan was to complete the works before the end of the year.

People were not always supported by staff who were regularly supervised or appraised.

People told us they felt safe. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

There were enough staff on duty to meet people's needs and there were always additional staff able to cover in the event of staff absence. Robust employment checks were in place to help to ensure new staff were appropriate to be working with and supporting people.

The risks to people's safety and wellbeing were assessed and regularly reviewed.

People were supported with the management of their medicines and there were regular audits by the management team. People were not always supported by staff who were sufficiently well trained, supervised and appraised.

People's healthcare needs were met and staff supported them to attend medical appointments.

People lived in a comfortable environment which was clean and free of hazards. They were able to personalise their bedrooms as they wished.

Staff had undertaken training in the Mental Capacity Act 2005 and were aware of their responsibilities in relation to people who might be deprived of their liberty. They ensured people were given choices and the opportunity to make decisions.

Throughout the inspection, we observed staff caring for people in a way that took into account their diversity, values and human rights. People were supported to make decisions about their activities in the home and in the community.

Information about how to make a complaint was available to people and their families, and they felt confident that any complaint would be addressed by the management.

Work was being progressed to ensure people had a choice about what happened to them in the event of their death and that staff had the information they needed to make sure people’s final wishes would be respected.

There was a clear management structure at the service, and people and staff told us that the registered manager and deputy manager were supportive and approachable. There was a transparent and open culture within the service and people and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider did not have effective systems in place to monitor the quality of the service. Where issues were identified they were not always addressed promptly.

During this inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At our previous inspection in January 2016 we identified a breach of the Regulations in relation to the management of medicines. When we inspected in March 2017 we found the service had addressed our concerns around the management of medicines and were meeting the Regulations.

Scott House provides care and support for up to twenty one men and women living with long term mental health issues. The service has a registered manager. 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 examined records and medicines for people using the service. We found the service had made improvements in their systems for ensuring records were correct. Staff had completed refresher training and their competency to administer medicines had been verified by senior staff. The service was meeting the Regulations in relation to safely managing medicines.

We visited Scott House on 21 and 22 January 2016. The inspection was unannounced.

At the previous inspection in July 2014 the service was meeting the Regulations we inspected.

The service provides care and support for up to twenty one men and women living with long term mental illnesses.

The service had a registered manager. 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.

The service did not always manage medicines appropriately. You can see what action we told the provider to take at the back of the full version of the report. People told us they felt safe. Staff had completed safeguarding training and knew how to recognise abuse and report safeguarding incidents. Handovers between shifts ensured staff were aware of recent incidents and the moods, health and welfare of people using the service. People’s needs were assessed and reflected in detailed risk assessments. There were sufficient numbers of staff to meet people’s needs and safe recruitment procedures were followed. The service provided a safe and comfortable environment for people, staff and visitors. The service was clean and hygienic.

Staff had the skills, knowledge and experience to deliver effective care and treatment. The manager and staff were aware of the provisions of the Mental Capacity Act and Deprivation of Liberty Safeguards and had completed relevant raining. People were provided with a healthy and tasty diet that reflected their preferences and choices. People using the service were supported with their healthcare needs including an annual health check with the GP.

People were happy with the relationships they had with staff. Keyworkers provided people with a specific member of staff who worked closely with them and gave extra support. People were supported to express their views and be involved in the planning and delivery of their care and support. People’s preferences were taken into account and staff treated people with dignity and respected their privacy. People were encouraged and supported to maintain and improve their independence.

Care and support plans were focussed on people’s needs, goals and preferences. Support plans identified and addressed people’s health and social care needs. They provided a framework for staff to deliver safe and appropriate care and support. People benefited from various activities which reduced the risk of individuals becoming bored, frustrated, isolated, or unhappy. The service had systems that enabled them to listen and learn from people’s experiences, concerns and complaints including regular ‘house’ meetings.

People using the service spoke positively about the manager. Staff told us the manager was friendly, approachable and made them feel valued. The provider had a system of staff meetings that enabled staff at all levels to feedback concerns and ideas. The service had regular staff meetings and team leader meetings where topics relative to the care and support provided were raised and discussed. The service and the provider used a system of reviews, checks, internal and external audits to assess and monitor the quality of service provided and identify any risks to the health safety and welfare of people using the service, staff and visitors. We found that records relating to the provision of care by the service were fit for purpose.

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, looking at records and speaking with people using the service and members of staff.

Please read the full report for evidence that supports our summary.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic.

We found that staff were supported with regular training and supervision to provide safe and appropriate care. Comments from people using the service included the following: 'They have been very good to me. I don't know what would happen to me if I wasn't here.' 'I'm good thank you. I know the staff and I'm comfortable.'

We looked at a random selection of care plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We saw that they covered a comprehensive range of care and healthcare needs and included appropriate risk assessments. We found that care plans were up to date and regularly reviewed which supported staff to deliver safe and appropriate care.

We found that there were procedures in place to deal with foreseeable emergencies. The service operated an on call contact scheme out of hours to provide staff with management support when needed. The training records we saw showed that staff had completed first aid and fire safety training.

Is the service effective?

We found that there were sufficient, suitably trained staff with appropriate experience to meet the needs of people using the service.

The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that the service had policies and procedures in place. At the time of the inspection there were no DoLS authorities in place.

Is the service caring?

We found that most members of staff and people using the service had been at the service for a long time. Their familiarity with each other ensured consistency and continuity of the care and support provided to people. People told us. 'It's great here, they really look after us.' 'It's like home, food good, room good, staff good.' People's diversity, values and human rights were respected. Staff respected people's privacy and dignity.

Is the service responsive?

We saw that care plans were person centred and recorded people's preferences. People and staff were listened to and where appropriate the service responded. We spoke with people who confirmed that they were involved in planning their care and treatment and were given appropriate information and support.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw that there were regular meetings with people and staff. People were confident that they could approach staff and the manager with any problems or issues. The staff were confident that they could bring any issues or suggestions to the attention of the management team

We found that the service had regular audits in place to assess and monitor the quality of their service provision.

We looked at care plans and saw that care was provided according to people's wishes and after liaison between associated professional. Staff that we spoke with were aware of instructions and guidance of how to meet people's support needs.

People who lived at the home told us they felt safe. Staff and people were clear about abuse and were able to inform us what they might do if any abuse occurred at the home.

We looked at staff records and saw that all staff had been checked thoroughly before commencing work at the home. Staff received an effective induction that ensured that the home provided an effective and safe service.

We examined minutes of meetings, surveys and audits that had been compiled by the provider. These told us that the home was continually reviewing and modifying the service.

People were observed to be treated with respect by members of staff and to have their privacy and dignity respected. People told us that they knew how to raise concerns or complaints and were confident that any issues would be addressed. Most of the staff have worked at the home for a number of years and know people who use the service very well.

The communal lounge was recently redecorated. Other areas would benefit from redecoration. We were assured by staff that redecoration was included in the maintenance schedule.

You can see our judgements on the front page of this report.