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St Mungo's Broadway - 2 Hilldrop Road Good

Reports


Inspection carried out on 30 May 2018

During a routine inspection

We carried out this inspection on 30 May 2018 and 5 June 2018. The first day of the inspection was unannounced. We informed the provider that we would be returning on the second day.

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 23 men.

During this inspection we found that the service had been steadily improving and addressing all issues identified by us during our inspections in December 2016 and May 2017. Staff and people using the service commented positively about the changes within the service. Both staff and people were encouraged to share their opinions, by the provider, about the service and contribute to any developments in the service provision.

The service had a registered manager in post. 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 current registered manager had joined the service in December 2017. The registered manager was supported by the members of the providers management team including the regional director and the head of services as well as the newly appointed deputy manager. The management team had the training and experience necessary to manage the regulated activity of accommodation for persons who require nursing or personal care.

At this inspection we found that the service had made improvements to how they managed medicines and people received their medicines in a safe way. Some additional improvements were needed to ensure PRN (as required) medicines administration was recorded correctly at all times and that PRN stock levels reflected the needs of people who used the service.

Risk to health and safety of people had been assessed and people lived in a safe environment. The provider needed to ensure all risk assessments carried out were equally robust and that appropriate records were in place to help to keep people and staff safe at all times.

The service provided people with freshly prepared food and drink which was nutritional and in suitable amounts. Staff were in the process of creating a nutrition information folder to ensure kitchen and care staff had an easy access to this information.

The provision of social activities at the service was reduced due to the recent changes in staff structure. However, the service was in the process of reviewing how activities were provided to ensure there was sufficient amount of interesting and fun things to do for people who used the service.

Staff helped to protect people from avoidable harm from others. Staff were trained in safeguarding adults and they understood their role in ensuring people using the service were safe from any type of abuse. Robust recruitment procedures in place ensured that only suitable staff worked with people. There were enough staff deployed on each shift and people’s needs were met with no delay.

The registered manager had assessed needs and preferences of people who used the service before they moved in. People were able to visit the service during the assessment process to find out if they liked it and if they would like to live there.

Staff were provided with regular mandatory and specialist training to enhance their skills and to be able to provide safe and effective care to people. Staff were also supported and their performance was monitored in regular one to one supervisions and yearly appraisal of their skills.

The service worked within the principles of The Mental Capacity act 2015 (MCA). Best Interest Decisions had been made when people did not have the capacity to decide about their care and treatment. S

Inspection carried out on 2 May 2017

During a routine inspection

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 detai

Inspection carried out on 14 November 2016

During a routine inspection

This inspection took place on 14 and 15 November 2016 and was unannounced. When we last inspected this service in May 2014 we found two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in medicines management and the suitability and safety of the premises. When we inspected again in September 2014, we found these areas of concern had been addressed.

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 27 men.

The home 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 home was unclean. The premises and equipment within the home was not maintained. Infection control was not being followed as adequate hand washing facilities were not always available and staff did not have access to sufficient personal protective equipment (PPE) and cleaning materials.

The provider did not adequately assess risks for all people using the service. Identified risks had not been assessed for all people who used the service. Risk assessments did not provide staff with enough guidance on how to recognise risk, actions to take or how to mitigate identified risks.

There were not always enough staff deployed in the service to consistently meet people's needs. People were left on their own for long periods of time without the support of staff. Not all of the care staff on duty provided care to people. Some staff were seen to be undertaking cleaning tasks only.

Incidents and accidents were not always recorded and reported to appropriate external organisations.

The provider did not always adhere to the Mental Capacity Act 2005 (MCA). The provider did not have a MCA or Deprivation of Liberty Safeguard (DoLS) policy in place. There were no best interest decisions or mental capacity assessments highlighting that people did not have capacity to sign their care plan or forms consenting to their care. Not all staff had received training in the MCA and staff did not always understand how this legislation impacted on the lives of people they were working with.

People were not always receiving care from staff who were competent, skilled and experienced. There was a risk that people were receiving care from staff who had not received training to meet the needs of people with certain health conditions. The provider did not keep appropriate records of training, identify staff training needs or monitor when staff needed their training updated.

Not all staff had appropriate regular supervision or annual appraisals.

People did not have access to drinking water and had to ask staff for drinks which sometimes resulted in a lengthy wait and placed people at risk of dehydration.

People’s privacy and dignity was not always respected.

Care plans were not person centred and did not state people’s individual preferences. Most care plans had not been signed. Updated care plans were contained electronically which meant that not all staff had access to the most up to date version as some staff did not have access to the electronic care management system. Care plans were not updated to reflect people’s changing health needs and important medical information was missing.

The provider did not always ensure robust recruitment practices were in place. Not all staff had a criminal records check carried out before working with people.

There were not effective systems in place to assess and monitor the quality of the service. Although some quality checking had been undertaken these had not been used to improve the quality of car

Inspection carried out on 10 September 2014

During an inspection looking at part of the service

As this was a follow-up inspection to check whether actions we required from our previous visit had been carried out, we did not speak with people who use the service or their representatives at this time.

On 1 May 2014 we visited and found that essential standards relating to management of medicines, and safety and suitability of the premises, were not being met. The provider submitted an action plan detailing how they would meet these standards. During this visit, on 10 September 2014, we checked whether the provider had carried out the actions and whether the standards were now met.

We found that medicines were managed appropriately and safely, and that people received the medicines they needed. Medicines were stored according to the manufacturers' instructions, and this was checked regularly by the provider.

We found that the premises were appropriately maintained, and had undergone a deep clean since our last visit to ensure that people were protected.

Inspection carried out on 1 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people�s safety and welfare. Suitable risk assessments had been carried out and staff were knowledgeable about the content of these.

Members of staff had been through an appropriate recruitment process to ensure that they had the skills and experience needed to safely support the people living at this service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. None of the people who used this service had applications submitted under this system. However, we saw evidence that the manager was organising training for staff in relation to the operation of the DoLS.

We noted some problems with the maintenance of the premises. In some cases this meant that people may not have been safe, or may not have had their privacy protected, when they were on the premises. We also found that people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We have asked the provider to draw up an action plan in relation to these risks and we will go back to the service to check that these actions are implemented.

Is the service effective?

We found that people's needs had been assessed and suitable support plans were in place. These were regularly reviewed. There were systems in place for obtaining verbal and written consent prior to providing support. The service used a system called 'Outcome Stars' as a method for involving people in decisions about their care.

People�s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Is it caring?

We observed that people were mostly relaxed and confident in their interactions with staff. Staff responded calmly when people became agitated. We spoke with five people using the service. Most people were satisfied with the support that they received. One person said "It's all right here." Someone else told us "The support is ok and they are aware of my health problems." However, there were some people who told us they were not happy with the service. For example, one person said "I don't like it here. I am lonely and no one cares."

Is the service responsive?

We examined how the service responded to verbal and written complaints as well as what actions they took in response to any adverse incidents involving people who used the service. We saw that the service had not received any written complaints. More general concerns were raised by people at monthly residents' meetings. These were monitored and responded to. The service could also show us evidence of how they responded to incidents. We saw that steps were taken to minimise the possibility of any incident recurring.

Is the service well-led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. Various health and safety audits were carried out including weekly fire and daily room safety checks. We saw that the service was making appropriate notifications to regulatory bodies, such as the CQC, in relation to any incidents or adverse events that had occurred.

People using the service were invited to attend monthly residents' meetings to feedback information about the quality of the service to the managers. Members of staff met daily for an hour long handover meeting where they discussed issues relating to the people using the service and their support needs. Members of staff were also currently attending reflective practice sessions which the provider had arranged for them. The members of staff that we spoke with told us that they found these sessions beneficial.

Inspection carried out on 10 January 2014

During an inspection looking at part of the service

When we last inspected the service on 19 April 2013 we found that the provider did not have effective processes in place to manage the recording and retention of appropriate information. The provider sent us an action plan detailing how they would address the issues we highlighted and become compliant. We visited this time to review records and to see that the measures detailed in their action plan had been implemented.

We found that each of the measures in the provider's action plan had been implemented. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 19 April 2013

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People's preferences were considered in relation to the delivery of care and people were involved in care planning. The provider respected people's choices and considered people's cultural needs.

We found that people's needs were assessed and that risk assessments and care plan records were reviewed as necessary.

The provider made sure that people who used the service were involved in deciding the food menus and that people were given a choice at each mealtime.

We found that people were protected from the risks of abuse as the provider took steps to make sure that people were protected. Staff we spoke with demonstrated that they knew their responsibilities to make sure people were protected.

Staff showed they knew the needs of the people they provided care to and staff we spoke with told us that they felt supported by the provider. We found that staff were supported to identify training needs and to attend relevant training.

We found that people were at risk of inappropriate care as the provider did not effectively record appropriate information in relation to the management of the service and the delivery of care.

The provider had effective systems in place to monitor care quality.

Inspection carried out on 19 June 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

On the day of the inspection there were twenty-five people using the service. We spoke to eight people using the service, the manager and five staff members, and looked at five people�s care records.

The majority of people using the service told us that they were happy living there. The home had two pet cats, which were popular with some residents. One person said �I love cats � there�s one cat � she sits on your lap.� People told us that there was a choice of activities to engage in, although not many of them chose to join in.

The majority of people told us that they were treated with respect by staff. However three people told us that staff did not listen to them. We observed some examples of staff supporting people in a friendly and professional way, but some examples of staff addressing people in a way that did not respect their dignity.

People were generally happy with the food provided to them at the home, however we noted that there was a lack of choice at mealtimes, and that people�s nutritional needs were not followed up by staff.

Most people told us that they felt safe at the home, and we saw evidence that any concerns to their safety were addressed promptly. The home had effective systems in place to ensure that people were protected from abuse.

Peoples' records were stored securely.

Reports under our old system of regulation (including those from before CQC was created)