78 Hoylake Crescent

78 Hoylake Crescent is a care home for up to four people who have mental health needs and learning disabilities. At the time of our inspection, one person with mental health needs was using the service. No one had a learning disability.

The service was owned and managed by a private partnership. They also own another registered care home and supported living services.

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

People were happy living at the service. They had good relationships with staff. They were involved in planning and reviewing their care.

Medicines were managed in a safe way. Risks to people's safety and wellbeing were assessed and planned for.

The environment was safely maintained. There were systems and audits to help make sure risks within the environment were identified and reduced.

The provider had made improvements to the service since the last inspection. They had involved staff to help them understand about keeping the service safe and meeting people's needs. There were suitable systems for dealing with and learning from complaints, accidents, incidents and safeguarding alerts.

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 inspection of the service was on 2 December 2021 (published 8 January 2022) and we rated the service requires improvement. 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

We carried out a comprehensive inspection of this service on 2 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 78 Hoylake Crescent on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

78 Hoylake Crescent is a care home for up to four people who have mental health needs and learning disabilities. At the time of our inspection, three people with mental health needs were using the service. No one had a learning disability.

The service was owned and managed by a private partnership. They also own another registered care home and supported living services.

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

Some aspects of the service were not safe. There were hazards within the environment which presented a risk for people using the service and staff. We discussed these with the management team so they could address these straight away.

Improvements were needed to the way in which medicines were managed. People received their medicines safely and as prescribed, but there was a risk of medicines being mismanaged because the systems were not robust enough.

There was not always evidence to show that adverse events had been learnt from and improvements made at the service. For example, when there had been instances of verbal or physical aggression there had not always been reflective practice for the staff to consider why this happened and if changes could be made to the service to reduce the risk of these reoccurring.

Records were not always accurate or complete. We found gaps in recording which included incomplete care plans, risk assessments and quality audits.

People were happy living at the service. They were given choices and were able to be independent when they wanted. The provider had offered short term accommodation to people who had gained new skills and moved to more independent settings.

People had enough to eat and drink and were supported to access healthcare services. They planned their own activities, which included attending places of worship, and were supported by staff when needed and when they wanted support.

People liked the staff and had good relationships with them. They felt staff treated them with respect. Staff were well supported and had the training they needed to care for people safely and meet their needs.

There were appropriate systems for dealing with complaints and people felt able to speak up about how they felt. They were asked for their views about the service and these were used to help plan for improvements.

The registered manager was one of the partners. They worked alongside staff to support people. People using the service and staff felt able to speak with the management team and had good relationships with them.

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.

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 providing support to people with learning disabilities or those with autism at the time of our inspection. However, they provided a model of care which maximised people's choice and independence. They provided personalised care which respected people's dignity and rights. They also had a culture where managers worked closely with people to help them develop their skills and work towards their own goals and aspirations.

The management team told us they had not supported people with learning disabilities since our last inspection and the primary purpose of the service was to support people with mental health needs, specifically those people wanting to develop skills to move on to more independent settings or their own homes.

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 rating at the last inspection (published 20 January 2021) was requires improvement. We identified breaches relating to safe care and treatment, good governance and fit and proper persons employed.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 work alongside the provider and 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.

78 Hoylake Crescent provides both short and long stay care for up to four people with mental health needs and mild learning disabilities.

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

The provider did not have effective systems in place to assess risks. We made a recommendation regarding the safe recording of medicines. The provider had not ensured that they always followed safe recruitment procedures robustly to safely recruit staff.

Staff were not always recruited safely as all recruitment checks were not always carried out as required.

The provider’s audits and checks to monitor the quality of care provided were not always effective as they failed to identify the issues we found during our inspection.

Care plans were not always comprehensive enough to ensure staff had appropriate information about people’s wishes when caring for them. We made a recommendation to the provider about this. The provider was not recording people’s end of lives wishes.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The registered manager was not always ensuring people received person centred care which was inclusive. The registered manager was not working within the principles of the mental capacity act to empower people to support them to make their own decisions.

Staff communicated effectively with each other about people’s care and support. Staff were provided with personal protective equipment. There were systems and processes in place to protect people from harm and abuse. The provider and staff understood their responsibilities to raise concerns both internally and externally.

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

Rating at last inspection

This service was registered with us on 30 August 2018 and this was the first inspection.

Why we inspected

The inspection was prompted because we have not yet inspected this service since registration and in part due to information of concerns we had received about the service. We undertook a focused inspection to review the key questions of safe, responsive and well-led. We also looked at part of the effective key question.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches of three of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, staffing and good governance. Please see the 'action we have told the provider to take' section towards the end of the report. During the inspection, we identified issues regarding fire safety. After the inspection we made a referral to the London Fire Safety Unit.

Follow up

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 work alongside the provider and 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.