Archived: 1 Hanway Place

We found that the provider had made some progress in some areas in addressing the concerns identified at the previous inspection. However some areas of concern remained outstanding. We were concerned at the speed with which the provider was addressing areas of non-compliance and whether the progress that had been made was sustainable. We concluded that the provider had not taken proper steps to ensure that each person using the service was protected against the risks of receiving treatment that was unsafe or inappropriate as they had not appropriately assessed the needs of each person receiving a service or planned or delivered treatment in line with this assessment.

Suitable arrangements were not in place to ensure that people using the service were protected against the risk of abuse, by taking reasonable steps to identify the possibility of abuse and prevent it before it occurred. The provider did not have regard to published guidance in relation to the protection of children and vulnerable adults. The provider had not protected people who use the service against the risks associated with the unsafe use and management of medicines by making appropriate arrangements for the handling and safe administration of medicines.

There was not an effective recruitment procedure in place that ensured that people employed to carry out the service were of good character and had the necessary skills and experience necessary for their role. The provider had not ensured that the information required under Schedule 3 of the Health and Social Care Act (2008) was available for each person employed by the service.

There were not suitable arrangements in place to ensure that staff providing the service were appropriately supported to provide safe and effective treatment as staff did not receive supervision or appraisal, and were not supported to undertake training or professional development.

The provider had not protected people who use the service and others who may be at risk by means of an effective system to regularly assess and monitor the quality of services provided. They had also not identified, assessed or managed potential risks relating to the health, welfare and safety of some people who use the service. People who use the service were not protected against the risks of unsafe or inappropriate treatment as an accurate record in respect of each person had not been maintained.

Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

People who use the service spoke highly of the treatment they received. We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their treatment. As a result of this inspection, we found that the provider had not taken proper steps to ensure that each person using the service was protected against the risks of receiving treatment that was unsafe or inappropriate. The provider had not carried out a proper assessment of the needs of each person, and were not planning and delivering care in line with such an assessment and in line with published guidance, to ensure that the people's needs were met and that their safety and welfare promoted. The provider did not have suitable arrangements in place to ensure that people were protected against the risk of abuse, by taking reasonable steps to identify the possibility of abuse and prevent it before it occurred. Also, the provider did not have regard to published guidance in relation to the protection of children and vulnerable adults.

The provider had not protected people against the risks associated with the unsafe use and management of medicines by making appropriate arrangements for the handling and safe administration of medicines. Overall, we found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that the provider had not made sufficient progress in becoming compliant with some outcome areas as identified at their previous inspection. We found that the provider still did not operate an effective recruitment procedure that ensured that people employed to carry out the service were of good character and had the necessary skills and experience for their role. The provider had not ensured that the information required under Schedule 3 of the Health and Social Care Act (2008) was available for each person employed by the service.

Additionally the provider had not made suitable arrangements since the last inspection to ensure that staff providing the service were appropriately supported to provide safe and effective treatment, as staff did not receive supervision or appraisal and were not supported to undertake additional training or professional development. Finally, the provideR had not ensured that people who use the service were protected against the risks of unsafe or inappropriate treatment as an accurate record in respect of each person had not been maintained.

We have taken enforcement action against the provider for this essential standard to protect the health, safety and welfare of people using the service.

Before a person was admitted staff carried out initial assessments to determine if people were suitable for the service and whether it could meet their needs.

The provider has not taken steps to provide care in an environment that was adequately maintained. There was no documented risk assessment on the safety of the environment.

There was no evidence appropriate recruitment checks had been carried out on all staff. We were therefore not assured that the provider had effective recruitment systems to ensure people's needs were met by the appropriate staff. We found that there were not always arrangements in place to support staff. There were no records kept on what training staff had undertaken.

The provider had a complaints policy and procedure which detailed the timelines for when a complaint would be acknowledged and responded to. When people were admitted to the service they were asked to sign a form which included a paragraph on how people could make a complaint if they wished.

Accurate and appropriate records were not always maintained for people who used the service. However, we acknowledged that improvements were being made to record keeping since our last visit in February 2013.

People were informed about and consented to their treatment. One person told us that they had a care plan and knew what it entailed and had signed it. They said that they were 'satisfied' with the quality of their care and that their needs were being met by the service.

Staffing levels were planned to accommodate the specific needs of people using the service and these were generally being met.

Medicines were prescribed to people appropriately.

We saw that audits were carried out to assess and monitor the quality of the service. However there were no arrangements in place to formally obtain people's views about the service and their care and treatment.

The provider has not taken steps to provide care in an environment that was suitably designed and adequately maintained. People who used the service and worked at the service were at risk of tripping over the carpet and the detached light in the basement was unsafe. The environment was not conducive to a therapeutic environment particularly where people received counselling and/or complementary therapy.

Accurate and appropriate records were not maintained for people who used the service. However, we acknowledged that improvements were being made to record keeping since our last visit.