The You Trust - 34-36 Shaftesbury Road

The You Trust – 34 - 36 Shaftesbury Road 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. 34-36 Shaftesbury Road accommodates up to 13 people living with mental health needs. The service does not provide nursing care. At the time of the inspection there were 11 people using the service.

A registered manager was in post but was not working in 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. Another manager was supporting the deputy manager with the day to day management of the service at the time of our inspection. Throughout this report we refer to this person as the manager.

Governance systems were being operated effectively and had identified areas for improvement. The work to make these improvements had taken place. Improvements had been made to the management of medicines. Audits of these were more effective and there were no unexplained gaps in records. Medicines storage was secure but temperatures checks needed to be done consistently.

People’s needs were assessed before they moved into the home, to ensure their needs could be met. Where it was appropriate for people, they were supported to transition to the home. People told us they made their own decisions and came and went as they pleased. Staff adhered to the principles of the Mental Capacity Act, 2005 (MCA) and understood people’s right to make unwise decisions. They supported people in the least restrictive way. Risks associated with people’s needs were well known by staff and new recording systems were being implemented at the time of the inspection. These provided comprehensive, person centred information about people.

Staffs knowledge of people was good and they provided person centred care. People were provided with appropriate mental and physical stimulation. People were treated with kindness and compassion. Observations reflected people were comfortable and relaxed in staff’s company. People were involved in their care and their independence was supported. People’s privacy and dignity was respected. People were encouraged to eat healthy balanced diets by staff who worked well as a team and supported access to appropriate healthcare.

There were sufficient staff to meet people’s needs and the provider demonstrated safe recruitment processes were followed. Staff understood their responsibility to safeguard people and had received training to do so. Various subjects of training were delivered to staff, in a variety of formats. The training subjects were based on the providers mandatory requirements and people’s specific needs. Staff received supervisions and felt supported. Following feedback from staff a new appraisal system had been developed and the provider aimed to roll this out in the coming months.

There was a process in place to deal with any complaints or concerns if they were raised. People told us they knew how to complain but had not needed to. The manager and deputy manager were accessible and operated an open-door policy. Staff and people were confident to raise concerns and felt listened to.

The provider was aware of their requirement to notify CQC of significant incidents and this was happening.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 10 and 13 November 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We found that the provider had followed their plan and this legal requirement had been met. The provider had taken action to ensure the premises were safely managed.

At the time of our last inspection this breach was included under the key question of effective. At this inspection we have also inspected the key question of safe to check how risks to people are managed. All focussed inspections consider the question of well-led.

This report only covers our findings in relation to the three key questions of safe, effective and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The You Trust - 34-36 Shaftesbury Road on our website at www.cqc.org.uk.

The You Trust – 34-36 Shaftesbury Avenue 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. 34-36 Shaftesbury Avenue accommodates up to 13 people living with mental health needs. The service does not provide nursing care. At the time of the inspection there were eight people living there.

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.

Risks associated with people’s medicines had not always been assessed with plans in place to mitigate risks. Records of medicine administration were not always fully completed. Policies and procedures in relation to the safe management of people’s medicines had not always been followed. This meant people were at risk from the unsafe management of medicines.

Quality assurance systems were not always effectively used to identify and make improvements to the quality and safety of the service people received. Audits had not always been completed and actions identified were not always acted on to ensure concerns were addressed.

Incidents were investigated and had been used to make improvements. Providers are required to have procedures in place to ensure the duty of candour is followed. The registered manager was not aware of this requirement and they told us the provider did not have a policy in place about this. This is important to promote an open and transparent culture when things go wrong.

The provider was working to improve key relationships with external health and social care professionals to promote effective joined up care for people.

Staff were aware of their responsibilities to safeguard people and protect them from abuse and the registered manager acted on concerns. People were supported to manage risks to their mental health and well-being by staff who knew and understood their needs.

Procedures were in place and followed by staff to prevent the risk of harm to people from emergencies such as fire. Checks were completed to monitor the safety of the premises and equipment for people. Concerns identified were acted on promptly and monitored for completion by the registered manager.

People told us there were sufficient staff to meet their needs. Staff were recruited safely and the provider used their own temporary staff to cover absences and provide a continuity of care for people.

Learning from incidents had been used to make improvements to the care people received.

People’s needs were assessed and recovery plans were in place to support people with their identified goals. People told us they were supported to achieve their goals such as moving on into independent living.

Staff completed training in equality and diversity. Staff showed an awareness of how to support people with their diverse needs including how people may experience discrimination and a commitment to address this.

Staff completed an induction and had access to a range of training to ensure they remained competent to meet the needs of the people they supported. Staff had received supervisions; however an appraisal system was not in place to enable staff to evaluate their performance with their line manager. The registered manager told us this was in development at the time of our inspection.

People were supported to attend healthcare and community services to support their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were confident the registered manager would listen and act on concerns. Staff spoke positively about the leadership in the home and regular meetings were held to share information and plan effective care and support for people. The provider had a set of values which were used to promote a positive culture in the home.

People told us they were kept informed by staff and involved in the running of the home. People said they were able to make decisions and these were respected by staff.

We found two breaches of the Regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

Effective maintenance of the home was not always carried out. Defects that had been reported had not always been adequately rectified. This meant that people and others were not always protected against the risks associated with unsafe or unsuitable premises because of inadequate maintenance.

People felt safe with the home’s staff. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm. Risks to people’s safety had been assessed and risk assessments were in place to manage identified risks.

People’s medicines were managed so they received them safely from trained staff. There were appropriate arrangements for obtaining, storing and disposing of medicines.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely. Staff were trained in a range of areas so people received effective care. Staff received regular supervision and had annual appraisals.

The requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards were understood by the registered manager and staff.

People were supported to have sufficient to eat and drink and to maintain a healthy lifestyle. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. Staff cared for and supported people in a warm, friendly and reassuring way. People’s privacy and dignity was respected.

Care plans contained information about people and provided guidance to staff on how they wished to be supported. Care plans contained personal histories about people and information about their plans for the future. People were encouraged and supported by staff to go out into the community.

Complaints were managed appropriately and, where necessary, appropriate action taken to prevent the risk of reoccurrence.

The registered manager operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable.

Staff felt supported by the registered manager and there was an ‘open door’ policy so that staff could discuss any issues of importance to them. The registered manager and her deputy worked alongside staff and this enabled them to monitor staff performance.

People were well supported by the registered manager and staff to live an independent life as much as they were able. Positive support plans were in place to enable people to maximise their potential.

The provider had a policy and procedure for quality assurance and a range of quality audit systems were in place to check on the quality of the care delivered. Weekly and monthly checks were carried out and there were regular staff meetings. Feedback was sought on the quality of the service provided and people and staff were able to influence the running of the service and make comments and suggestions about any changes they felt would improve the service provided to people.

We found one 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.

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, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People only moved into this service once they had undergone a thorough assessment. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. People spoken with confirmed that they had access to medical support as necessary. There were enough staff to meet people's needs and to provide them with the support they needed. People described the staff as, 'Lovely" and "Supportive'. People had been cared for in an environment that was safe, and well maintained.

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 had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people's care and support needs and that they knew them well. Staff had been well trained, and were provided with the right training to support people with their mental health needs. The service worked with other health and social care services to make sure people received all the care and support they needed.

Is the service caring?

We observed that staff had a good understanding of people's support needs. They were supportive and were available when people needed them.

Is the service responsive?

Records showed people's preferences, interests, and diverse needs had been recorded and care and support had been provided that met their wishes. People were supported to maintain and increase their independence.

Is the service well-led?

People and their representatives were asked their views and these were listened to. The manager had a system to record, monitor, evaluate and improve the service, care and support that people received.

We spoke with four people who use the service, four staff and one stakeholder.

All of the people we spoke with told us they were happy with the care and support they received. One person who used the service said, 'It is beautiful here. I love it". A stakeholder told us; 'This is a happy home. It has a nice vibe and residents are looked after'.

We found that peoples views and experiences were taken into account in the way that the service was provided; their care was assessed and delivered. People told us they had the freedom to 'do as they pleased' and their day to day decisions were respected by the staff. A stakeholder told us; 'The residents like it here and always give me good feedback'. They also said that the staff were always accessible.

Medicines in the service were managed effectively. Staff we spoke with us told us they had received medication training and felt supported with any other training they wished to do. All the staff working at the service had been employed using an effective recruitment process which included the necessary checks to ensure they were suitable to work there. One member of staff said they enjoyed working there and didn't consider their job a 'chore'. The service had an effective complaints policy and procedure in place and there were different ways available for people using the service to feedback or complain.