Archived: Church Road Hostel

Church Road Hostel is a supported living service that can support people with mental health needs. The service provides 24-hour care and support for up to 19 people. People live independently and have their own tenancy agreements for the rooms they occupy. There were 15 people using the service at the time of our inspection. Shared areas included lounges, a dining area, bathrooms and garden. There was a main staff office with sleep in arrangements of one staff member at night.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Since our last inspection, a registered manager had been recruited and people and staff spoke positively about how management of the service had improved. Arrangements to monitor and assess the quality and safety of the service had been strengthened. More audits and checks were used and where issues were identified, action was taken to improve the care and support people received. The registered manager knew what was required to develop the service and was working to an effective action plan.

Risks to people’s health and wellbeing had been more fully assessed. People were involved in assessments of potential risks to their safety and in identifying measures to keep them safe. Care plans provided clear guidance for staff to follow. Staff knew the risks people faced and how to reduce these.

People were supported by a consistent team of staff who were safely recruited. Staff had undertaken further training to support them in their role and meet people’s individual needs. The registered manager had improved the arrangements for staff supervision and to check and monitor that staff had the skills to support people effectively.

People were supported to develop their daily living skills to enable them to live more independently. Further activities were available to people which aimed to reduce the risk of social isolation. Staff supported people to access the local community and maintain relationships with friends and family where appropriate.

Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. Medicines were managed safely, and people had their medicines at the times they needed them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible in their best interests; the policies and systems in the service supported this practice. Staff knew people well and used this knowledge to provide personalised care. Staff respected and promoted people's rights, including their right to be treated with respect and dignity.

People were supported to be healthy and eat and drink well. Staff understood how to support people with their healthcare needs and involved other professionals if people became unwell or required additional services.

People knew how to raise any concerns. Staff listened and acted on what people said and there were regular opportunities for people to contribute to how the service ran.

There was an open and inclusive atmosphere in the service and the registered manager showed effective leadership. Staff felt well supported and had confidence in the registered manager and the improvements he had made.

We have made a recommendation about the management of medicines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 April 2018) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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.

This inspection took place on 6 February 2018. The last inspection of this service was carried out in December 2015. At that inspection the service was meeting the regulations we looked at and was rated Good overall and in all five key questions. At this inspection we found the service Requires Improvement within the key questions of safe, effective, responsive and well-led and as a result has received an overall rating of Requires Improvement.

The service did not have registered manager but a new manager had joined the service and was in the process of registering with the 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.

People were not always safe because the provider did not fully and appropriately assess all of the risks people presented with. As a result risk management plans were not in place to mitigate all known risks.

People were supported by staff who did not have up to date training. Staff did not receive training during the year leading up to our inspection.

People were bored and unstimulated. The service did not provide meaningful activities to people within the home or in the community. People received little support to develop the skills necessary to move on to independent living. For example, there were no systematic programmes in place for teaching skills around activities for daily living such as shopping or cooking.

Poor governance was evident at the service. People’s care had been planned by a management team which had not identified or taken action to resolve shortfalls in quality. The provider’s quality assurance checks had not identified or rectified failings in people’s safety and activity levels or in staff training. A new manager came into post just prior to our inspection. They emphasized their commitment to address these issues and drive improvements.

The provider used appropriately robust recruitment practices to ensure people were supported by safe and suitable staff. Medicines storage, administration and recording practices at the service were safe. Staff conducted checks and drills to maintain their preparedness to keep people safe in the event of a fire.

People’s needs were assessed and they were supported by supervised and appraised staff. People were treated in line with the Mental Capacity Act 2005 and had access to healthcare services whenever they required. People’s nutritional needs were being reassessed because the service provided one meal to people each day and people were not always motivated to prepare healthy meals at other times.

People received their support from staff who were caring and kind. Staff knew people well and provided emotional support when it was required. Staff respected people’s privacy and supported them to make decisions.

During this inspection we found breaches relating to risk management, staffing, person centred care and good governance. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 10 December 2015 and was unannounced. At our previous inspection in April 2014, we found the provider was meeting the regulations we inspected.

The service had 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.

People told us they liked staying at Church Road Hostel and said the staff who supported them were polite and caring towards them. There was a relaxed and friendly atmosphere when we visited.

People were supported to have their health needs met. Staff worked with the person to access the GP and other local health services as appropriate to help make sure their individual health needs were met. We saw that people’s prescribed medicines were being stored securely and managed safely.

There were systems and processes in place to protect people from the risk of harm and staff were aware of safeguarding procedures. Appropriate recruitment checks took place before staff started work.

Staff received training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People were asked for their consent to the care and support they received.

There was a system in place for dealing with people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take appropriate action.

The registered manager understood their role and responsibilities and positive feedback was received from staff about their leadership. There were effective systems in place to help ensure the safety and quality of the service provided.

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

Is the service safe?

People told us they felt safe. Feedback about the service included "Very good", "I like it here" and "No problems". All of the people we spoke with said that they felt able to raise any issues or concerns with the staff who worked at Church Road Hostel.

We saw that Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Financial procedures had been reviewed following a recent Safeguarding investigation with improved oversight and auditing of records at provider level.

Is the service effective?

People's assessed needs were being met by experienced staff with the necessary skills and knowledge. Staff had access to training and supervision to help them do their jobs well.

Individual health and care needs were assessed and people were involved in reviewing their support plans. The use of more specific measurable actions within individual plans could however benefit people using the service in helping them to reach their set goals.

Is the service caring?

People using the service told us they were treated with dignity and respect. Their comments included "The staff are nice, no animosity here", "The staff are very helpful" and "They're nice people".

We saw that people could be as independent as they wanted to be and were able to come and go from the Hostel as they pleased. Assessments were undertaken and support was provided to individuals with their activities of daily living as required.

Is the service responsive?

People using the service told us that they would welcome more things to do including trips out with staff. Plans were in place to provide alternative activities and the service should continue to look at creative ways to enable people to live as full a life as possible.

Is the service well-led?

An acting manager was in post at the time of this inspection. Staff spoken to had worked at the service for a number of years and had a good understanding of the ethos of the home.

Quality assurance processes were in place however these could be developed to more fully involve people using the service and ensure that their views were acted upon.

The manager sent us an action plans on the 19th and 28th of August 2013. They said a care plan had been completed for this person and placed on their file. They also said they would be auditing people's folders to make sure that their care plans were up to date.

At our last inspection we found that the registered provider had failed to notify the Care Quality Commission about incidents which were reported to the police.

The manager told us in the action plan that in future the Care Quality Commission would be notified of all reportable incidents. They said there had been no further incidents reported to the police however they and all staff were fully aware of their responsibility to notify the Care Quality Commission of any such incident.

They told us they were provided with a lunch time meal each day. One person said 'The food is okay. I am a diabetic and staff know what I need and they help me'. Another person said 'The food is good, we get a meal at 12.30 and that does me most of the day'.

One person said 'there is enough staff around as far as I am concerned, it helps that they have been around as long as I have, they make sure I am alright and everything is in place'. Another person said 'The staff are really good actually, they treat me with respect. I needed a place like this to get me ready to go back into the community'. They told us they if they had any concerns about the service they would tell staff or the manager and they would do something about it.

A care manager for one of the people using the service said the support their client received from their key worker was significant in developing their self-esteem and independence. Another care manager told us the service was meeting the basic day to day needs of the residents, if a person using the service asked for assistance, generally the staff responded in an appropriate manner.

We found that important information relating to a person using the services care and support needs was not readily available to staff.

We found the registered provider had failed to notify the Care Quality Commission about incidents that had happened at the home.

They told us if they had any concerns about the service they would speak to the manager or staff.

They told us their privacy was respected and that staff treated them with dignity and respect.

They told us they had support plans and they met regularly with their key workers to talk about their health and social care needs.

They told us they felt safe living at the hostel and there was enough staff around when they needed them.