This inspection took place on 2 and 3 May 2017 and was unannounced. St Mungo's Broadway – 2 Hilldrop Road is a care home which is registered to accommodate a maximum of 29 people with a history of alcohol misuse, homelessness and mental health conditions. On the days of our inspection, the service was providing care for 24 men.At our last inspection on 14 and 15 November 2016, we found significant shortfalls in the care provided to people. We identified breaches of Regulations 9, 10, 11, 12, 14, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, we identified breaches of Regulations 16 and 18 the Care Quality Commission (Registration) Regulations 2009.
These breaches related to inadequate care planning and risk assessment, poor infection control practices, unclean, poorly maintained and unsafe premises, unsafe recruitment practices, inadequate provision of staff training, supervisions and appraisals, poor staff understanding of the Mental Capacity Act (MCA), lack of provision of drinking water and a lack of auditing processes to ensure good governance and overall management of the service provided. We were not satisfied that care and treatment was being provided safely.
We took action to impose a condition which required the provider to undertake a monthly audit of care plans, risk assessments, cleaning and maintenance, infection prevention and control, staff training, supervisions and appraisals, staff recruitment, incident reporting, staffing levels and submit a monthly report to the Care Quality Commission (CQC) outlining their findings.
The provider was also placed into special measures. Special measures are designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Its purpose is to ensure that inadequate care significantly improves and provides a clear timeframe within which the provider must improve the quality of care they provide. When a provider is placed into special measures, the CQC will re-inspect within six months.
This inspection was carried out within the six-month time frame to check if improvements to the quality of care had been implemented. At this comprehensive inspection we found the registered provider had taken action to achieve compliance with all of the regulations previously identified as non-compliant during the comprehensive inspection in November 2016. However, we identified concerns regarding medicines management.
At the time of the inspection, the registered manager was no longer working at the service. An interim manager was responsible for day to day running of the service. The regional director advised us that they were commencing recruitment for a new 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.
Medicines were not being managed safely. People's Medicine Administration Records (MAR's) were not always completed in full or accurately. We found one instance of a medicine not administered as prescribed. Medicines stocks were not checked. Medicine audits had failed to identify and improve on the issues that we found.
At this inspection, we found that levels of cleanliness had significantly improved across all areas of the service. Infection prevention and control measures were in place and monitored. Hand washing facilities were available in toilets and bathrooms.
Staffing levels and deployment had been reassessed and increased. Additional dedicated cleaning staff were recruited and an additional staff member was deployed to support senior staff.
Incidents and accidents were recorded and reported to appropriate external organisations.
At this inspection, we found detailed current risk assessments were in place for people using the service. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person. However, we identified two instances of where risk assessments had not reflected the person’s current circumstances, which was brought to the attention of the provider and addressed.
We found that care plans were person centred and reflected what was important to the person. Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's preferences.
Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure a better oversight of when staff training, supervisions and appraisals were due.
Staff were safely recruited with necessary pre-employment checks carried out.
Significant improvements had been made to ensure that consent to care was obtained from the appropriate person. Care plans specified best interest decisions that had been made. All staff had received training on Mental Capacity Act 2005 (MCA) and staff understood the importance of obtaining consent from people.
People had access to drinking water and a tea room had been created to enable people to make their own hot drinks at a time of their preference.
People told us they were treated with dignity and respect and that staff were caring. We received consistent feedback from staff that as a result of staffing changes, they were able to spend more time and develop better relationships with people who used the service.
The provision of activities had increased and care staff were enabled to deliver activities in evenings and weekends.
Referrals had been made to other healthcare professionals to ensure people's health was maintained.
Staff and resident meetings were held regularly.
We found that improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from staff regarding the management structure in place and the support they received. Managerial oversight of the service had improved since the last inspection. Good practice had been developed, but further time was needed to address outstanding issues and for the service to demonstrate that the improvements that had already been made had been fully embedded and could be sustained.
At this inspection, we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, as the provider has demonstrated significant improvements, the service is no longer rated as inadequate for any of the five questions and it no longer remains in special measures.