St James Mews

St James Mews is a care home providing personal care and accommodation for up to nine people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were nine people using the service. The service is separated into two separate living parts, Mews 1 and Mews 2. The service was situated behind a secured gate on the same site as another service registered with the same provider.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

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 did support this practice. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The model of the service did not follow the RSRCRC guidance. However, the provider had a plan in place as to how they are going to mitigate the effects to people in the service and how they were going to remodel the service. The provider had made improvements since the last inspection. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests, for example, one person loved horses and staff supported them to go horse riding regularly. Staff supported people to achieve their aspirations and goals, for example, monthly key worker reviews detailed what aspirations people had and then this was reflected in the following review as a completed action. The provider had made improvements regarding the environment to ensure people were supported in a clean and safe environment. The provider told us they were also continuing to improve other areas of the environment.

Right Care

People’s daily notes were not always being completed and reflective of the care and support people were receiving. The home manager had already identified this as an area that needed improving. However, people received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Relatives gave positive feedback about the staff and the support they give. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. The provider had worked hard to ensure people were able to communicate in their preferred way, staff and the provider told us people were less frustrated now they were able to express their choices in a way that suited them.

Right Culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. People and those important to them, including advocates, were involved in planning their care. Relatives told us they were always informed if there were any incidents, accidents or if their relative was unwell. The provider had worked to ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 inadequate (published 29 June 2022) and there were 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.

This service has been in Special Measures since 29 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 05 May 2022 and rated the service inadequate. Breaches of legal requirements were found. We imposed a condition on the providers registration for this service which required them to send us updates on the action they were taking to address the issues. The provider was complying with this condition. 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, Effective and Well-led which contain those requirements.

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.

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 inadequate to requires improvement. 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 St James Mews 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.

St James Mews is a care home providing personal care and accommodation for up to nine people. The service provides support to autistic people and/or have a learning disability. At the time of our inspection there were nine people using the service.

The service is separated into two separate living parts, Mews 1 and Mews 2. The service was situated behind a secured gate.

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

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.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

The service had not always supported people to make decisions that followed best practice in decisions making. For example, the kitchen was sometimes locked, and people were unable to access the kitchen freely. People who needed their medicine covertly did not have best interest decision meetings to ensure that decisions were being made for the right reasons.

The service did not always give people care and support in a safe and well-maintained environment. For example, there was broken flooring causing a trip hazard and a broken electrical box which a person told us had fallen on their head.

People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to take part in activities, however this was not always recorded accurately and efficiently.

The service could support up to nine people and was located on site with another care home. The model of the service does not reflect the Right Support, Right Care, Right Culture guidance

Right care

The service did not have enough staff who were appropriately skilled to people’s needs and keep them safe.

Some people had individual ways of communicating such as Makaton (a form of sign language), staff told us that they needed more training in this and more frequently to be able to communicate with people more effectively.

People were able to take part in activities and pursue interests that were tailored to them. For example, one person really liked horse riding and staff were able to support them to do this weekly. Also, another person enjoyed going to the gym and staff were able to support them to access the local gym.

Right culture

People did not always receive good quality care, support and treatment because staff were not always trained to support people’s specific needs. There was a lack of oversight from senior management regarding quality assurance within the service. Risks to people’s health were not always identified. No guidance had been provided to staff about how to support people with other risks. Risks relating to the environment had not been mitigated to keep people safe. Following the inspection, the service provided us with evidence that a system was in place to analyse incidents and accidents. However, the service had not consistently and correctly submitted notifications to CQC.

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 25 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines and Infection prevention and control. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm. Please see the Safe, Effective and Well-led sections of this full report.

Immediately following the inspection, we asked the provider for assurances about the immediate actions they were taking to address the most serious risks. This included concerns about the management of epilepsy, choking risks, diabetes management and constipation management.

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 St James Mews on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the service not keeping people safe from harm or abuse and inadequate risk assessments and guidance for staff about risks to people. We also identified that staff had not undertaken the required training to support people effectively and safely and people’s needs had not been properly assessed prior to moving into the service. There was a failure to follow the legal framework to obtain people’s consent to care being provided. The registered provider had failed to effectively monitor and improve the quality of the service.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

St James Mews is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St James Mews is registered to provide accommodation and personal care support for up to nine people with a learning disability, physical disability, people who misuse drugs and alcohol, autistic spectrum disorder, sensory impairment, younger adults and mental health needs. The purpose built accommodation was situated within a gated mews and split into two parts. There was a five bedded male only house and a four bedded female only house. At the time of our inspection there were nine people living at the service.

At our last inspection on 24 April 2018, we rated the service Good. We re-inspected this service earlier than planned due to concerns that had been raised about people’s safety. At this inspection we found the evidence continued to support the rating of Good.

Prior to this inspection there had been disruption to the service from people displaying behaviours that challenged the service, staff and other people. At this inspection we found that people continued to receive safe care. Risks associated with people's care and support were managed safely. People’s care needs were fully assessed and people were involved in the day to day planning of their care and making choices about their lives and routines.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 felt safe and comfortable with the staff who supported them. There was a relaxed and friendly atmosphere around the home. People told us staff were kind and caring.

There were sufficient staff to provide safe and individual care to people. Staff were suitably trained and received regular supervisions and appraisals.

Medicines continued to be managed safely and people received their medicines as prescribed.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff knew the people they were supporting well. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

Risk assessments continued to be in place and they identified current risks to people as well as ways for staff to minimise or appropriately manage those risks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they were provided with opportunities to follow their interests and hobbies and they were introduced to varied activities. People told us their privacy, dignity and confidentiality were maintained.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

The provider had a complaints procedure in place and people who used the service and their relative were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Where actions were identified as a result of these they were quickly addressed.

Further information is in the detailed findings below.

St James Mews is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St James Mews is registered to provide accommodation and personal care support for up to nine people with a learning disability, physical disability, people who misuse drugs and alcohol, autistic spectrum disorder, sensory impairment, younger adults and mental health needs. The purpose built accommodation was situated within a gated mews and split into two parts. There was a five bedded male only house and a four bedded female only house. At the time of our inspection there were nine people living at the service.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 and their relatives told us they felt safe and comfortable with the staff who supported them. There was a relaxed and friendly atmosphere around the home. People told us staff were kind and caring.

There were sufficient staff to provide safe and individual care to people. Staff were suitably trained and received regular supervisions and appraisals.

Medicines continued to be managed safely and people received their medicines as prescribed.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff knew the people they were supporting well. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

Risk assessments continued to be in place and they identified current risks to people as well as ways for staff to minimise or appropriately manage those risks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they were provided with opportunities to follow their interests and hobbies and they were introduced to varied activities. People told us their privacy, dignity and confidentiality were maintained.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

The provider had a complaints procedure in place and people who used the service and their relative were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Where actions were identified as a result of these they were quickly addressed.

Further information is in the detailed findings below.

The service provides care and support for up to nine people with learning disabilities. People who used the service had moderate care needs; however, some were at higher risk of presenting challenging behaviours which may harm themselves or others. At the time of our inspection there were eight people using the service. The purpose built accommodation was split between one four bedded male only house and one four bedded female only house within a gated mews.

A registered manager was not employed at the service. 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. However, a manager had applied to register with the CQC.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities. Each person had a key worker who assisted them to learn about safety issues such as how to evacuate the building in an emergency and to speak to if they felt unsafe. The manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The manager and care staff used their experience and knowledge of caring for people with learning disabilities and complex needs effectively. Staff assessed people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed within the service, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified. The provider’s policies and management plans were implemented by staff to protect people from harm.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Where people could retain the information, they had been supported to understand what their medicines were for and when they needed to take them. This was reinforced by staff who administered medicines.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as epilepsy and diabetes. People had been supported to understand their health conditions and had been given information to help them manage their own health and wellbeing.

We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. We observed people being consulted about their care and staff being flexible to request made by people to change routines and activities at short notice.

The manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. People could involve relatives or others who were important to them when they chose the care they wanted. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. Staff were trained about the safe management of people with behaviours that may harm themselves or others.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment in the service were well maintained to promote safety.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The manager recruited staff with relevant experience and the right attitude to work well with people who had learning disabilities. New staff and existing staff were given extensive induction and on-going training which included information specific to learning disability services.

Staff received supervisions and training to assist them to deliver a good quality service and to further develop their skills. Staff had specialised, on-going training about managing behaviours and physical interventions to protect themselves and others from harm. Staffing levels were kept under constant review as people’s needs changed. The manager ensured that they employed enough staff to meet people’s assessed needs.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. People were supported to make healthy lifestyle choices around eating and drinking.

The manager produced information about how to complain in formats to help those with poor communication skills to understand how to complain. This included people being asked frequently if they were unhappy about anything in the service. If people complained, they were listened to and the manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

The manager and the deputy manager had demonstrated a desire to deliver a good quality service to people by constantly listening to people and improving how the service was delivered. People and staff felt that the service was well led. They told us that managers were approachable and listened to their views. The manager of the service and other senior managers provided good leadership. The provider and manager developed business plans to improve the service.