Oswald House

We found the following examples of good practice.

The provider had established effective infection prevention and control procedures which were understood and followed by the staff. All visitors including professionals were subject to checks to ensure an up to date lateral flow test and evidence of double COVID-19 vaccination was viewed before entry into the home.

There was a good supply of personal protective equipment (PPE) for staff and any visitors to use. Staff had received training on the use of PPE and we observed staff wearing it correctly during our inspection.

People living in the home were able to maintain contact with friends and family with visits either in the home or out of the home.

People's health and well-being was carefully monitored. A regular programme of testing for COVID-19 was in place for staff and people living in the home. This meant swift action could be taken when any positive results were received.

Daily cleaning schedules were implemented and these were enhanced with additional touch point cleaning.

Pathways (North West) Limited - Oswald House is registered to provide accommodation, rehabilitation, care and support for up to nine women with complex mental health issues in a gender sensitive unit. The home is a large detached house located in the village of Oswaldtwistle, Accrington. At the time of the inspection, there were nine people using the service.

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

People gave us consistently positive feedback about what it was like to live in the home. Comments people made included, “I love it here. It feels like a home, not a house” and “The support here is absolutely amazing.” People told us staff supported them in their recovery goals and enabled them to have a good quality of life.

Staff knew how to protect people from abuse. People told us they felt safe in the home and there were enough staff to support them. Accidents and incidents were fully investigated to see if any lessons could be learned. Staff helped people to carry out daily living tasks including cooking and cleaning when necessary.

The provider had systems to ensure staff received the training, support and supervision necessary to deliver effective care. Two people who used the service and their keyworkers had received training in dialectical behaviour therapy (DBT). Staff were able to use this therapeutic approach to reduce the risk of people self-harming or having suicidal ideas.

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

We observed caring and respectful interactions between staff and people who lived in the home. People had keys to their own bedrooms and had agreed with staff under what circumstances they were able to enter without permission.

People told us that using the recovery star with staff helped them plan and achieve their rehabilitation goals. The recovery star is a nationally recognised tool to help people measure their own recovery progress with the help of staff.

People received care which was responsive to their diverse needs. Staff supported people to participate in activities relevant to their interests. The provider had systems to gather feedback from people who lived in the home. Records showed this feedback had been acted on to improve the support people received. Any complaints had been fully investigated and a response provided to the complainant.

The service was well-led. The provider and registered manager demonstrated a commitment to continuous improvement in the service. Staff told us they received excellent support from the registered manager and felt their views were always listened to. The provider had systems to ensure people who used the service were involved in deciding how it was run.

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

Rating at last inspection

The last rating for this service was good (published 11 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oswald House is registered to provide accommodation, rehabilitation, care and support for up to nine people with complex mental health issues. The home is a large detached cottage located in the village of Oswaldtwistle, Accrington.

Over the four days of the last inspection which took place on the 29, 30 October 2015 and 02, 08 November 2015 we found the provider to be in breach of three of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one of the Care Quality Commission (Registration) Regulations 2009. We asked the provider to make improvements around individual environmental risk assessments and make adjustments and adaptations to the premises to recognise and mitigate any risk based behaviours. We also asked the provider to ensure that necessary referrals were made to the Commission and local authority informing of any safeguarding concerns and to review and follow procedural guidance in relation to pre admission and admission of people to the service.

The Commission is continuing to investigate matters connected to a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as stated in the previous inspection report. As such the Commission is still not yet in a position to determine the actions that may be taken at the conclusion of those investigations. However during this inspection we found the provider had taken steps to ensure they were now compliant with all of the regulations that were reviewed.

At the time of this inspection there was a manager in post. The manager had started the application process to become registered manager with the Commission. 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 registered provider had ensured an acting manager was in post with oversight from the area manager, until a new registered manager was recruited.

People indicated satisfaction with the service provided and spoke positively about the staff team who supported them. People looked relaxed in the presence of the staff team. People told us they had “Settled in well”. We saw evidence of people leaving the service without any restrictions placed on them.

We noted the service had developed processes and procedures to maintain a safe environment for people using the service and for staff and visitors. This included individual environmental risk assessments and daily ‘housekeeping’ and health and safety checks were also completed.

Fire audits were in date and compliant. Fire safety checks and fire exercises were carried out and staff had received fire training. The service had clear procedures to follow in case of an emergency. All people using the service had a personal emergency evacuation plan (PEEP).

Staff displayed knowledge of the various signs and indicators of abuse and were clear about what action they would take if they witnessed or suspected any abusive practice. Training in safeguarding and whistle blowing had been completed and procedural guidance was evident to support this.

We saw an adequate staffing level at the time of inspection and throughout the rotas we reviewed. People corroborated this by telling us they had the support they needed when needed. We also observed a good level of staff interaction to support this. Staff told us they had the time to carry out daily tasks and support people safely on a day to day basis.

Safe and robust recruitment systems were in place which ensured the service took appropriate steps to verify people’s previous employment and conduct, identity and any criminal record before being successfully appointed. Induction processes were also implemented to ensure the correct amount of training and support was given to new staff. Staff corroborated this by telling us the induction process was detailed and thorough. Procedures were in place to support the service in taking action in the event of staff misconduct.

The service had processes in place for appropriate and safe administration of medicines and staff were adequately trained. Medicines were stored safely and in line with current National Institute for Health and Care Excellence (NICE) guidance. NICE provides national guidance and advice to improve health and social care.

Care files were in date and regularly reviewed and detailed information which was personal to each person around the person’s needs, wishes, feelings and health conditions. It was evident that the person had contributed to these files and had signed when appropriate.

Appropriate training was provided. Staff confirmed they received a variety of appropriate training to equip them to safely and knowledgably support people living at the service. A training schedule was also in situ detailing training courses available for the following year.

The service was working within the principles of the Mental Capacity Act 2005 and ensured any conditions or authorisations to deprive a person of their liberty were being met. These provide legal safeguards for people who may be unable to make their own decisions. At the time of inspection these safeguards were being appropriately managed.

Meal times were very relaxed and people could choose what they wished to eat. People freely used the kitchen area to prepare meals, snacks and drinks with the support of staff when required. Weight management and dietary care plans were in situ when required and appropriate referrals had been made to health professionals.

During the inspection we noted positive staff interaction and engagement with people using the service. Staff addressed people in a respectful and caring manner and the service had a calm and warm atmosphere. We observed people enjoying each other’s company, conversing and accessing the community.

People told us they were happy to approach the manager with any concerns or questions.

We found the manager to be very approachable and they assisted us professionally with our inspection by providing us with any requested documentation without delay. The manager displayed an awareness of people's current needs and circumstances and was committed to the principles of person centred care and inclusion.

The service was last inspected in March 2013 and was found compliant in all areas inspected. At the time of this inspection there was no registered manager employed. However there was a deputy manager who provided management cover alongside the directors. 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.

During this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, and one breach of the Care Quality Commission (Registration) Regulations 2009. These were related to safeguarding, premises and equipment, failing to provide safe care and treatment, and failure to notify the Commission of notifiable incidents. You can see what action we told the provider to take at the back of the full version of the report.

The Care Quality Commission is continuing to investigate issues related to an incident at the home. As such the Commission is not yet in a position to determine the actions that may be taken as the investigation has not concluded.

People told us they felt safe living at the home. They referred to the home as a safe place. Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. However, we found that the manager had not referred safeguarding incidents to the relevant Authority and had not notified the Commission.

We saw that in most cases the service had created adequate detailed risk plans for each person. These identified risks such as self-harm, suicide and fire setting. However for one person these had not been completed.

The service had an admission policy but this was not consistently followed. The policy failed to provide a robust admission procedure. However, following the inspection, management have reviewed the policy and have provided the Commission with a more robust policy.

We found environmental risk assessments and policies were in place to protect staff and people using the service. However these policies needed reviewing and updating. We found in some cases the risk assessments did not reflect the individual risk that people using the service may have posed to themselves. This meant the location was not adequately risk assessed for people who may be at risk of ligature. Subsequent to the inspection the service provider has carried out internal and external work on the premises to ensure these risks are now being managed more effectively.

We saw overall detailed care plans which gave clear information about the people’s needs, wishes, feelings and health conditions. These were reviewed monthly and more often as needed by the manager. Staff told us they were required to read care plans to familiarise themselves after an absence from work of two weeks or more.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safe Guards (DOLS). These provide legal safeguards for people who may be unable to make their own decisions. The manager also demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who uses the service in their best interests. We saw two people using the service were subject to DOLS documentation and referral process relating to these people had been followed in line with current guidelines.

Staff told us they felt able to approach the manager and directors for any support and guidance and felt confident that any issues raised would be resolved effectively.

We found sufficient staff were deployed to meet the people’s needs and people told us the staff always had time to converse with them and were very helpful and attentive. We observed regular staff interaction to support this and noted people leaving the service to access the community with staff support.

All people spoken with gave positive feedback about the caring attitude of the staff and confirmed that staff always respected their choices, wishes and feelings. We saw religious preferences were respected.

We found an overall good recruitment system in place and a thorough induction process for all new staff starting in the service. However we noted that induction plan required signatures from staff on completion.

Processes were in place for the appropriate administration of medication. Staff were adequately trained in medication administration.

We saw evidence of detailed training programmes for staff. We noted all staff had been enrolled at college to complete “care certificate” training. All people spoken with were very positive about staffs knowledge and skills and felt their needs were being met appropriately.

We saw that people’s nutritional requirements were being met and choice was offered at every meal time. People were supported to independently make shopping lists and access the community to purchase groceries. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

We had positive feedback from people using the service, relatives and staff about the deputy manager and directors for the service. People told us they were happy to approach management with any concerns or questions. We saw evidence that an open door policy was followed.

The interactions we saw between staff and people using the service were respectful and friendly. One person told us "they just haven't got any bad staff" and another that the manager "is very thorough, she likes to see things through, and make sure they're done properly." One person said that the staff were "easy to approach", and that they "leave us on our own" but that there was "always someone to go to" if they needed help,

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from harm good staff recruitment.