This unannounced inspection took place on 12 November 2014. The home is registered to provide accommodation with personal care for up to 17 adults with mental health problems. The home does not provide nursing care. The property consists of two adjoining terraced houses that have been linked. On the day of our inspection visit there were 14 people living there.
There was a registered manager 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.
We last inspected this service on 19 and 22 November 2013 when we found they were not compliant with Regulation 15, safety and suitability of premises. There were insufficient safety measures in place to protect people from harm caused by people smoking in their bedrooms. After the inspection the provider told us about actions they had taken to minimise the risks. During this inspection we saw measures had been put in place to reduce the risks of harm from passive smoking and from fire.
People were not protected against the risks associated with inappropriate or unsafe care because there were no clear procedures in place to ensure that staff understood the principles of the Mental Capacity Act 2005. There was no guidance in place to show how staff had reviewed decision making for people who were unable to give their consent to care, treatment and support.
The care plans provided information on how to keep people safe, for example moving and handling practice, mental illness, behaviour and nutrition. However, many of the risk assessments were out of date and had not been regularly reviewed. The manager assured us that the risks had been informally reviewed but this could not be evidenced in the records. People told us they felt safe. Comments included us “I have no concerns. I can’t think of anything they could do better. I feel safe here.” A health professional told us the service gave people “A stable, settled, steady home” where “People feel safe”.
People lived in a safe environment. The building and equipment were generally well maintained. A few areas showed signs of wear and tear and the manager showed us evidence that they had plans in place to replace worn or broken furnishings and fittings. Medicines were stored and administered safely. Staff understood how to recognise signs of harm or abuse and how it should be reported.
People were involved and consulted about their health and personal care needs. The registered manager and staff understood people’s current needs, and told us they regularly reviewed the care plans with each person, although this could not be fully evidenced by the records. Relatives told us they felt welcomed, involved and regularly informed.
Menus were balanced and varied. People told us they enjoyed the meals. They were offered choices to suit their individual preferences and nutritional needs.
Staff were appropriately trained and skilled. Regular training was provided covering health and safety topics and also topics relevant to people’s health and personal care needs. People told us there was always enough staff on duty and assistance was provided promptly whenever they asked. People were treated with care and respect.
Staff told us the home was well managed and there were good communication systems in place. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and opportunities to request advice, support, or express views or concerns at any time.
There were systems in place to monitor the quality of care including questionnaires, a comments box, and regular resident’s meetings. People told us they knew how to make a complaint and were confident they could raise any concerns and these would be listened to and acted upon. The home had received no complaints in the last year.
There were a number of breaches under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full report.