Nelson Street

Nelson Street provides accommodation and support with personal care for up to three adults with mental health needs. At the time of our inspection there were two people using the service.

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

A person told us the service was safe and they trusted the staff. People’s risks had been assessed and plans were in place to minimise the risk of harm. Care records were personalised and reflected people’s preferences. However, the provider was in the process of changing to an electronic system and a new member of staff was using a personal computer to access confidential care records. We have made a recommendation in relation to good governance.

The building was in need of repair and the provider showed us records that maintenance improvements had been scheduled. Communal areas were in need of redecoration such as the wall plaster was peeling near the windows. After the inspection, the provider told us the wall had been repainted since the inspection. We have made a recommendation about the environment of the service.

People received adequate support with their medicines, but the provider needed to include more detail about medicines administered on an ‘as required’ basis. The provider made these changes during the inspection. People told us they had access to healthcare support when they needed it.

A person and staff spoke highly of the management team and reported the service had a positive and open culture. A person told us they knew how to make complaints if they needed to and thought the staff were friendly.

People and staff told us there were enough staff to keep people safe and records demonstrated staff were recruited safely. Staff received training to support them to carry out their roles. People had input into what they drank and ate and were encouraged to eat a balanced diet.

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.

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 19 September 2017).

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.

The service was last inspected in November 2015 and was rated as Good overall with a recommendation made for the safe management of medicines. At this inspection, we found that the provider had addressed the issues and medicines were now being managed safely. We found that the service continued to be rated Good.

There was a registered manager at the service 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 2008 and associated Regulations about how the service is run.

The service was safe and had practices in place to protect people from harm. Staff were knowledgeable about safeguarding and what to do if they had any concerns and how to report them. People who used the service told us they felt safe and protected from harm.

Risk assessments were personalised and thorough. Staff knew how to support people in line with their risk assessments and to minimise risks.

Recruitment practices were safe and records confirmed this.

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Newly recruited care staff received an induction and training for staff was provided on a regular basis and updated regularly. Staff spoke positively about the training they were provided.

Staff demonstrated a good understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis.

People were supported to have access to healthcare services and receive on-going support and records confirmed this.

Staff demonstrated a caring and supportive approach towards people who used the service.

The service promoted the independence of the people who used the service and people felt respected and treated with dignity.

Care plans were person centred and focused on people’s individual needs. Care plans were reviewed regularly and any changes were documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service told us they knew how to make a complaint.

Staff spoke positively about the registered manager and their management style.

The service had quality assurance methods in place and carried out regular audits. The service monitored the feedback from people who used the service by way of an annual questionnaire and a monthly residents meeting.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Risk assessments were in place which included information about how to support people in a safe manner. The service carried out various health and safety audits, for example in relation to fire alarm testing and hot water temperatures. Checks were carried out on staff before they began working with vulnerable adults, including criminal records checks to help ensure staff were of suitable character. We found that medication was stored and administered safely.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with their individual care plans. We found that care plans were in place which included information about how to meet people's assessed and individual needs. People we spoke with said they were satisfied with the support provided. One person told us "it's a good place, they look after me." Another person said "the staff are on the ball." We found that people were supported to attend heath care appointments, for example with GP's and consultant psychiatrists.

Is the service caring?#

We found that staff interacted with people in a respectful and friendly manner. People told us that staff promoted their dignity, choice and independence. One person told us "they treat me nicely; they ask everything, if you want to go out, if you want to cook something."

Is the service responsive?

We found that assessments of people's needs were carried out before people began using the service. Care plans were regularly reviewed which meant the support provided was able to respond to people's needs as they changed over time. People told us that the service provided support with things that were important to them for example one person said the service was supporting them to eat a more healthy diet.

Is the service well-led?

The service had a registered manager in place. Staff we spoke with told us they found the manager to be approachable and accessible. The service had various quality assurance systems in place. Some of these included seeking the views of people who used the service, for example regular residents meetings. One person told us "we have monthly meetings to see if there are any issues we want to bring up."

People were getting support they needed once they raised concerns with staff or if it was observed and relevant contact was made with a health professional.

The registered manager had updated the recruitment and selection procedure to ensure staff recruited were suitably qualified and had experience to work at the service. People at the service said to us "X is very good are always there to help me and to talk to".

Staff were supported well and they all told us they had received supervision within the last two months, we saw evidence to confirm this.

The provider's admission process was clear and people's needs were assessed. Care plans however did not demonstrate that care was always planned and delivered in line with people's identified needs.

The staff recruitment process was inadequate and did not demonstrate safe, robust practices.

People that used the service told us that they felt there were enough staff to meet their needs. The provider needs to review the appointment of the nominated individual, as currently the registered manager holds both roles.

Staff told us that they felt supported by the registered manager. However, there was insufficient evidence to demonstrate that staff had received developmental training and regular formal supervision.

The complaints procedure was adequate but would benefit from review.