We carried out an unannounced inspection at Oswald House on the 1 August 2016.Oswald House is registered to provide accommodation, rehabilitation, care and support for up to nine people with complex mental health issues. The home is a large detached cottage located in the village of Oswaldtwistle, Accrington.
Over the four days of the last inspection which took place on the 29, 30 October 2015 and 02, 08 November 2015 we found the provider to be in breach of three of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one of the Care Quality Commission (Registration) Regulations 2009. We asked the provider to make improvements around individual environmental risk assessments and make adjustments and adaptations to the premises to recognise and mitigate any risk based behaviours. We also asked the provider to ensure that necessary referrals were made to the Commission and local authority informing of any safeguarding concerns and to review and follow procedural guidance in relation to pre admission and admission of people to the service.
The Commission is continuing to investigate matters connected to a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as stated in the previous inspection report. As such the Commission is still not yet in a position to determine the actions that may be taken at the conclusion of those investigations. However during this inspection we found the provider had taken steps to ensure they were now compliant with all of the regulations that were reviewed.
At the time of this inspection there was a manager in post. The manager had started the application process to become registered manager with the Commission. 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. The registered provider had ensured an acting manager was in post with oversight from the area manager, until a new registered manager was recruited.
People indicated satisfaction with the service provided and spoke positively about the staff team who supported them. People looked relaxed in the presence of the staff team. People told us they had “Settled in well”. We saw evidence of people leaving the service without any restrictions placed on them.
We noted the service had developed processes and procedures to maintain a safe environment for people using the service and for staff and visitors. This included individual environmental risk assessments and daily ‘housekeeping’ and health and safety checks were also completed.
Fire audits were in date and compliant. Fire safety checks and fire exercises were carried out and staff had received fire training. The service had clear procedures to follow in case of an emergency. All people using the service had a personal emergency evacuation plan (PEEP).
Staff displayed knowledge of the various signs and indicators of abuse and were clear about what action they would take if they witnessed or suspected any abusive practice. Training in safeguarding and whistle blowing had been completed and procedural guidance was evident to support this.
We saw an adequate staffing level at the time of inspection and throughout the rotas we reviewed. People corroborated this by telling us they had the support they needed when needed. We also observed a good level of staff interaction to support this. Staff told us they had the time to carry out daily tasks and support people safely on a day to day basis.
Safe and robust recruitment systems were in place which ensured the service took appropriate steps to verify people’s previous employment and conduct, identity and any criminal record before being successfully appointed. Induction processes were also implemented to ensure the correct amount of training and support was given to new staff. Staff corroborated this by telling us the induction process was detailed and thorough. Procedures were in place to support the service in taking action in the event of staff misconduct.
The service had processes in place for appropriate and safe administration of medicines and staff were adequately trained. Medicines were stored safely and in line with current National Institute for Health and Care Excellence (NICE) guidance. NICE provides national guidance and advice to improve health and social care.
Care files were in date and regularly reviewed and detailed information which was personal to each person around the person’s needs, wishes, feelings and health conditions. It was evident that the person had contributed to these files and had signed when appropriate.
Appropriate training was provided. Staff confirmed they received a variety of appropriate training to equip them to safely and knowledgably support people living at the service. A training schedule was also in situ detailing training courses available for the following year.
The service was working within the principles of the Mental Capacity Act 2005 and ensured any conditions or authorisations to deprive a person of their liberty were being met. These provide legal safeguards for people who may be unable to make their own decisions. At the time of inspection these safeguards were being appropriately managed.
Meal times were very relaxed and people could choose what they wished to eat. People freely used the kitchen area to prepare meals, snacks and drinks with the support of staff when required. Weight management and dietary care plans were in situ when required and appropriate referrals had been made to health professionals.
During the inspection we noted positive staff interaction and engagement with people using the service. Staff addressed people in a respectful and caring manner and the service had a calm and warm atmosphere. We observed people enjoying each other’s company, conversing and accessing the community.
People told us they were happy to approach the manager with any concerns or questions.
We found the manager to be very approachable and they assisted us professionally with our inspection by providing us with any requested documentation without delay. The manager displayed an awareness of people's current needs and circumstances and was committed to the principles of person centred care and inclusion.