The inspection took place on 21 March 2016 and was an unannounced inspection. This meant the provider had no prior notice of our inspection. The service consists of Redburn House which provides accommodation and personal care for up to ten people with mental health needs. In addition, the provider had a separate registration for personal care which allows it to provide services in the community. Supported living services are provided at seven properties, where staff aim to support people to rehabilitate and develop life skills.On the date of the inspection there were 29 people using the service.
A registered manager was 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.
During our previous inspection in August 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to Good Governance, Safe Care and Treatment and Staffing. As part of this inspection we checked whether improvements had been made in these areas as well providing an updated rating for the service under the Care Act 2014. At this inspection, we identified the provider had not made the required improvements and was still in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Medicines were still not managed in a safe way. Stock levels of medicines did not match with what was recorded as present, meaning some medicines were unaccounted for. Some medicines were not given in line with the prescribers instructions.
Safeguarding procedures were in place which staff had a good understanding of. People we spoke with told us they felt safe living in the home and when cared for in the community. Some risks to people’s health and safety were assessed with clear plans in place. However there were some notable admissions with a lack of risk assessments in place detailing how staff supported people safely whilst taking them out in the community.
Incidents were not always managed in a safe way. We saw where medication errors and behavioural incidents had occurred robust preventative measures were not always put in place. We were concerned that behavioural incidents had occurred where staff had not received appropriate training.
There were sufficient staff to ensure people received an appropriate level of care and support whilst allowing them to maintain a level of independence.
Although recruitment procedures had been improved shortly before the inspection, we were concerned that a staff member had been recruited in an unsafe way in November 2015.
Some areas of the premises were not safe as they had not been adequately checked and maintained by staff.
We were concerned about the managers understanding and application of the Mental Capacity Act and Mental Health Act (MHA). There was a lack of monitoring of a person’s care and as such as change in their circumstances had not been identified by the service.
People had access to a range of health professionals and we saw their advice was regularly sought for example over behaviours that challenge or health conditions.
Staff had received basic training in a number of subjects. However there were a number of key omissions with a number of staff not receiving even basic training in subjects such as behaviours that challenge and mental health awareness.
We observed the lunchtime and saw the food looked appetising. However we identified that nutritional risks associated with one person were not well managed by the service.
Staff were kind and caring and treated people with a good level of dignity and respect. Care was delivered by a stable group of staff who knew people well. We observed care and saw some good examples of kind and compassionate care.
Initiatives were in place to involve people in daily tasks around their house and promote their independence within the community. The service helped people at Redburn House to move out into the community and develop their skills although there was a lack of structure to these plans.
Care records were in a transitional phase and as such we found them difficult and confusing to navigate which meant there was a risk of inappropriate care and support being provided.
People told us they were satisfied with the service and had no cause to complain. However improvements were needed to the way the complaints procedure was brought to the attention of people who use the service.
The service had failed to ensure significant improvement to its quality following our previous inspections in May 2014 and August 2015. The service had failed to adequately address risks within the timescales stated on action plans submitted to the Commission.
Some systems were in place to assess and monitor the quality of the service, however these were not fully embedded or not sufficiently robust to identify and improve the service.
Staff told us morale was good and said they felt well supported by the organisation. People’s views on the service were regularly sought through a range of mechanisms.
We found several breaches of the Health and Social Care Act 2008 (Regulated Activities 2014) Regulations. You can see what action we asked the provider to take at the back of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.