Wainwright Crescent

Wainwright Crescent provides step down and respite support for people with mental health conditions. The aim is to support and assist people to manage their mental health and wellbeing, develop their skills and confidence to maintain living in the community. Wainwright Crescent can accommodate a maximum of 12 people. At the time of this inspection there were eleven people using the service. Typically, people can stay at Wainwright Crescent for a maximum of 28 days. However, this can be extended depending on people’s individual circumstances.

Our last inspection of Wainwright Crescent took place on 12 September 2017. The service was rated requires improvement overall with one breach of regulation. We found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014, safe care and treatment. At this inspection we found sufficient improvements had been made to meet the requirements of this regulation and the service is now rated good overall.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People living at the service told us they felt safe. Staff were aware of their responsibilities in protecting people from abuse. We found systems were in place to make sure people received their medicines safely so their health needs were met. With the exception of October and November 2018, regular checks and audits of medicines management were undertaken to make sure full and safe procedures were adhered to. We have made a recommendation about the service’s medicine management policy as this had not been reviewed.

On the day of the inspection we found there were sufficient numbers of staff to meet people’s needs and it was evident that staff had been safely recruited. During the inspection we observed staff treated people with respect and dignity, and staff supported them in a way which met their needs.

We found very clear evidence that people’s care and support was planned and reviewed with them and not for them. The people we spoke with told us the standard of care they received was good. People’s care records contained detailed information and were recovery focussed. The service encouraged people to maintain a healthy diet and worked collaboratively with external services to promote people's wellbeing and positive discharge outcomes. Staff told us they enjoyed working at the service and had received support, training and supervision to help them to carry out their roles effectively. 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 support this practice.

People told us staff were caring and kind and as a result of the emotional support they had received from staff, they felt more confident. We saw the service promoted people’s independence by supporting people to manage their own routines, such as cooking, cleaning and washing. People who were assessed as safe to do so were supported to administer their own medicines. People were able to access their local community and the service provided regular opportunities for meaningful and stimulating social diversions, with an emphasis on improving people’s mental well-being.

We found a strong leadership framework in place. This meant there was clear lines of accountability within the organisation and systems which supported the running of the service were well-embedded.

Wainwright Crescent provides respite support and step down support for people with mental health conditions. It can provide a service for up to twelve people. At the time of the inspection there were eleven people using the service. One person was admitted on the day of the inspection. Wainwright Crescent was in the process of changing its function and the proposed new model was to increase step down provision and reduce the respite provision. The service would also provide short stays for people using the Community Enhancing Recovery Team (CERT) service.

There was a registered manager at the service. 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 we found people were not always protected against the risks associated with the management of medicines. At this inspection we found sufficient improvements had been made to ensure medicines were managed safely at the service.

At this inspection we found new concerns about some people’s risk assessments. An assessment of risk had been completed prior to a person being offered a place at the service, but this required improvement.

We also saw the assessment of people’s individual potential risks and/or the measures in place to reduce and manage the risks to the person required improvement. Although we did not find this had negatively impacted on people using the service; this presented a risk that staff may use inconsistent and ineffective practices to support people. We spoke with the registered manager at the time of our inspection, and they assured us immediate action would be taken to review people’s risk assessments and care plans.

This was a continued breach in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At the last inspection we found that ineffective systems were in place to monitor and improve the quality of the service provided. This was a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we saw a plan of action had been completed by the registered provider to improve the systems in place to monitor and improve the quality and the safety of the service provided. We saw these systems had been embedded in practice. We saw sufficient improvement had been made to meet the regulation. However, our findings during the inspection showed the system in place to audit peoples care plans required additional improvements. We shared this feedback with the registered manager; they assured us immediate action would be taken to make these improvements.

People we spoke with told us they felt ‘safe’ and had no worries or concerns.

Staff recruitment procedures ensured people’s safety was promoted.

Staff had undertaken safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm.

People and staff we spoke with did not express any concerns about the staffing levels at the service.

We did not find any concerns about infection control during our visit. However, we saw the service would benefit from being refurbished.

People we spoke with made positive comments about the quality of care they had received. We saw people responded well to staff and they looked at ease and were confident with staff.

The service had received compliments about the care and support provided from people who had used the service and from people’s relatives.

In people’s records we found evidence of involvement from other professionals such as mental health professionals.

People took responsibility for their own meals. During the inspection we saw people preparing food and drinks for themselves.

Staff had received formal supervision and an annual appraisal, although the frequency of their supervision sessions was not in line with the provider's own policies.

Staff had undertaken mandatory training which was regularly updated. We discussed with the registered manager how staff may benefit from receiving more in depth training to increase their knowledge about mental health conditions. Following the inspection the registered manager sent us details of further training that had been arranged for staff for the next three months. They also told us they were identifying other mental health training for staff to complete.

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.

People we spoke with made positive comments about the staff and told us they were treated with dignity and respect.

The service no longer employed an activities worker. The registered manager told us they had been considering obtaining an occupational therapist student for the service to support people to participate and engage in meaningful activities.

The service had not received any complaints since the last inspection. There was a complaints procedure available to people and their representatives. The service had introduced a local ‘grumbles’ procedure to encourage people to voice any concerns they may have.

The service held regular community meetings for people using the service to attend. This showed the registered provider actively sought out the views of people to continuously improve the service.

Accidents and untoward occurrences were monitored by senior managers to ensure any trends were identified. These checks helped to identify any concerns so appropriate action can be taken to improve the quality of support provided.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link

for 'Wainwright Crescent' on our website at www.cqc.org.uk'

Wainwright Crescent provides respite support and step down support for people with mental health needs. It can provide a service for up to twelve people.

The service had a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

At this inspection we found improvements had been made. However, although systems were in place to monitor the quality of the service these were not always effective and we found a continued breach in regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

People we spoke with, that used the service told us they were very happy with how care and support was provided at the home. They all spoke extremely positively about the staff and the way the home was managed.

People told us they felt safe living at the home. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people, and management plans to reduce the risks were in place to ensure people’s safety.

People were not always protected against the risks associated with the unsafe use and management of medicines. Policies and procedures did not ensure appropriate systems were in place for the recording, safe keeping and disposal of medicines.

We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

There was predominantly enough skilled and experienced staff on duty to meet people’s needs. However, some staff felt additional staff would be beneficial at key times, such as weekends and bank holidays when management were not at the service. Although this was being addressed at the time of our inspection.

There were robust recruitment procedures in place. Staff had received formal supervision and an annual appraisal, although this was not always documented in line with the provider’s policies. Staff received training to be able to fulfil their roles and responsibilities.

People’s nutritional needs were met. People purchased and cooked their own food during their stay and support was provided by staff as required.

People’s needs had been assessed before they went to stay at the home and we found they had been involved in planning their care. The care files we checked reflected people’s main needs and preferences so staff had clear guidance on how to care for them. However, we found these were not always reviewed.

People had access to activities which provided regular in-house stimulation, and people accessed the community independently during their stay.

There was a system in place to tell people how to make a complaint and how it would be managed. However, complaint outcomes were not always clearly evidenced.

Our inspection identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of this report.

We talked with four people who used the service. They told us they were happy at the service, happy with the care they received, liked the staff who looked after them, and felt well supported. Some comments captured included, "It's lovely here,' 'I look forward to coming (for respite),' 'Everybody (staff) very, very nice 'very helpful,' 'It's a lifeline for me and my family,' 'Staff know me and my needs,' and 'Care is 100%.'

During our inspection we conducted a tour of the premises and found it was clean and tidy. There were systems in place to reduce the risk and spread of infection.

We found people's needs had been met by sufficient numbers of appropriate staff.

We found there was a complaints process in place.

Another person we spoke with said that regular meetings were held, where they discussed many things. The said if they raised any concerns they were resolved.

People also told us that staff treated them with respect, listened to them, gave them choices, made them feel safe and supported them in activities they liked.

Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed.

There was an effective system to regularly assess and monitor the quality of service that people received. There was a complaints policy that took account of complaints and comments to improve the service.

You can see our judgements on the front page of this report.