About the service St Martins of Tours Housing -158-162 New North Road Is a residential care home providing support to men difficult to place because of enduring mental health needs, forensic backgrounds and/or substance misuse issues. There are 18 rooms for people situated across three floors, each with shared communal facilities. The service includes a nearby three bedroomed house for people who are transitioning to independent living. There were 16 people using the service at the time of this inspection.
Following the first two days of this inspection we were informed about safeguarding concerns. A decision was made to return for an extra day of inspection to examine those risks.
People’s experience of using this service and what we found
People spoke positively of the support they received from staff. Two people told us about the support that they were receiving to move on to live in their own independent accommodation.
However, although we found that steps had been taken to address the safeguarding matter our judgement was that the provider had not effectively addressed anti-social behaviour issues at the service either from current or past service users and that people using the service had been placed at risk as a result. This was not helped by the fact that the provider had not communicated incidents fully with the CQC in recent months.
This service provides care for a challenging group of people. There are many positive aspects of care provision such as co-production work and a good level of success for helping people to move on. However, a number of people using the service have particularly challenging needs and it can mean that there are times when the placement breaks down and people either return to hospital or may need to be evicted. This is a challenge for the provider. It was not clear to us that the provider had effective systems in place to manage anti-social behaviour and the impact of this on other people using the service and the local community. Or that the provider had effectively learnt lessons about this as anti-social behaviour had been a factor at this service for some time.
In addition, we found that the quality assurance initiatives, although good and effective at day-today matters, had not been able to assess, monitor and mitigate the risks to people using the service, particularly safeguarding risks.
Other aspects of the service were running smoothly. The home was clean and safely maintained although there needed to be improvement to the management of people's individual fridges and food cupboards. Some of these were not hygienic and risk assessments for this were needed.
The manager was new and showed some effective leadership. Staff told us they felt well supported. People spoke positively about the management of the home.
People’s individual support plans and risk assessments were detailed and up to date. These included guidance for staff Information on the support that people required. The plans and risk assessments included information about signs of mental health crises, and information about the risk of drug and alcohol misuse. People had regular key worker meetings with staff where concerns and plans were discussed.
People’s medicines were stored and administered safely. Where people self-administered their own prescribed medicines, this was monitored by staff.
Staff members received regular training to support them in carrying out their roles. They also received regular supervision from their manager to enable them to discuss practice in effectively supporting people.
Systems were in place to assess and monitor the quality and delivery of care to people. Regular monitoring of safety and practice had taken place although, as above, the monitoring needed to be extended to cover the anti-social behaviour challenges faced at the service.
People’s views of the support provided by the home had been sought. People also had the opportunity to express their views during house meetings and co-production events designed to seek feedback on policies and procedures and changes to the home.
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.
Staff were caring and treated people with dignity. People’s differences including cultural and religious needs were understood and respected by staff.
Staff understood the importance of social interaction. People were supported to maintain the relationships they wanted. A regular activity programme took place based on needs and interests. People were encouraged to participate in regular meal clubs where they were supported to cook nutritious meals and socialise around the table. People were also encouraged to participate in group or individual sessions in relation to their wellbeing and progress. For example, sessions had taken place to assist people to prepare for and seek working opportunities. A training course around understanding and skills in using a person-centred recovery model of support was due to take place and some people had signed up for this.
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 (published 9 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
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 from 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.