House of St Martin

The House of St Martin is a residential care home, part of The Langley House Trust, a Christian based organisation. It provides accommodation with personal care for up to 31 men. The focus of the service is to support ex-offenders or those at risk of offending with physical and mental health needs, dementia, substance misuse as well as people with learning disabilities and autism. 26 people lived there when we visited.

The home is a three - storey wheelchair accessible building with single room accommodation, some of which are en-suite. There is a large communal lounge/dining area, a smaller sitting room and inner courtyard area. It is set within a six-acre site.

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

Most people we spoke with said they enjoyed living at the House of St Martin, but their experiences varied. One person said, “It's really good living here. I have made friends. I like listening to music, looking at the birds and watching the weather.” A professional said, “Overall, the people that I see seemed to love it there.”

Several people said there wasn’t enough to occupy them. One said, “I'm a bit bored during lockdown, there's not much to do.” Since we last visited the service in April 2019, the service employed an activity co-ordinator, who was organising group activities such as art and crafts and gardening. Wheelchair accessible transport was provided so people could go out for trips and drives, although trips into the community were restricted by lockdown when we visited.

People did not always have their needs met because of staffing and skill shortages. There was a high turnover of staff with heavy reliance on agency to safely run the service. Where staff were unfamiliar with people' needs, this had a negative impact on their experience of care. Staff did not have all the skills, training and support they needed to provide safe and effective care and treatment.

People were not prevented from receiving unsafe care and treatment as assessments, care plans and staff handover information did not include all the information staff needed to minimise risks to people's health, safety and welfare.

The incident reporting system was unclear. We were not confident all incidents were reported or followed up, so the provider could not rely on this information to manage known risks.

Quality monitoring systems were not effective. Three breaches of regulations were identified at the inspection in relation to safe care and treatment, good governance, staff and staffing skills.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care used at House of St Martin’s did not fully maximise choice, control and independence for people with a learning disability. The National Institute for Health and Care Excellence recommends residential care ‘should usually be provided in small, local community-based units (of no more than six people)’. The environment of care with 31 people living in one house with large noisy shared communal facilities were not ideally suited to the needs of people with learning disabilities, autism and mental health conditions. Some outbuildings which were being refurbished to provide additional space for people. This included plans to provide a small kitchen so people would have facilities to learn to cook and a new laundry, so people could do their own laundry.

Right care:

The care and support provided, did not always meet the needs of people with learning disabilities. Staff did not receive the training they needed, so they did not develop the skills to provide appropriate support. This was made worse because of high staff turnover and heavy reliance on agency staff, so people did not always receive care from staff they knew and trusted. People’s care wasn’t person centred. Care plans were not focused on people’s strengths, abilities and individual goals.

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people with learning disabilities led confident, inclusive and empowered lives. This was because the provider was trying to meet the complex needs of a wide range of people. Staff lacked the skills needed and the environment was not ideally suited to supporting needs of people with learning disabilities.

We discussed our concerns about how the House of St Martin supported people with a learning disability and/or autism with the manager, the Director of Operations and the Director of Quality and Compliance. We requested they review their Statement of Purpose about who the service is for and what they are trying to achieve. We will arrange a meeting with them to follow this up further.

Most people said they felt safe living at the service. Staff had a good understanding of signs of abuse and felt confident any safeguarding concerns reported were listened to and responded to.

Staff had received infection control training and followed up to date infection prevention and control guidance to help people stay safe. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.

People, staff and professionals spoke positively about the new manager who was making improvements.

People did not always to have as much choice and control of their lives as they wanted. Staff supported people in the least restrictive way possible and in their best interests; but documentation of best interest decisions needed improvement.

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. (Report published May 2019). The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Why we inspected

We undertook this inspection to follow up concerns raised with us about staffing levels and skills and poor standards of care. Also, safeguarding concerns about bullying and intimidation by some people towards other more vulnerable people and by some staff. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report. We have identified three breaches of regulations in relation to Safe care and treatment, Staffing and staff skills and in Good governance. The provider has agreed to mitigate immediate risks by a voluntary undertaking not to admit any more people to House of St Martin until further improvements have been made.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for House of St Martin on our website at www.cqc.org.uk.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The House of St Martin is part of the Langley Trust and is a residential care home. It provides accommodation and personal care for up to 31 people living at the House of St Martin. They also provide housing and tenancy services for men with multiple needs, mental health issues and substance misuse issues. The project consists of community houses within the local area. CQC only inspects services that deliver a regulated activity such as personal care, therefore we did not look at this project as part of the inspection.

The House of St Martin has gone through a big change since the last inspection in 2016. In 2018 the Home transitioned from a hostel for ex-offenders to a residential care home. The care home remains focused on working with ex-offenders but also supports men with multiple needs including substance misuse issues, mental health needs or a learning disability.

The management team have had to implement new ways of working since registering as a care home. and review the skills required for the new ways of working. Because of this the provider is reviewing referrals on a case by case basis. The provider told us this was to ensure staffing levels and skills meet the needs of people living in the home. At the time of the inspection 17 people lived at the home.

People’s experience of using this service:

However, whilst the home was managed by a supportive and progressive management team who were clearly committed to improving the service, we did find areas of concern during the inspection that had not been improved in a timely manner. For example:

•Care plans were not always person centred and people did not have end of life plans in place.

•Staff were not always well trained with regards to managing people’s physical healthcare needs and the provider had not made sure everyone had access to homes transport vehicle.

•People told us they felt safe living at The House of St Martin. People described staff as caring and kind towards them. Staff were approachable and friendly with people they cared for and knew them well.

•The house was homely and looked after, and we observed people engaging with each other in a supportive manner. Interactions between staff and people was respectful and we saw lots of banter which people seemed to enjoy.

•The grounds were extensive and the provider had plans to develop them so that people could learn new skills such as growing their own vegetables and creating outside areas where people can have personal space.

•Where needed, staff were quick to support people to have access to health care professionals such as GPs, dentist and opticians or, when necessary, emergency services.

•People had their nutritional needs met. People told us they enjoyed the food and there was plenty of choice. People had access to drinks and snacks throughout the day.

•There were some restrictions placed on people as part of their release from prison. People told us staff were sensitive to these restrictions and did their best not to let them affect what people wanted to achieve.

•There was a house representative who attended national meetings with the provider. These meetings enabled people who lived at the House of St Martin to have a voice and feed in to policy and development at a national level.

•The management of risk to people was robust, and people’s medicines were managed well. There was an outside contractor that came in everyday to manage infection control within the home and staff checked health and safety concerns, such as water outlets and fire equipment. The provider carried out robust quality assurance checks which had highlighted some of the concerns found during the inspection.

Rating at last inspection:

At the last inspection the service was rated as Good (September 2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

House of St Martin is registered to provide personal care for adult male offenders and those at risk of offending. It also offers a floating support service in Somerset which does not come within the scope of our registration requirements. House of St Martin is a supported living service. Supported living is a way of providing housing and support to help people to lead independent lives. The service also provides support to people in their own homes in the community that includes personal care and social support and prompting with daily activities.

Care and support is provided twenty four hours a day by staff who work from an office on the premises. House of St Martin is a service run by a national Christian charity, Langley House Trust, which delivers offender rehabilitation services. The service aims to provide assistance and support to enable people to make positive life changes and live life crime-free. House of St Martin has accommodation for 19 people. At time of visit, five people lived there. One person was away from the home for a few days on a family visit.

There is 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.

The registered manager and staff had the skills and knowledge needed to support people living in the main house and in the community.

People said they were supported by kind and caring staff. One person said, “The staff have been brilliant. (Member of staff) has stopped people going off the tracks. They are as good as gold here. (Member of staff) has the magic touch. They are really good. I can’t praise them enough.” Another person said “the staff are good. They do listen. They do their jobs with respect and kindness.”

People received support that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about how the service supported aspects of their day to day lives.

This inspection took place on 12 September 2016 and was announced. The registered provider was given 48 hours’ notice because the location was for people who are often out during the day. We needed to be sure that the manager and some of the people who used the service would be available to speak with us.

House of St Martin is registered to provide personal care for adult male offenders and those at risk of offending. It also offers a floating support service in Somerset which does not come within the scope of our registration requirements. House of St Martin is a supported living service. Supported living is a way of providing housing and support to help people to lead independent lives. The service also provides support to people in their own homes in the community that includes personal care and social support and prompting with daily activities.

Care and support is provided twenty four hours a day by staff who work from an office on the premises. House of St Martin is a service run by a national Christian charity, Langley House Trust, which delivers offender rehabilitation services. The service aims to provide assistance and support to enable people to make positive life changes and live life crime-free. House of St Martin has accommodation for 19 people. At the time of our visit there were four people who lived there.

There is 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.

The registered manager and staff had the skills and knowledge needed to support people living in the main house and in the community.

People said they were supported by kind and caring staff. One person said, “The staff have been brilliant. (Member of staff) has stopped people going off the tracks. They are as good as gold here. (Member of staff) has the magic touch. They are really good. I can’t praise them enough.” Another person said “the staff are good. They do listen. They do their jobs with respect and kindness.”

People received support that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about how the service supported aspects of their day to day lives.

People told us they felt safe with the service and staff who supported them. One person said “It is very safe here. If there are any problems staff sort them out straight away. They are very skilled at what they do.” Another person said “They have done an amazing job to keep me safe. If it was not for them I would not be here. They have never let me down.”

All staff understood their role in maintaining a safe environment for people and the importance of being alert to any possible abuse or if people were at risk of neglecting themselves.

There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. For example, staff were able to accompany people to appointments and participate in projects with people.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There was always a senior member of staff on duty or on call to support staff and people receiving a service. Staff and people receiving a service commented on the availability of the manager who ensured support was being delivered in a skilled way.

The registered manager and staff had a clear vision for the service they wanted to supply to people. They kept their skills and knowledge up to date by on-going training and reading.

The vision and values of the service were seen in the way staff interacted with and communicated with people.

There were systems in place to ensure people received safe and appropriate support with their medicines.

There were effective quality assurance systems in place to monitor support and ensure the service was as safe and effective as possible.

We saw evidence that arrangements were in place to obtain consent of people who used the service. During the information gathering process we saw that people had time to think about the options available to them.

One person we spoke with said they had been involved in drawing their support plan up and that it contained 'realistic goals'. They said that their opinions had been 'definitely' taken into consideration and that it reflected their needs.

People who used the service that we spoke with said that staff were very good at their jobs, comments included 'very professional' and 'my key worker is wonderful'. People said that staff were competent and that they were 'looked after'.

People said staff were good at 'organisation', 'managing time', 'prioritising', 'communicating', 'caring' and one person said that they felt 'they actually care rather than just a job'.

People we spoke with said that there were 'ample opportunities to voice any concerns' and 'we get listened to'. One person said 'it's improved my personal situation with the help I've got'. We saw that the results of annual surveys were fed back to people via DVD's or a hard copy.

We saw assessments and support plans that were comprehensive and thorough, signed by the people using the service to indicate their agreement with the plans.

People told us that they felt involved in the running of the service through "service user meetings" and also through regular discussions with staff. We saw notes from these meetings which had action points. People told us that "everything we have asked for has been done".

We found that staff were knowledgeable about safeguarding and we saw a training plan and certificates which showed us that they had attended the relevant training. People told us that they felt safe living at the House of St. Martin.

Staff told us that the supervision and general training was felt to be supportive, giving them the skills and knowledge to deliver a good service to the people living at St. Martins.

The manager showed us a number of systems which ensured that the quality of the service being delivered was regularly monitored to ensure that people were safe and receiving effective care and support.