Bleak House

The service was operated 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 using the service can live as ordinary a life as any citizen.

The home had a new manager in post who had registered with the Care Quality Commission in February 2018. 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 carried out an unannounced comprehensive inspection of Bleak House on 22 June 2017. A breach of Regulation 20A, requirement as to display of performance assessments, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, was found.

We undertook this focused inspection on 26 April 2018 to check that the service was now meeting legal requirements. The service was inspected against one of the five questions we ask about services: is the service well led. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Bleak House' on our website at www.cqc.org.uk.”

People were supported by a staff team who understood the aims of the service and were motivated to support people according to their choices and preferences.

The registered manager was approachable and the atmosphere in the service was relaxed and inviting.

The leadership and management of the service was of a good standard. It was clear from our discussions with the registered manager that they understood their registration responsibilities with regards to submission of statutory notifications about significant events that occurred at the service.

Staff and people spoke positively about the management at the service.

Quality assurance and monitoring systems were in place which included seeking the views of people who used the service. The registered manager routinely gathered feedback from people living in the service.

The registered manager and staff worked in close partnership with external health and social professionals.

At the last inspection in May 2016, the service was rated as Requires improvement. We identified breaches in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment. People who used the service were not protected from the risks associated with living in accommodation that was inappropriately maintained. Records in relation to health and safety checks in the service were also inappropriately maintained. Processes and systems to manage medication in a safe way for people were ineffective and controlled drugs were inappropriately stored. The registered provider sent us an action plan in response to the breaches we identified stating what measures they were going to take in order to address the issues. At this inspection we found the registered provider had taken the action required of them to meet the regulation.

At the last inspection we made a recommendation for the registered provider to consider current best practice on quality assurance systems and takes action to update their practice accordingly. During this inspection we found improvements had been made to the quality assurance systems at the service.

This comprehensive inspection took place on 22 June 2017 and was unannounced.

The service had a manager 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.

The registered manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC as required. Copies of the most recent report from CQC were on display at the service. However, we noted when planning this inspection that the current CQC rating for the service was not accessible through the registered provider's website. This meant any current or prospective users of the service, their family members, other professionals and the public could not easily assess the most current assessments of the provider's performance. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20A: Requirement as to display of performance assessments.

People received their medicines as prescribed. The systems in place for the management of medicines were safe and controlled drugs were stored appropriately.

People were protected from the risk of abuse as staff understood the signs of abuse and how to report concerns. Systems were in place and well understood to help staff or people report concerns. People were supported safely because risks to people were identified and plans were put in place to minimise these risks.

There were enough staff to support people to follow their chosen activities, lifestyle and to keep people safe. Effective recruitment processes were in place and these were followed by the service. Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions and appraisals.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had an awareness of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

People were supported to access health professionals when required, including district nurses and doctors, to make sure they received continuing healthcare to meet their needs.

Improvements had been made to the environment and we saw one bathroom and toilet had been refurbished, flooring had been replaced in two other toilets and new dining tables and chairs had been purchased.

Staff provided care and support in a meaningful and caring way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People were treated with dignity and respect. Staff used methods of communication to speak with people and include them in conversations, and ensure they were understood. For some people this included supported communication using pictures and symbols, for example, to help with choosing food.

Bleak House had a welcoming, happy and positive atmosphere with people following full and active lifestyles of their choosing. Some people had lived at the service for many years and were very familiar with the manager.

People told us they knew how to complain. There was a complaints procedure in place which was accessible to all.

The manager had implemented an effective quality assurance system which ensured the service was continually improving and a range of audits and checks were completed regularly to ensure that good standards were maintained.

Records were well maintained and kept securely.

You can see what action we told the provider to take at the back of the full version of the report.

Bleak House is registered to provide accommodation and personal care for up to 19 people with learning disabilities and/or mental health conditions, and on the day of this inspection there were 17 people using the service. The home is located in Patrington near Hull. There are several shared bedrooms as well as single bedrooms and shared communal facilities. The service has use of a vehicle and people who use the service also access community based day services, education and employment. The service is within walking distance of local amenities.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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 our inspection we found that the recording and storage of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that some of the bathrooms and toilets in the service were not properly maintained which meant some areas could not be effectively cleaned. This was a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that there was a quality assurance system in place but it could be developed further. We found during our inspection that medicines, health and safety and maintenance were being audited but we had concerns about these areas of practice, which made us question how effective the audits were. We also noted that some record keeping was not effective; regular audits may have identified the improvements that needed to be made. We have made a recommendation about this in the report.

You can see what action we told the registered provider to take at the back of the full version of the report.

People told us that they felt safe living at Bleak House and we found that people were protected from the risk of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the service.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed.

We saw that staff completed an induction process and had received training in a variety of topics. Staff told us that they were happy with the training provided for them.

People had their health and social care needs assessed and person centred plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health care professionals in the community.

People using the service were positive about the caring attitudes of staff. We observed that staff were kind, caring and attentive to people’s needs. People’s privacy and dignity were respected. People’s nutritional needs had been assessed and people told us they were very happy with the food provided.

We saw that there were systems in place to assess and record people’s needs so that staff could provide personalised care and support. Care files were updated regularly and information shared so that staff were aware of changing needs.

Care staff and people who lived at the service told us that the service was well managed. People told us they would not hesitate to express concerns or make a complaint, and they were confident their concerns would be listened to and acted on. There was a process in place to manage complaints that were received by the service. In addition to this, there were systems in place to seek feedback from people who lived at the service, relatives and staff.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Improvements to prevention and control of infection practices within the service had been made so the service was safe, clean and hygienic and people who used the service were not at immediate risk.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Since our last visit to the service in May 2014 the manager had made a Deprivation of Liberty Safeguarding (DOLS) application to the authorising body. The application had been accepted and was appropriately signed, dated and was to be reviewed regularly.

Is the service effective?

We saw improvements had been made to the cleanliness of the general environment and the living areas within the service. One person who used the service said 'I try to help the staff keep my room clean and tidy.'

We found that improvements had been made to record keeping within the service.

Is the service caring?

We observed that personal wishes and choices recorded in the care plans we looked at were carried out in practice. People who talked with us said 'It is lovely here' and 'The staff are our friends.'

Is the service responsive?

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The provider for this service is also the manager. We found they had taken action to improve infection control practices and care plan recording since our last inspection in May 2014. This had a positive impact on people's care and wellbeing and reduced the risk of harm to people who used the service and others.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the manager and staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

The home had proper policies and procedures in relation to Deprivation of Liberty Safeguards (DOLS) although no application had needed to be submitted. The manager had a good understanding of when an application should be made and in how to submit one. This meant that people were safeguarded as required.

We found that the service was clean, tidy and there were no malodours in the building. However, we had a few minor concerns about infection control practices which we have addressed in our report.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the prevention and control of infections.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People's health and care needs had been assessed and care plans were in place. Some of the care plans had not been reviewed regularly. It was therefore not possible to confirm that all people's needs were being met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the planning and delivery of effective, safe and appropriate care that meets people's needs and protects their rights.

Is the service caring?

Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and people were included in all conversations. People who spoke with us said 'The staff really look after us' and 'I love it here'.

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service.

People had commented in the surveys as follows; 'No criticisms of the service at all', 'Always made welcome', 'Communication is always very good' and 'Everything is as good as it possibly could be'. Three relatives had written 'X is very happy here', 'Y is very comfortable and staff are good at discussing their health and wellbeing with us' and 'Really pleased how Z is looked after. Z looks well and is healthy.'

Is the service responsive?

We saw evidence in people's files that they enjoyed a range of activities including drama groups, music, craft work and shopping. Some individuals regularly attended day centres and spent time with their peers. We watched people enjoy dancing to music during our visit. Two people showed us their favourite CD's and these were played as part of the music session.

The service had a complaints policy and procedure in place and this was accessible to people, staff and visitors to the service. Staff said the policy/procedure would be read to people who used the service if needed and it was discussed during resident meetings. There had been no formal complaints made in the last 12 months.

Is the service well led?

Staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality of service at all times.

People were very happy with their support and we observed that there was a friendly and relaxed atmosphere in the home. Care plans were detailed and individualised and had been regularly updated. The environment was well maintained and suited the needs of people who used the service appropriately.

There were systems in place for recruitment and induction and these were followed well. Staffing levels were monitored and managed in a way that focussed on the needs of the people who used the service. There were extensive audit systems in place and there were several methods used to ensure that people who used the service, their families and staff were involved in giving feedback and shaping the development and changes in the day to day running of the service.