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Reports


Other CQC inspections of services

Community & mental health inspection reports for St Mary's Hospital can be found at Leeds and York Partnership NHS Foundation Trust.

Inspection carried out on 4 December 2017

During a routine inspection

We inspected St Mary’s Hospital on 4, 5 and 6 December 2017 and 1 and 2 February 2018. The inspection was announced because we wanted to ensure people, their relatives and staff were available to support the process.

At the last inspection in July 2016 we found the provider had breached two regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to medicines management and overall oversight of the service including appropriate reporting of incidents. The service was rated overall Requires Improvement.

An action plan was submitted to us by the provider outlining how they would improve. We saw improvements had been made in all areas at this inspection and the provider was no longer in breach of any regulations. The service is now rated overall Good.

The service provides care and support to people living in 16 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. 91 people were supported at the time of 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/ or autism using the service can live as ordinary life as any citizen.

A registered manager was 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.

People received an extremely person centred service. Staff had excellent knowledge around how people communicated and they used this to empower people to make their own decisions and direct their own care. The use of positive behavioural support had meant people were less anxious and confident enough to access their community and live as ordinary a life as possible. Care plans reflected the person centred detail staff needed to know to support people how they preferred.

Staff training in specialist areas such as postural management meant people experienced less discomfort or pain due to their physical disabilities and improved mobility and independence. Staff felt supported by their managers and enjoyed the range of training on offer to develop their skills. Their improved knowledge helped them deliver effective support for people.

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 understood how to recognise abuse and report issues of concern to protect people.

People and their families were able to describe the positive outcomes achieved because they received such high quality person centred support. Staff treated people with respect and dignity at all times. Staff looked to problem solve and worked to support people to achieve their aspirations. We saw examples of people improving their health, accessing their dream holiday, starting a new hobby and using technology to control their own environment.

The leadership and culture of the service was positive. Managers empowered their staff to have ideas and be part of developing the service. There was energy behind continuous improvement and we saw people were innovatively involved in developing the service.

New quality assurance processes were in place to help the provider ensure quality was consistent. Systems were in place to ensure staff were recruited safely and that the health and safety aspect of delivering support

Inspection carried out on 11 July 2016

During a routine inspection

We carried out this inspection on 11, 12, 13 and 14 July 2016. This was an announced inspection as it was part of the inspection of Leeds and York Partnership NHS Foundation Trust. We last inspected the supported living service in September 2014 and the service was rated overall good. However, during the inspection in 2014 we found a breach of the Health and Social Care Act 2008 because the provider had failed to ensure safeguarding concerns were reported through the correct channels. At this inspection, we found the provider is still not ensuring the system in place guarantees all safeguarding incidences are recorded in the correct way.

The service is registered to provide personal care to people living in their own homes. At the time of our visit the service provided personal care to 89 people with learning disabilities and/or autistic spectrum disorder across the city of Leeds.

The current registered manager was in the process of de-registering from that role as they no longer had day to day responsibility for the service. An operations manager was in post and told us they had started to apply to become the new 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.

Systems in place for the management of medicines were not robust enough which meant people were at risk of not receiving their medicines correctly.

There were not robust systems in place to monitor and improve the quality of the service provided. Data collated was not always analysed which meant improvements that could be made may have been missed. Not all safeguarding information was reported correctly.

The service did not use a staffing tool or risk assessment to evidence staffing levels had been reviewed based on people’s needs and that levels in place were safe. We saw that people were well cared for but that staffing levels may impact on people’s access to activities and the community.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. People and their families were involved in the assessment and review of care and support plans.

There were risk assessments in place for people who used the service. Risk assessments covered areas such as mobility, travelling independently and finances. This meant that staff had the written guidance they needed to help people to remain safe. Recognised tools for areas such as nutrition and pressure care were not used to help staff understand how to monitor and when to refer to professionals.

The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. We saw examples of the process being followed but this needed to be implemented fully for decisions.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.

Staff told us that their house manager was supportive. Most staff had received regular and recent supervision and an annual appraisal. The policy for this area was undergoing review to improve the support staff would receive. The new approach was awaiting approval at the time of this visit.

Not all staff training was up to date. Staff told us they had received training which had provided them with the knowledge and skills to provide care and support. The operations manager told us outstanding training will be completed by the end of 2016.

Recruitment and selection procedures were in place and we saw that appropriate checks had been mostly undertaken before staff began work. How

Inspection carried out on 30 September 2014

During a routine inspection

We carried out an inspection on 30 September, 1 and 2 October 2014. This was a short notice announced inspection to ensure people were available. The last inspection took place on the 25 and 26 November 2011 and there were no breaches of regulation.

The Supported Living Service provides support to 94 adults who have a learning disability and or a profound physical disability. People live in a variety of properties across the city of Leeds and received 24 hour support provided by Leeds and York Partnership NHS Foundation Trust

There is a registered manager in place. 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 level of responsibility for the registered manager had been expanded within the Trust and they were not managing the service on a day to day basis.

We observed people who used the service smiling and interacting with the staff, using both verbal and non verbal communication. People told us the staff were “Okay” and they “Felt safe with their carers.” They told us about their experiences within the service and that they were involved in developing their own care plans. One person told us “I have joined a local gym to keep fit”; and “I am learning new things and meeting people.” We saw from records and when speaking with staff that they understood peoples support needs, were enabling and encouraging and treated people with kindness and respect.

We saw that staff were able to communicate with the people they were supporting. One member of staff told us “I have worked in the service for six years and I have been working with the same people over that time. This means I have had the opportunity to get to know them and understand how they communicate. People who used the service have an individual weekly plan. This meant each person was able to do activities suited to them. Two people we met went to college to study daily living skills. Other people enjoyed baking, going on holiday, going out for a trip to the seaside and spending quality time in their house doing personal activities. We saw the staffing levels were adequate to meet people’s needs. The service was carrying a high number of vacancies but staff were working extra hours and bank staff were being used to limit the impact of these vacancies.

We were able to visit four houses. The properties had been adapted by the landlord to allow people who used wheelchairs and requiring the use of hoists to help them move around to continue to live there. We saw that where people’s needs changed and the property they were living in had become unsuitable they had negotiated with their landlord a moved to new accommodation. People who used the service told us they had been able to help design the décor of their new accommodation and had been able to visit the bungalow before they moved. We saw evidence in people’s care records that this process had been managed in an inclusive and sensitive way.

We saw evidence that staff received training that enabled them to provide appropriate support to people. We saw that staff had an annual appraisal and this allowed them to identify and plan for their future training needs. We observed positive interactions with people who used the service and staff. One member of staff said “This has been the best year of my life I have helped support a person in their own home and whilst doing this I have developed my own skills.” A person who used the service said “The more independent you get the greater the challenge for your staff. Staff are getting to know me a step at a time.”

We saw evidence that CQC had not been notified of incidents that had happened in the service. However they had notified the local authority as required. This was a breach of Regulation18 of the Health and Social Care Act 2009 (Registration) Regulations 2009. The action we have asked the provider to take can be found at the back of the report.

Inspection carried out on 16 January 2014

During a routine inspection

The service cares for and supports people with a wide range of complex needs. They were not all able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the service.

We spoke with one person who used the service. They told us they were happy with the care provided and were involved with their care and support needs. They said, “The nurses are great.”

We saw that people who used the service were responded to promptly when they asked for any support or assistance. We saw that care practices were good and all interventions were explained. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and a lively and homely atmosphere in the service.

We spoke with five staff. This included the Lead Nurse and Clinical Team Manager. Staff said people who used the service received good, person centred, individualised care. One staff member said, “Care here is brilliant, I would have any member of my own family cared for here if I could.”

Inspection carried out on 6 March 2012

During an inspection to make sure that the improvements required had been made

We carried out a visit to 3 Woodlands Square at St Mary’s Hospital on 6 March 2012 to follow up compliance actions made following the previous review of compliance at 3 Woodlands Square in October 2011.

Because we needed specific information from the management to demonstrate their compliance with the essential standards, we did not need to speak directly with patients from the wards.

Inspection carried out on 25, 26 October 2011

During a themed inspection looking at Learning Disability Services

There were seven patients in 3 Woodlands Square at St Mary’s Hospital when we visited. Five of the seven patients were detained under the Mental Health Act. Two patients were voluntary patients. We met and introduced ourselves to six of the patients using the service. One patient was on leave on the first day of our inspection and was discharged from the service on the second day of our inspection. We spoke with five patients to get their views of the service.

Overall, patients and their relatives told us they were satisfied with the care and treatment at the unit. Patients we spoke with said, “I like all the staff”. “I like living here”. One relative told us, “Smashing care”. Patients’ told us they enjoyed the activities on offer from the service and were able to still attend their usual daytime activities whilst staying at the unit. This was positive as it enabled people to have consistency in the support they received.

Review