The inspection took place on 30 January and 2 February 2017 and was unannounced. The service is a care home for up to ten women living with mental health conditions. At the time of our inspection six people were living in the home.The home 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 service was last inspected in April 2016 when we identified two breaches of regulations, made three recommendations and rated the service Requires Improvement overall. At this inspection we found the service had addressed the previous breach of Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service now had clear records that people’s needs were assessed and reviewed regularly. However, the service had failed to address the breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although records showed they had commissioned training resources to ensure staff had sufficient skills and knowledge to perform their roles, these had not been effectively implemented.
The home had followed our recommendation regarding medicines record keeping. However, systems to monitor medicines had not been maintained and errors in medicines administration were found during the inspection. Medicines had not been managed in a safe way that ensured people received them as prescribed. The provider took immediate action to address these issues.
Care files contained a range of risk assessments with clear measures in place for staff to follow in order to mitigate risks. Where people presented with behaviours which could challenge the service, there were appropriate and detailed plans in place to de-escalate situations with clear instructions regarding the use of physical intervention as a last resort. The home had a number of general risk assessments, which included measures which were restrictive on people living in the home. We have made a recommendation about restrictive risk assessments.
There were enough staff on duty to meet people’s needs. Records showed safe recruitment practice had not been followed.
Staff were knowledgeable about the different types of abuse people might be vulnerable to and knew how to escalate concerns. Incidents that should have been raised as safeguarding alerts had not been escalated appropriately. We have made a recommendation about safeguarding adults.
Care plans were personalised and contained a high level of detail about how to meet people’s individual needs and preferences. People were supported to join in a range of community and in house activities. Information about people’s care plans and activities was not always in a format that was accessible to them. We have made a recommendation about making information accessible to people living in the home.
People told us they liked the food. People were supported to be involved in meal preparation and specialist religious dietary requirements were met. Menu choices and other aspects of shared living were discussed at regular house meetings where people could make decisions about the running of the home. People were supported to access healthcare services as required and to maintain their health. Where people had health conditions which required specific guidelines these were clear and in place.
The home sought consent from people and where people lacked capacity to consent to their care appropriate applications to deprive them of their liberty had been made. Where people lacked capacity to make decisions in some areas of their lives, but could make other decisions, information in care plans was not always clear about what support they needed to make their own choices. We have made a recommendation about following the Mental Capacity Act 2005.
People told us the staff were caring and treated them with dignity and respect. Staff spoke about the people they supported in a positive way, emphasising their strengths and qualities. Care plans included information about supporting people to maintain their relationships with their families, but did not explore support people may require with other relationships in their lives. We have made a recommendation about supporting people with relationships.
People and staff spoke highly about the interim manager who was in charge of the day to day management of the home. They told us they were a good manager who created a family atmosphere in the home.
Quality assurance systems and audits were not operating effectively. They had not identified or addressed health and safety or maintenance issues in the home. There was no oversight of the quality of care plans by a registered person. The provider was not submitting notifications as required to CQC.
We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the end of the full version of this report.