York Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.York Road can accommodate up to fourteen people with forensic mental health needs with care and supported provided to help people to rehabilitate them in the community. There were twelve people using the service at the time of this inspection.
The service had a registered manager. 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 at risk of not receiving sufficient levels of support that was appropriate to meet their needs. The care files and reviews we inspected were not all up to date. Some people’s risk assessments were not updated or revised following changes in their circumstances and care. Some care plans, reviews and risk assessments had not been signed by people to indicate their agreement to what was written down on their behalf. The acting manager confirmed with us they would ensure all people’s care plans would be reviewed immediately together with people living in the home. This is in line with the provider’s own policies and procedures. The acting manager also told us that staff will receive additional training with this to ensure they fully understand their responsibilities and carry them out as required. The example above showed the provider was not assessing or mitigating risks to people’s safety effectively. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People received their medicines as prescribed and staff knew how to manage medicines safely. Those people who were able to, took their medicines themselves with minimal assistance from staff.
We inspected the home’s medicines administration policies and procedures. Staff completed medicines training and competency assessments before they were able to administer medicines to people. Safe medicines management processes were implemented and people were supported to self-medicate where they were able to do so. A new policy to do with clozapine was drawn up, to be implemented immediately with staff training to ensure all staff were knowledgeable and competent to administer clozapine where necessary.
Some areas of this home were tired and needed refurbishment and redecoration. The annexe particularly looked drab and needed redecoration throughout, together with new carpets in the communal areas.
Staff were suitably trained and supported to carry out their work effectively. The acting manager told us that the provider’s training schedule helped to ensure all staff received appropriate training and support for their roles and their work in the home.
Staff told us they were well supported with appropriate training and were able to discuss any concerns or issues with the manager whenever they needed to do so.
All of the people living at York Road had the capacity to make decisions about specific aspects of their care and support at the time of this inspection.
People were supported to maintain good health and have appropriate access to healthcare services.
People were encouraged to plan, shop and prepare their own food. We saw they had a varied and nutritious diet. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.
The acting manager ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable.
People and staff said they thought there were enough staff to meet people’s needs. We looked at staff rotas and observed care being provided for people and we found there were sufficient levels of staff available to meet people’s needs.
People were assessed as having the capacity to make decisions for themselves and were supported to do so. Staff had received appropriate training and had a good understanding of the Mental Health Act (MHA) 1983 and the Mental Capacity Act 2005 and knew when each set of legislation applied.
People were encouraged and supported by staff to become more independent by developing the necessary skills and knowledge. This included eating well and staying healthy. When people needed care and support from healthcare professionals, staff ensured people received this.
Most people had care plans outlining the goals they wished to achieve and what support they required from staff. People were involved in planning their care and their views were sought and planned for as a central and important part of the process. The service monitored people’s changing needs and involved them in discussions about any changes that needed to be made to their care plans.
Staff respected people’s privacy and treated them with respect and dignity.
People told us they were able to contribute to the assessment and care planning process of their care through a number of different ways that they found useful. This included Care Programme Approach (multi-disciplinary agency) meetings, key worker meetings and house therapy meetings. We saw evidence that care plans reflected what people had said they would like and how they would like their care to be delivered. Care plans included details of people’s social activities and of their engagement with the community. Not all care plans we inspected were regularly reviewed up to the date of this inspection.
People knew how to make a complaint or how to raise a concern if they needed to do so. The registered manager told us they reviewed all complaints that had been made to check if there were any trends emerging. None had been identified at the time of this inspection.
Staff said the acting manager was doing a good job in the absence of the registered manager. They told us he was supportive and they felt able to raise any concerns they had with him. Staff said the acting manager included them in discussions about the service and they felt involved in service progression and development.
The results from the last satisfaction survey undertaken for 2016 - 2017 were mostly positive in all areas that questions were asked. They showed that people were satisfied with the support provided by staff and the services more generally in the home.
We found the auditing processes in place were ineffective in identifying some areas of staff practice and procedure that needed improvement. For example some people’s care plans and risk assessments were not up to date. Also we did not see evidence to provide assurance that audits were robust enough to identify medicines concerns.
At this inspection we identified a breach in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.