Edwin Therapeutic Unit

Edwin Therapeutic unit is a residential care home providing personal for up to three people who have complex needs. This includes people with a learning disability, autistic spectrum disorder, mental health difficulties, an eating disorder and people with anxieties which can affect their behaviours. There was one young person living at the service at the time of the inspection.

Accommodation was provided over three floors. There was a communal lounge, kitchen and dining room.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care did not always maximise people’s choice, control and independence. When people’s freedoms had been restricted there was not a review of this restriction to assess if there was a less restrictive alternative. People were supported by staff to pursue their interests and to achieve their aspirations and goals. People were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community.

Right care:

• Care was not always person-centred as it did not always promote people’s dignity, privacy and human rights. One person had no privacy as they were supervised at all times. This restriction had not been reviewed in line with a condition in their DoLS. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. People received kind and compassionate care.

Right culture:

• Staff knew and understood people well and were responsive to their needs. People’s quality of life was enhanced by the service’s positive culture of inclusivity.

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

Young people told us staff were kind and caring, spent time talking to them and they were confident any concern they raised would be addressed.

Young people were supported to have maximum choice and control of their lives, but a restriction on one young person’s privacy had not been reviewed to ensure it was the least restrictive, since it had been put into practice. In addition, this young person’s risk assessment for them to receive regular timed checks contradicted the staff practice of constant supervision during the day and night. Reviewing this young person’s restrictions monthly was also a condition of their Deprivation of Liberty Safeguards (DoLS).

Quality monitoring systems were not always effective and lacked the robustness to identify shortfalls and drive continuous improvement in the service.

Since our last inspection a new registered manager had been appointed who had changed the culture of the service from poor to positive. As a result, there was effective communication, staff felt valued and supported and young people received better outcomes.

The provider had acted on two recommendations made at the last inspection. This was to consult with young people in the redecoration of their home; and to follow national guidance in promoting health eating for young people.

Young people were listened to and encourage to raise any concerns or complaints.

There had been improvements in the management of medicines so young people could be confident they received the right medicines at the right time. Medicines were stored, recorded and administered by staff who had been assessed as having the necessary skills.

We were assured the provider was making sure infection outbreaks could be effectively prevented or managed. The registered manager took an active role and had oversight of infection control prevention.

Staff training plans were designed around young people’s care and support needs. Staff supervision and support was consistent and included reflective practice. Staff told us they felt well supported.

Staff were checked that they were suitable to work with young people before they started to support people.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 11 December 2021) and there were breaches of regulations. At this inspection, enough improvement had been made and the provider was no longer in breach of these regulations, except the monitoring of the quality of care, which remained a breach of regulation. In addition, we found a new breach of regulation with regards to applying the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management and oversight of the service, the MCA and DoLS and protecting people from abusive practices.

The enforcement action we took:

We issued a Notice of Decision to impose a condition of registration pursuant to Section 12(5)(b) of the Health and Social Care Act 2008.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Accommodation was provided over three floors. There were two communal lounges and a small garden and utility room to the back of the care home.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care did not always maximise people’s choice, control and independence. The behavioural reward system did not always follow the principles of Positive Behaviour Support (PBS). The aim of PBS reward systems is to encourage positive behaviours. However, one young person’s reward system did not focus on their positive behaviours, which constituted a punitive approach. This was because some behaviours were out of their control due to their complex mental health.

Right care:

• Care was not always person-centred as it did not promote people’s dignity, privacy and human

rights. Personal information about young people and staff had been shared with other young people and staff. Young people had been blamed by a staff member for an event which had taken place at the service. As a result, the young people were anxious, one of them believing inaccurately that as a result they were going to be arrested by the police.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. There was a high turnover of staff who had not received consistent support. This impacted young people as they did not receive consistent support from staff they knew well. It also limited their ability to form long-lasting and positive relationships with staff as staff members and their assigned keyworker kept changing.

The service was not well-led as the registered manager and provider did not have full oversight of the service. Quality monitoring systems continued to be ineffective and lacked the robustness to identify shortfalls and drive continuous improvement in the service. Feedback from social care professionals was that the service was ‘reactive’ rather than ‘proactive’.

Young people were not always treated well and with dignity and respect which had a negative impact on their well-being.

Young people were not consistently supported and encouraged to maintain a balanced diet. Young people had put on weight and their food records contained a lot of unhealthy fast foods. We made a recommendation the provider seeks national guidance that promotes healthy eating for young people.

The management of medicines had deteriorated which put young people at risk of serious harm. High risk medicines were not stored safely and there were discrepancies in medicines records so it could not be assured young people had taken their medicines as prescribed by their doctor. We sought immediate assurances from the provider on obtaining a suitable medicines cabinet and the steps they planned to take to address the unsafe medicines practices detailed above. We will check how the provider has implemented this action plan at our next inspection.

We made a referral to the fire service due to concerns about fire doors which did not close in the event of a fire and limited access to fire extinguishers.

When things went wrong lessons were not learned nor action taken to help improve young people’s safety. There continued to be incidents about young people locking or unlocking doors and causing them or others harm.

Assessment of risk did not always include clear guidance for staff on how to keep young people safe. Staff were advised to use ‘reasonable force’ when people exhibited behaviours, but there was no definition of what this constituted. There were no formal meetings to discussed what strategies worked well with young people. Staff passed information to one another in the communication book, but this information was not used to update peoples' care plans.

We were not assured the provider was making sure infection outbreaks could be effectively prevented or managed. The registered manager did not take an active role or have oversight of infection control prevention. The provider’s infection prevention and control policy was not up to date. At the inspection, we had to remind staff to ensure their face masks covered their noses.

It was not evident the service always followed safeguarding policies and procedures. When reviewing a safeguarding incident, the registered manager stated staff should have contacted the police but hadn’t taken on this responsibility themselves. The registered manager was not able to explain the reasoning behind their decisions and the provider, who was the designated safeguarding lead, was not able to add anything further to this safeguarding incident.

Staff training plans were not designed around young people’s care and support needs. Not all staff had undertaken training in positive behavioural support, which underpinned the service; or mental capacity. Bank staff had undertaken limited training. Staff supervision and support was not consistent and did not meet staff’s expectations or needs. Staff did not receive monthly or regular supervision with their line manager; nor did assistant psychologists attend six weekly clinical supervisions, as set out in their job descriptions.

Staff were checked that they were suitable to work with young people before they started to support people.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 29 April 2021). The provider was in breach of regulation as there was not effective oversight to monitor and improve the quality and safety of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of this regulation. In addition, we found a further six breaches of regulation with regards to treating people with dignity, providing person-centred care, protecting people from abuse, medicines management, staff training and supervision and infection control.

Why we inspected

The inspection was prompted in part due to concerns received about keeping young people safe, assessing their needs, acting on concerns and the overall management of the service. A decision was made for us to inspect and examine those risks and undertake a comprehensive inspection.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management and oversight of the service, medicines, infection control, complaints, keeping people safe, staff training and supervision, meeting young people’s needs, protecting young people from abuse and treating them with dignity and respect at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this

Accommodation was provided over three floors. There were two communal lounges and a small garden and utility room to the back of the care home.

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

Feedback from a social care professionals and relatives were that young people were building positive relationships with staff. This helped to reduce young people’s anxieties and build their confidence. They received weekly reports from the service, to help them understand their young people’s care and support.

Improvements to the service had been made in the environment, in the employment of assistant psychologists and in the detail provided in young people’s records. However, quality assurance systems were not robust enough in identifying shortfalls in service provision. Medicines audits were not fit for purpose, infection control procedures differed from practice and there was a lack of overview in the patterns of people’s behaviours.

Young people’s views were sought at keyworker meetings and service user meetings. Staff and relatives said they had approached the registered manager when they had concerns. Feedback was that their concerns had mostly been acted on.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s independence was promoted through working towards individual goals. Staff spoke with people and about people, in a manner which promoted their positive characteristics.

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 27 February 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection control and staffing. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with risk assessments, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Edwin Therapeutic Unit is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service was registered to provide care for up to three young people with learning disabilities, autism spectrum disorder, mental health issues and eating disorders. There was one person living at the service as another person had transferred to another service the week before the inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post who was present during inspection. 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.

At the last inspection on 30 November 2017, the overall rating of the service was ‘Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not supported to maintain and develop their independence nor to meet their assessed needs and goals.

We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulations and said that this would be completed by the 31 March 2018.

We also made recommendations about the helping people to maintain a balanced diet and to make sure staff skills were kept up to date with best practice.

At this inspection, we found the service had improved. The registered manager had led a cultural shift in the staff team so that they were clear about the aims of the service. These were to support people to maintain and develop life skills. People were encouraged to work towards achieving their goals, to take steps towards independence and be responsible for their meals.

The frequency of staff training in key areas had changed to help ensure they knew how to support people’s individual needs.

Staff knew what steps to take to safeguard people from situations in which they may be at risk of experiencing abuse. Risks to people's safety had been assessed, monitored and managed to make sure people were protected from harm. There were enough care staff to provide people with the care they needed. Checks had been completed before new care staff had been appointed. Suitable provision had been made to prevent and control infection. Lessons had been learned when things had gone wrong. There were policies and procedures for the management of medicines and staff had received training in how to give and record people’s medicines.

People were helped to access healthcare services. Staff understood how to support people to make informed choices and decisions. 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 communicated with people in a kind manner and treated them with dignity and respect. Positive and valued relationships had developed between people and staff. People were supported to pursue their hobbies and interest. People had access to advocates when necessary.

People were asked for their views about the service and there were opportunities for them to raise any concerns or complaints so they could be acted on. The quality of the service was monitored through a programme of checks and audits so that any shortfalls could be addressed.

Edwin Therapeutic Unit is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service was registered to provide care for up to three people with learning disabilities, autism spectrum disorder, mental health issues and eating disorders. There was one person living at the service at the time of the inspection.

There had not been a registered manager at the service since 23 July 2015. The manager of the service had applied and was being assessed as to their suitability for the role. 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 2008 and associated Regulations about how the service is run.

The service was last inspected in March 2017. Seven breaches of Regulation were found with regards to the provider failing to : Regulation 9, ensure care plans were personalised; Regulation 11, follow the principles of the Mental Capacity Act 2015; Regulation 12, safely manage risks to people; Regulation 13, make referrals to local authority safeguarding; Regulation 16, to record and respond to complaints; ensure quality auditing systems were in place and have sufficient managerial oversight of the service; and Regulation 18 (HSCA) provide adequate staff to meet people’s assessed needs; Regulation 18 (Registration Regulations) notify CQC of events and incidents without delay. The service was placed in special measures.

After the inspection the provider sent us a plan of action setting out how they planned to address the breaches of Regulation. They told us the identified breaches had been met before the date of our inspection visit on 30 November 2017.

We also made recommendations about the way medicines were audited and providing nutritious and healthy meals.

At this inspection, we found improvements. However, we also found two breaches 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.

Quality assurance processes had identified shortfalls in the service and most had been addressed. However, the service was not meeting its aim to support people to become more independent and develop life skills. Instead, people had become reliant on the staff support provided. Improvements had been made to care plans so they were personalised but people had not been supported to meet their assessed needs and individual goals.

People had their health and nutritional needs assessed but we have made a recommendation in relation to supporting people to have a balanced diet.

New staff received a structured induction and were provided with a programme of training in areas essential to their role. We have made a recommendation about the planned frequency of the training programme to ensure staff are competent and up to date with their practice.

Improvements had been made in assessing potential risks and guidance was in place and available to staff to make sure people were protected from harm.

People were supported by staff who were trained to recognise the signs of abuse and the provider had reported concerns about people's safety to the relevant authorities.

Staff understanding of the principles of the Mental Capacity Act 2005 had improved through training and discussion.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager had submitted DoLS applications to ensure that people were not deprived of their liberty unlawfully.

The systems in place for the management of medicines had been reviewed and there were clear records and checks in place to make sure people received their medicines as prescribed by their GP.

Staff were trained in the safe administration of medicines, gained people’s consent before giving a person their medicines and appropriate records were kept.

Checks were carried out on all staff so that they were fit and suitable for their role and level of staffing provided met people’s assessed needs.

Staff communicated with people in a kind manner and treated them with dignity and respect. Staff had developed positive and valued relationships with people.

Quality assurance systems had been introduced which monitored the quality of the service on a regular basis.

The service was based in central Gravesend close to the town centre and its shops and amenities. The service was in a quiet residential street and consisted of three bedrooms over two floors, an office, a communal lounge, a kitchen and two bathrooms. There was a small garden accessed by people in the rear of the property.

The service did not have 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. We spoke to the registered provider about this and were told that another manager would be taking over management of the service with another service as a dual registration.

The provider did not have effective systems in place to protect people against abuse and harm. The provider had up to date policies and procedures but did not give staff correct guidance on how to report abuse in line with the Health and Social Care Act 2014 or the local authority’s safeguarding adults policy, protocol or guidelines.

Risks were not consistently assessed and managed to keep people safe from avoidable harm. Some risks assessments were out of date and staff did not have access to one person’s risk plan for managing their behaviours that challenge.

Assessed staffing levels had not consistently been adhered to. Some incident reports showed that where three staff should have been on shift there were on occasions only two or one staff member supporting three people who were funded to receive one to one support.

The principles of the Mental Capacity Act 2005 were not consistently being adhered to. Where people were assessed as not having the capacity to make a certain decision a best interest meeting was being held; however, only one person was recorded as being involved in the decision.

Food safety checks had been carried out regularly. There was a menu for people to choose food from and have input to. People had enough to eat and drink, and received support from staff where a need had been identified. However, there was a lack of fresh fruit and vegetables being recorded as being eaten by people and Staff did not consistently support people to eat healthily.

Care plans were not personalised and did not contain enough information on how to motivate people to engage with their support programme. One person had recommendations made by a psychologist but these had not been included in the person’s care documents.

Complaints were not consistently used as a measure to improve the service delivered to people. Not all complaints were being recorded which meant that the service could not learn, and make improvements, from people’s experience.

The registered provider did not always keep up to date with current legislation and national guidance. Advice given to care workers around safeguarding vulnerable people was not in line with the local safeguarding policy or legislation. The registered provider did not have appropriate knowledge of the Health and Social Care Act 2008 and CQC Registration Regulations 2009.

The registered provider did not have effective systems in place to monitor the quality of care and support that people received. Quality audits had not been completed since April 2016 and there was no other documented evidence of managerial or senior management oversight of the service in the absence of a registered manager.

The registered provider was not aware of their responsibility to comply with the CQC registration requirements. They had not notified us of all events that had occurred within the home and had moved a person from the service to an unregistered location without applying for urgent registration.

Medicines were being stored and administered safely by staff who had received training on medicines administration. Audits were happening and the stock check of medicines was correct, but the system for auditing did not have an expected stock check meaning that errors in the future could be missed. We have made a recommendation about this in our report.

The staff were kind and caring. Good interactions were seen throughout the day of our inspection, such as staff sitting and sharing conversations with people as equals. People spoke positively about the care and support they received from staff members.

People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions.

Staff were trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff were able to meet their line manager on a one to one basis regularly. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.

The culture in the service was homely and there was an informal and friendly atmosphere where people felt able to take the lead in their lives.

People had access to healthcare professionals to meet their needs and we saw records that people had been registered with local primary healthcare services and had been referred to specialist services when required.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If sufficient improvement is not made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Edwin Therapeutic Unit is registered to provide accommodation for young people who need a high level of therapeutic care and supervision due to learning disabilities, autism, mental health needs or behaviour that challenges themselves or others. The location is registered to provide personal care for a maximum of three people. At the time of our inspection, only one person lived at the service but another person was moving in that week.

At the time of our inspection the unit manager had been in post since the previous registered manager had left in August 2015. The unit manager had applied to the Care Quality Commission to become the 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the unit manager had applied for DoLS authorisations for some people living at the service, with the support and advice of the local authority DoLS team. The unit manager and staff understood their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments and decisions made in people’s best interest were recorded.

People told us they felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure people’s safety. However, the fire risk assessment was due to be reviewed. We have made a recommendation about this.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

There were enough staff with the right skills and knowledge to meet people’s needs. Staff received the appropriate training to fulfil their role and provide the appropriate support. Staff were supported by the unit manager and the provider who they saw on a regular basis. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. People’s care plans were person centred and gave staff the information and guidance they required to give people the right support. People were encouraged and supported to be as independent as possible. Detailed guidance was available for staff to follow to support people who displayed any behaviour which caused a risk to themselves or others.

People had access to the food that they enjoyed and were able to access drinks when they wanted to. People’s nutrition and hydration needs had been assessed and recorded. Staff supported people to meet any specific dietary needs. People were supported to remain as healthy as possible with the support of healthcare professionals.

People were supported to participate in a range of activities they enjoyed within the unit and in the local community. People were supported to complete educational courses to develop their skills and confidence.

Processes were in place to monitor and improve the quality of the service being provided to people.

We asked the provider to provide an action plan that outlined how improvements could be made within a set time frame. We have received the action plan and this follow-up inspection was scheduled to check that improvements have been carried out.

During this follow-up inspection, we found that remedial actions had been taken and that the provider had achieved compliance with the Regulation 18 of the Health and Social Care Act 2008.

At the time of our follow-up inspection, only one person was living in the unit. We spoke with the registered manager, the acting deputy manager and one member of care staff. We looked at the set of records for the person who used the service, staff training records, three of the service's policies and procedures.

During this inspection, the inspector focused on answering our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes the records we looked at and what the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people who used the service were protected from the risk of abuse because the registered manager, the deputy manager and other members of care staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

The provider ensured that staff's need for training and the development of their skills were taken in consideration. Training in the principles of the MCA and DoLS had been provided and refresher courses were scheduled.

Is the service caring?

We found that people were supported by staff who were mindful of people's needs. A member of staff told us, "We care for our residents and the more we learn about how to care for them the better".

Is the service responsive?

People's views were considered and represented by an independent mental health advocate when necessary.

Is the service well-led?

The provider and registered manager ensured that remedial actions to achieve compliance with the regulations had been carried out. They told us, "We have scheduled a team meeting in February 2015 where staff will have the opportunity to discuss possible scenarios (about MCA and DoLS) and put their knowledge in practice, and we have discussed this during supervision".

During this inspection, the inspector focused on answering our 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 we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people who used the service were protected from the risk of abuse because all staff were trained in the safeguarding of vulnerable adults and the management of challenging behaviour. However we found that training on the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards (DoLS) was not effective. We found risk assessments with clear action plans were in place to ensure people remained safe.

Is the service effective?

The person who used the service told us they were satisfied with the quality of care that had been delivered. We looked at their assessment of needs and support plan and we checked that the delivery of care was in line with their care plans and assessed needs. Stimulating activities were chosen by the people who used the service. The person who used the service commented, "I don't get bored here". Additional training was available to staff if people had specific needs.

Is the service caring?

We found that people who used the service were supported by kind and attentive staff. A member of staff told us, "The young people we look after are very vulnerable. They need patience, understanding, support and above all stability'. The person who used the service told us, "I am very happy here" and "The staff are nice".

Is the service responsive?

People's needs had been assessed before care and support began and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's care plans included their history, wishes and preferences. People were involved with reviews of their care plans. People's views were sought about the quality of care that they received and their views were taken into account. The person who used the service told us, "I get choices and I am the one to choose' and " If I am not happy I tell them (staff) straight away and they know and they change things'.

Is the service well-led?

We found that the registered manager operated an effective system of quality assurance to identify how to improve the service. People who lived in the service were regularly consulted about their level of satisfaction. The manager told us, "This is such a small service, we have residents meetings every day and continuously check their satisfaction". We saw the service operated an open door policy and staff were encouraged to express their views. A member of staff told us, "The manager, the acting deputy manager and the owner are very approachable, we communicate very well and as it is such a small place we are a little like a family".

People told us they "Liked" living at Edwin Therapeutic Unit. Comments included "I like it here" and "It's okay, i just wished there was more to do sometimes". Another person said "it's not like home, but I understand why I have to be here". One relative said "I have no complaints so far although I would like to be kept more up-to-date with things that happen".

We reviewed the care records for both of the people who used the service. We found that the care plan for a person who was new to the service was not readily available as it was still being developed by the Provider. We also found that risk assessments were not always robust enough as they lacked appropriate information to guide staff on how to reduce areas of risk.

We found that the service had completed the appropriate checks in order to maintain a safe and suitable environment for people. We also saw that there were systems in place to monitor the quality and effectiveness of the care that people received.