Blackburn Road

Pathways (North West) Limited – Blackburn Road 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.

Pathways (North West) Limited – Blackburn Road is registered to provide accommodation and personal care for up to seven people with a mental health diagnosis. There were seven people living in the service on the day of our inspection. Staff employed to support people were referred to as life skills trainers which reflected the rehabilitation focus of the service.

The home did not have a registered manager in place. 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. A new manager had been appointed since the last inspection. They were in the process of applying to CQC to register as manager of the home.

At our last comprehensive inspection on 5 April 2017, we found the provider was not meeting two of the regulations we reviewed. We therefore asked the provider to take action in relation to the recruitment of staff and the systems in place to monitor the quality and safety of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Safe’ and ‘Well-led’ to at least good. During this inspection we found recruitment processes had been improved, although one aspect of the process needed further action. This was because reasons for gaps in applicants’ employment history had not been properly investigated and documented by the staff at head office who were responsible for the recruitment process. We found systems in place to monitor the quality and safety of the service were now sufficiently robust.

People told us they felt safe in the home and staff were kind, caring and respectful towards them. Staff had completed safeguarding training and were able to tell us the correct action to take should they witness or suspect abuse. People told us there were always sufficient numbers of staff on duty to support them with activities or daily living tasks.

Robust systems were in place for the safe handling of medicines. Staff had received training in how to administer medicines safely. Their competence for this task was assessed when they started work at the home. The manager confirmed they would ensure these competence assessments were completed on an annual basis.

Care records we reviewed included detailed information about the risks people might experience. Care plans were in place to help ensure staff provided the level of support necessary to manage the identified risks. Care plans were regularly reviewed to address any changes in a person’s needs.

Systems were in place to help ensure the safety and cleanliness of the environment. People who used the service were encouraged to participate in cleaning the home.

Staff told us they received the induction, training and support necessary for them to be effective in their role. The provider had recently introduced a new training system which staff told us was good quality and appropriate to help them meet the needs of people who lived in the home.

Staff had a good understanding of the Mental Capacity Act (MCA) 2005. 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 were encouraged to have a healthy diet, although staff recognised people were able to make their own choices about the food they ate. The manager had introduced improved systems to monitor the physical health of people who lived in the home.

Staff demonstrated a commitment to providing high quality person-centred care which met the diverse needs of people who lived in the home. Care records we looked at showed people who used the service had been involved in reviewing their care and support plans. The provider had recently introduced a system of electronic care records. Staff had provided positive feedback on this initiative as they considered it allowed them to spend more time with people who lived in the home.

The nationally recognised ‘Recovery Star’ was used to help people recognise the goals they had achieved. People who used the service were encouraged to participate in activities which met their interests and helped to promote their health and well-being. People told us staff would always encourage them to be as independent as possible.

All the people we spoke with told us they felt able to raise any concerns with their keyworker or the manager and were confident they would be listened to. We noted systems were in place to encourage people who used the service to provide feedback on the care and support they received.

Staff we spoke with told us they enjoyed working in the service and felt valued by both colleagues and the manager. Staff felt able to raise any issues of concern or make suggestions to improve the service in supervision and staff meetings.

The manager had a good understanding of the needs of people who lived in the home. They told us they operated an ‘open door’ policy for people who used the service and staff. They demonstrated a commitment to on-going service improvement.

Pathways (North West) Limited – Blackburn Road is registered to provide accommodation and personal care for up to seven people with a mental health diagnosis. There were six people living in the service on the day of our inspection. Staff employed to support people were referred to as life skills trainers which reflected the rehabilitation focus of the service.

The service had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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.

During this inspection we identified two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to adequately protect people from the risk of unsuitable staff. The provider had not carried out the required additional checks when people had worked previously with vulnerable adults or children to ascertain why their employment in that service had ended. In addition the provider’s management systems had not been robust enough to identify the shortfalls we found during the inspection. Action plans were not always in place following audits. Some action plans did not identify who was responsible for required actions or the timescales in which they should be completed. This had resulted in the same issues being identified in two consecutive audits related to people’s care records and one person’s prescribed medicines. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe with the staff who supported them. They told us staff were always available to support them in the activities they wished to do. People were enabled to make their own decisions and told us staff always promoted their independence. During the inspection we observed staff were caring and respectful in their interactions with people who used the service.

Staff had received training in the safe administration of medicines. The competence of staff to administer medicines safely was regularly assessed.

Care records we reviewed included detailed information about the risks people might experience. Care plans were in place to help ensure staff provided the level of support necessary to manage the identified risks. Care plans were regularly reviewed to address any changes in a person’s needs.

Systems were in place to help ensure the safety and cleanliness of the environment. People who used the service were encouraged to participate in cleaning the home.

Staff told us they received the induction, training and supervision they needed to be able to carry out their roles effectively. Staff were able to demonstrate a good understanding of the legal frameworks under which individual’s placements at the home were arranged. The registered manager had also taken appropriate action to apply for restrictions in place in a person’s best interests to be legally authorised.

Staff demonstrated a commitment to providing high quality person-centred care. People were supported to achieve their rehabilitation goals. Care records we looked at showed people who used the service had been involved in reviewing their care and support plans. The nationally recognised Recovery Star was used to help people recognise the goals they had achieved. People who used the service were encouraged to participate in activities which met their interests and helped to promote their health and well-being.

Records we reviewed showed that, where necessary, people were provided with support from staff to attend health appointments. People were also supported by staff as far as possible, to maintain a healthy diet.

All the people we spoke with told us they felt able to raise any concerns with the registered manager and were confident they would be listened to. We noted systems were in place to encourage people who used the service to provide feedback on the care and support they received.

Staff we spoke with told us they enjoyed working in the service and felt valued by both colleagues and the registered manager. Staff felt able to raise any issues of concern or make suggestions to improve the service in supervision and staff meetings.

The registered manager demonstrated a commitment to driving forward improvements in the service. The provider had developed a ‘service user forum’ which helped to identify areas for improvement across the three services they owned in the local area.

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from harm good staff recruitment.