Archived: Creative Support - Manchester Enduring Mental Health Needs Service

Updated 18 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14, 15 and 16 November 2017 and the first day was announced. This meant the service was given 24 hours’ notice because the location provides a supported living service to younger adults and we needed to be sure that someone would be in. The inspection was carried out by one adult social care inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information in the PIR, along with other information we held about the service such as notifications. A notification is information about important events which the service is required to send us by law.

We contacted Manchester local authority safeguarding, contracts and commissioning teams to find out what information they held on the service. We also contacted other health and social care professionals such as social workers and community psychiatric nurses with whom the service had involvement. Further details of the feedback they provided are contained within the report.

The service is registered with the Care Quality Commission to provide personal care support. However not everyone supported was in receipt of personal care. At inspection, we spoke with four people living at the service including one person who was supported with personal care. We spoke with six staff members including four support workers, the registered manager and the project manager. We looked at records relating to the service, including two support plans and daily comments records, three staff personnel files, safeguarding records, minutes of staff and tenants meetings, and quality monitoring records.

Updated 18 January 2018

This inspection took place on 14, 15 and 16 November 2017 and the first day was announced. This meant the service was given 24 hours’ notice because the location provides a supported living service to younger adults and we needed to be sure that someone would be in.

Creative Support Manchester Enduring Mental Health Needs Service (Wellington Road) is a 24-hour supported accommodation project for people with long term experience of mental health needs such as schizophrenia and psychosis. The service is registered with the Care Quality Commission to provide personal care support.

Wellington Road consists at two adjoining properties. One property comprises of six bedrooms with en-suite facilities sharing communal lounge, kitchen and laundry and the other property comprises six self-contained flats. People who lived in the flats were able to and did access the communal areas at the other property. Support is provided for up to 12 individuals with a mental health needs, dual diagnosis, alcohol and drug issues, complex needs, challenging behaviours, physical disability and forensic backgrounds. The service focusses on recovery and rehabilitation support and offers a holistic approach to managing people’s mental health needs, involving various health and social care professionals and working with people to move on to more independent accommodation.

At the time of our inspection, there were 11 people supported at Wellington Road, two of whom were also receiving the element of personal care support.

This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in September 2016. The inspection was carried out by one adult social care inspector. There was a manager in post who had been registered with CQC since December 2016. A registered manager is a person who has registered with CQC 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 overall atmosphere at Wellington Road was warm, friendly and homely. We observed people living there appeared comfortable and safe in their surroundings.

People told us they felt safe at Wellington Road. This was supported by the fact that staff provided reassurance and there was a system of security checks and security cameras installed on the premises.

People supported had personal emergency evacuation plans in place to help ensure they were evacuated safely in the event of an emergency. These plans were not easily accessible to staff and emergency services. We made a recommendation that these important documents were kept in a more accessible location.

Risk assessments were thorough, detailed and person centred and provided sufficient information to help staff support people safely. People’s support needs were holistically assessed and care plans recorded in detail the support each person required. Records also included detailed evaluations of people’s progress to date. There was sufficient information to ensure staff supported people effectively.

Staff had been trained in safeguarding principles and knew what to do if they suspected abuse was taking place. There was a system for reporting incidents and accidents, including safeguarding, that occurred at the service. We saw these were recorded and actioned in a timely manner. This meant the service had appropriate measures in place to ensure people were kept safe and their health and well-being was protected.

Staffing levels were suitable to people’s needs and when required appropriate steps were taken in a timely manner to ensure all shifts had adequate staff cover.

The recruitment process was safe as all required documentation and checks were collected prior to staff being employed. This helped to ensure staff of suitable character were employed to work at the service. The registered provider had ensured people using services were a part of the recruitment process and we saw they had participated on interview panels.

Medicines were stored and administered safely. Prior to our inspection, several medicine errors had taken place and we saw the registered manager and registered provider had taken appropriate action to minimise the risk of reoccurrence. Monthly audits were carried out which helped to ensure safe practice.

Environmental and equipment checks were carried out regularly to ensure both the internal and external environments in which the service was provided was safe and fit for purpose.

Transition meetings involving all relevant health professionals were held to ensure moving into Wellington Road was the appropriate place to support people’s needs. Records showed that people participated actively in making the decision to move to the service.

Staff had received an induction and training considered mandatory by the registered provider. This included the care certificate for staff new to the care industry and topics such as safeguarding, mental health awareness and medication. This helped to ensure staff were competent to undertake their roles.

Communication between staff was good and there were various measures used to ensure staff were kept up to date on what was going on at the service each day. This included daily staff handovers and a staff communications book. Handovers were detailed and informative and ensured staff on shift were updated on what had taken place throughout the previous shift.

Staff told us they enjoyed their work and felt valued for their contribution to the service. From records and discussions with staff we noted they were supported through regular supervisions. This helped to ensure staff received adequate professional development to help them provide effective care and support to people.

We observed that staff always asked people’s permission before undertaking a task. The registered manager and staff we spoke with demonstrated they understood the Mental Capacity Act (MCA) and had received training in this area. The registered provider had processes in place to deal with situations of where a person lacked capacity to make their own decisions. However no one currently using the service needed this. There was sufficient evidence in people’s care plans to demonstrate consent to care had been sought appropriately and the service was working within the principles of MCA.

People were supported to plan and prepare their own meals. Care records and daily notes we looked at provided evidence that the service promoted healthy diets to support people’s mental health and wellbeing. This demonstrated the service’s commitment to encouraging healthy nutrition and supporting people’s independence and choice.

From care records, we saw that people were supported to access health care professionals including specialist mental health services such as GPs, dentists and community psychiatric nurses and to attend medical appointments. This meant the service had systems in place to ensure people’s healthcare needs were met as and when required.

People using the service told us both the staff and the managers at Wellington Road were kind and caring. We saw that people had developed good relationships with staff. We observed staff treated people with kindness and respect and that there was good interaction between people and support workers.

The service promoted people’s independence and helped them maintain friendships and enjoy the social interaction with other people at the service.

Staff knew the individuals they supported and demonstrated this by telling us about people and their preferences.

Where required, the service used assistive technology such as portable telecare alarm to help ensure people’s needs were attended to responsively.

People had choice in deciding what activities they wanted to participate in and they were encouraged and supported to attend these. These included attending college and seeking employment. The service also supported people to maintain relationships that were important to them. The service was committed to ensuring people’s mental health and wellbeing was adequately supported by engaging in meaningful activities and maintaining important relationships.

There was a good system of recording and monitoring complaints. We saw that complaints were well managed and that people were not afraid to make a complaint or to raise concerns. We noted the service had reviewed how it recorded the outcome of a complaints investigation which helped to improve the transparency of the complaints process.

People also took the time to compliment the staff on their caring nature and the level of support they received. The project manager documented these and shared them with staff.

People had confidence in the management and staff of Wellington Road. The registered manager and the project manager were well known and everyone we spoke with, including staff, said that they were very approachable and proactive. There was an open and inclusive culture and atmosphere at the service and people told us they were happy and settled in their environment.

The registered manager was passionate about the development of the service and complimented the dedication and competence of the staff team. The registered manager also understood and had met their legal obligations to notify CQC of any significant incidents.

Staff were adequately supported in their caring roles. This support included strong leadership from managers, staffing meetings and policies and procedures. This helped to ensure staff were able to perform effectively and thus create better outcomes for people supported.

There was a robust system of audit and quality assurance mechanisms in place to monitor service quality and delivery and thus gave the registered manager and the provider good oversight of all operations.

The registered provider participated in quality improvement