York Road

York Road is a care home providing personal care to up to a maximum of fourteen people. The service provides support to adults with forensic mental health needs with care and support provided to help people to live with more independence in the community. At the time of our inspection there were 12 people using the service.

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

People were kept safe. Staff demonstrated they knew how to raise safeguarding concerns and were aware of the processes to follow in order to keep people safe.

Care and support plans were developed to ensure people’s needs and risks were met appropriately. People were assisted to work towards achieving their goals in terms of their independence. Risk management strategies were in place to assist staff to help people to manage these risks and to identify triggers for behaviours that may cause distress.

The administration of medicines was managed in a safe way. There were policies and procedures in place for staff to follow and staff told us they found them helpful in ensuring people received their medicines safely.

The service was following safe infection prevention and control procedures to keep people safe.

People were assisted to become more independent with their menu planning and budgeting so as to enable them to eat more healthily. They were helped with developing their meal preparation skills.

The service was flexible and adapted to people's changing needs and wishes and promoted their independence. Care was person centred and risk assessments were in place.

People's diversity and their unique individual needs were well-respected by staff. The staff team knew people well and were able to provide appropriate support.

People received personalised care and support according to their needs and wishes.

Staffing levels were good and appropriate to ensure people's needs were met in a safe, timely and consistent way.

Staff were supported and encouraged to continue their professional development so they could progress their knowledge and skill base and provide the best outcomes for people. Staff received a wide range of training that covered the essential areas of their work although they told us this could be widened to include more specialist training. Staff received one to one supervision and support on a regular basis.

People's health care needs were being met and they had access to healthcare services where needed.

Staff were kind and caring, they respected and valued people using the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies, procedures and systems in the service were all focused on achieving these outcomes.

People's privacy was respected and people were supported to maintain contact with those people who were important to them.

York Road was well led. The provider's ethos and values put people at the heart of the service. This vision was driven by the registered manager and by the staff team who were empowered to contribute fully to support a person-centred model of effective care. This helped people using the service, with complex needs, to achieve their hopes and aspirations for more independent living.

There was an effective complaints policy and procedure in place that the registered manager reviewed in order to ensure where necessary improvements were made.

There was clear evidence of collaborative working and good communication with other professionals in health and social care as well as in the community and education sectors. The provider built effective relationships with the community and with health and social care professionals so that people using the service would benefit.

There was a comprehensive and effective governance system in place. People and staff were confident about approaching the registered manager if they needed to. They recognised that their views and feedback were valued. Feedback was used to support quality service developments.

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

Rating at last inspection

This last rating for this service was good (published 15 January 2019).

Why we inspected

This was prompted by a review of the information we held about this service.

We 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.

Follow up

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

Some areas of this home were tired and needed refurbishment and redecoration. The annexe particularly looked drab and needed redecoration throughout, together with new carpets in the communal areas. After the inspection the provider sent us an action plan which identified how improvements would be made. At this inspection we found the provider had made the necessary improvements and we rated the service Good.

31, York Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. 31, York Road can accommodate up to fourteen people with forensic mental health needs with care and support provided to help people rehabilitate in the community. There were eleven people using the service at the time of this inspection.

The service had a registered manager who was on long term sick leave and who left the service recently. The acting manager told us they would be applying to register as manager with the CQC. A registered manager is a person who has registered with the CQC 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 provider managed risks to people’s care, including those relating to medicines management and infection control. Staff received training in managing medicines and the provider assessed staff were competent. Processes were in place to protect people from abuse and neglect including staff training.

People were supported to maintain good health and have appropriate access to healthcare services. People were encouraged to plan, shop and prepare their own food. We saw they had a varied and nutritious diet.

Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

There were safe recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable. There were enough staff to meet people's needs.

People were assessed as having the capacity to make decisions for themselves and were supported to do so. Staff had received appropriate training and had a good understanding of the Mental Health Act (MHA) 1983 and the Mental Capacity Act 2005 and knew when each set of legislation applied.

People had care plans outlining the goals they wished to achieve and what support they required from staff. People were involved in planning their care and their views were sought and planned for as an important part of the process.

Staff respected people's privacy and treated them with respect and dignity.

People knew how to make a complaint or how to raise a concern if they needed to do so. The acting manager told us they reviewed all complaints to check if there were any trends emerging that needed addressing in order to improve the service.

Staff said the acting manager was doing a good job in the absence of the registered manager. They told us he was supportive and they felt able to raise any concerns they had with him. Staff said the acting manager included them in discussions about the service and they felt involved in service progression and development.

The results from the last satisfaction survey were positive. They showed that people were satisfied with the support provided by staff and the services more generally in the home.

The provider had greatly improved their auditing processes that ensured areas of staff practice that previously needed improvement are now of a good standard. People’s risk assessments and care plans were regularly reviewed and updated as required and staff medicines practices met good standards.

York Road can accommodate up to fourteen people with forensic mental health needs with care and supported provided to help people to rehabilitate them in the community. There were twelve people using the service at the time of 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.

People were at risk of not receiving sufficient levels of support that was appropriate to meet their needs. The care files and reviews we inspected were not all up to date. Some people’s risk assessments were not updated or revised following changes in their circumstances and care. Some care plans, reviews and risk assessments had not been signed by people to indicate their agreement to what was written down on their behalf. The acting manager confirmed with us they would ensure all people’s care plans would be reviewed immediately together with people living in the home. This is in line with the provider’s own policies and procedures. The acting manager also told us that staff will receive additional training with this to ensure they fully understand their responsibilities and carry them out as required. The example above showed the provider was not assessing or mitigating risks to people’s safety effectively. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People received their medicines as prescribed and staff knew how to manage medicines safely. Those people who were able to, took their medicines themselves with minimal assistance from staff.

We inspected the home’s medicines administration policies and procedures. Staff completed medicines training and competency assessments before they were able to administer medicines to people. Safe medicines management processes were implemented and people were supported to self-medicate where they were able to do so. A new policy to do with clozapine was drawn up, to be implemented immediately with staff training to ensure all staff were knowledgeable and competent to administer clozapine where necessary.

Some areas of this home were tired and needed refurbishment and redecoration. The annexe particularly looked drab and needed redecoration throughout, together with new carpets in the communal areas.

Staff were suitably trained and supported to carry out their work effectively. The acting manager told us that the provider’s training schedule helped to ensure all staff received appropriate training and support for their roles and their work in the home.

Staff told us they were well supported with appropriate training and were able to discuss any concerns or issues with the manager whenever they needed to do so.

All of the people living at York Road had the capacity to make decisions about specific aspects of their care and support at the time of this inspection.

People were supported to maintain good health and have appropriate access to healthcare services.

People were encouraged to plan, shop and prepare their own food. We saw they had a varied and nutritious diet. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

The acting manager ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable.

People and staff said they thought there were enough staff to meet people’s needs. We looked at staff rotas and observed care being provided for people and we found there were sufficient levels of staff available to meet people’s needs.

People were assessed as having the capacity to make decisions for themselves and were supported to do so. Staff had received appropriate training and had a good understanding of the Mental Health Act (MHA) 1983 and the Mental Capacity Act 2005 and knew when each set of legislation applied.

People were encouraged and supported by staff to become more independent by developing the necessary skills and knowledge. This included eating well and staying healthy. When people needed care and support from healthcare professionals, staff ensured people received this.

Most people had care plans outlining the goals they wished to achieve and what support they required from staff. People were involved in planning their care and their views were sought and planned for as a central and important part of the process. The service monitored people’s changing needs and involved them in discussions about any changes that needed to be made to their care plans.

Staff respected people’s privacy and treated them with respect and dignity.

People told us they were able to contribute to the assessment and care planning process of their care through a number of different ways that they found useful. This included Care Programme Approach (multi-disciplinary agency) meetings, key worker meetings and house therapy meetings. We saw evidence that care plans reflected what people had said they would like and how they would like their care to be delivered. Care plans included details of people’s social activities and of their engagement with the community. Not all care plans we inspected were regularly reviewed up to the date of this inspection.

People knew how to make a complaint or how to raise a concern if they needed to do so. The registered manager told us they reviewed all complaints that had been made to check if there were any trends emerging. None had been identified at the time of this inspection.

Staff said the acting manager was doing a good job in the absence of the registered manager. They told us he was supportive and they felt able to raise any concerns they had with him. Staff said the acting manager included them in discussions about the service and they felt involved in service progression and development.

The results from the last satisfaction survey undertaken for 2016 - 2017 were mostly positive in all areas that questions were asked. They showed that people were satisfied with the support provided by staff and the services more generally in the home.

We found the auditing processes in place were ineffective in identifying some areas of staff practice and procedure that needed improvement. For example some people’s care plans and risk assessments were not up to date. Also we did not see evidence to provide assurance that audits were robust enough to identify medicines concerns.

At this inspection we identified a breach in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

When we visited 31, York Road there were eleven people using the service. We spoke with seven of the people using the service, the registered manager, three members of staff and a visiting social worker. We reviewed three people's care plans and three staff files.

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. All the staff who had been recruited to the service had had their credentials checked to ensure they met the home's policy and procedures. This helped to ensure that people's needs were met.

Was the service effective?

People who use the services health and care needs were assessed with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected three people's care files. They included essential information about the person, comprehensive needs and risk assessment information, care and support plans as well as records of keyworker meetings.

Staff received regular and appropriate training and supervision to ensure they were able to meet the specific needs of people using the service.

Was the service caring?

People were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The seven people we talked to said the staff treated them well and respected their privacy.

People who use the services told us they attended regular house meetings where they were able to discuss relevant issues and make decisions about what they wanted to do. We saw from reading the minutes of these meetings that meeting the wishes and preferences of people was the main priority. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

People met regularly with their keyworker to review their care and support. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint and they said they would be supported if they made a complaint. There was an appropriate complaints procedure in place and the complaints that had been made had been properly dealt with under the policy guidelines. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in relation to developing their independence.

The views of people who use the services, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

All told us they had care and support plans. They told us they had key workers with whom they held regular meetings to discuss their care and support needs. They also told us they had regular contact with their care coordinators and appropriate health care professionals.

All spoke positively about staff. One person said 'This place is pucker, the staff are very supportive, they always encourage me to do the things that help me keep well'. Another person said 'The staff are interested in what we think, they are very nice people, they don't go sticking their noses in but they help me when I need help'.

All of the people we spoke to told us they knew about the home's complaints procedure. They said if they had any concerns they would tell staff or the manager and they would do something about it.

People told us they took turns to shop, cook and wash up. Staff encouraged them to eat healthy meals and sometimes they helped them to cook.

We saw that people were receiving their medication as prescribed by health care professionals.

They told us they felt safe living at the home and that staff treated them well. People who were living at the home when we last inspected told us things had improved. One person told us 'things are a lot better. Staff are more respectful. It's better with the new manager'. Another person told us 'a lot of staff have left and we have new staff, things have improved, the new staff are respectful in the way they talk to us'. Another person told us 'staff listen to us and it's more relaxed, we still have problems sometimes but it's better'.