St Mungo's Broadway - 53 Chichester Road

Our previous inspection on 21 February 2017 found two breaches of regulation and made two recommendations. We rated the service as “requires improvement”. During this inspection on 9 February 2018 we found that the service had taken necessary action and made improvements. The service is now rated as “Good”.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

People who used the service told us that they were satisfied with the care provided and said that they felt safe in the home and around care staff. People told us they were treated with dignity and respect in the service.

Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults. Risk assessments were in place which clearly detailed potential risks to people and how to protect people from potential harm. We noted that risk assessments had been prepared with the involvement of people and were reviewed regularly.

Systems were in place to ensure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We looked at the recruitment process to see if the required checks had been carried out before staff started working at the home. We looked at the recruitment records and found background checks for safer recruitment had been carried out.

People who lived in the service and care staff told us there were sufficient numbers of staff to safely meet people’s needs. Management explained that there was consistency in respect of staff with a number of staffing having worked for the service for many years. They also advised that there was flexibility in respect of staffing so that they could deploy staff where required.

People in the service were able to smoke in their bedrooms but were not allowed to smoke in communal areas. We discussed this arrangement with management and they explained they ensured people were supported to smoke in a safe manner. Fire and emergency procedures were in place and there was evidence to confirm that necessary checks were carried out regularly.

On the day of the inspection, the home was clean and there were no unpleasant odours. However, we noted that there were several areas of the environment that were 'tired' looking. The bathrooms on the first and second floor were in need of renovation. We also noted that some carpets in communal areas were old and in need of replacing. We have made a recommendation in respect of this.

Our previous inspection found that there were gaps in staff training and staff had not received yearly appraisals. We found a breach of regulation in respect of this. Our inspection in February 2018 found that the service had made improvements in this area. There was documented evidence to confirm that staff had received training and an appraisal.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Care support plans contained information about people's mental state and communication.

Arrangements were in place to ensure that the nutritional needs of people were met. An external catering company prepared meals in the home. People had a choice of a daily cooked breakfast, cooked hot lunch and a light dinner.

People were supported to maintain good health and have access to healthcare services and received on-going healthcare support and we saw documented evidence of this. Care records included information about appointments with health and social care professionals.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The registered manager informed us that none of the people who used the service were subject to any orders depriving them of their liberty. We noted that people could freely go out when they wanted to.

Our previous inspection found there was limited information in care support plans about their care needs and preferences. This inspection in February 2018 found that the service had taken action and updated care support plans so that they included a detailed care support plan which provided information about people’s communication, mobility, special interests, mental health, health needs and cultural/religious beliefs.

People told us that there were enough activities in the home. During the morning of the inspection we did not observe a formal activity taking place. However, in the afternoon we observed people interacting with one another in the lounge and playing pool.

Our inspection in February 2017 found that there were some areas where the quality of the service was not effectively checked and we found a breach of regulation in respect of this. During this inspection in February 2018, we found that the service had taken appropriate action and implemented effective checks and audits.

Care staff had a positive attitude and were of the opinion that the home was well managed and management were supportive and approachable. Care staff told us that the service had improved since the last inspection.

At our last inspection on 27 and 28 November 2014 the service was rated as “Good” and there were no breaches of regulations.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

People who used the service told us that they were satisfied with the care provided at the home. We observed that people were well cared for and appeared comfortable around care staff. People told us they felt safe in the home and around care staff. Care professionals we spoke with said they were confident people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Care staff we spoke with knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and care staff were aware of potential risks to people and how to protect people from harm. However, we noted that people’s risk assessments varied in respect of detail and information.

On the day of the inspection we observed that care staff were not rushed and were able to complete their tasks. There was consistency in terms of care staff so that people who lived in the home were familiar with them and care staff were familiar with each individual’s needs. The majority of care staff we spoke with told us there were generally sufficient numbers of staff for them to attend to their duties.

We looked at the recruitment process to see if the required checks had been carried out before staff started working at the home. We looked at the recruitment records and found background checks for safer recruitment had been carried out.

There were systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. However, during the inspection we observed that the temperature of the cabinet where medicines were stored had not been monitored and recorded. We made a recommendation in respect of this.

We found the premises were clean and tidy and there were no unpleasant odours. There was a record of essential inspections and maintenance carried out. We also saw evidence that the home had fire procedures in place and carried out checks in respect of this. The home had an infection control policy and measures were in place for infection control.

Staff had undertaken an induction when they started working at the home and we saw evidence of this. We were provided with a matrix for twelve members of staff detailing what training they had completed. We noted that there were some gaps in staff training in relation to first aid, medicines management and health and safety. At the time of the inspection we noted that care staff had not received Mental Capacity Act (MCA) training and this was confirmed by care staff we spoke with.

We saw evidence that staff had received supervision sessions in the last year. Staff had not received an appraisal in 2016. We found a breach of regulation in respect of the gaps in training and lack of appraisal in 2016.

There were arrangements to ensure that the nutritional needs of people were met. On the day of the inspection we observed people eating their breakfast and lunch. Care staff were aware of the importance of healthy eating in the home. One way they did this was to ensure that there was fruit available daily in the lounge and we saw evidence of this during the inspection. People’s weights were recorded monthly so that the service was able to monitor people’s nutrition.

People were supported to maintain good health and have access to healthcare services and received on-going healthcare support and we saw documented evidence of this. Care records included information about appointments with health and social care professionals.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Care plans contained some information about people's mental state and communication.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The regional manager informed us that none of the people who used the service were subject to any orders depriving them of their liberty. We noted that people could freely go out when they wanted to.

During the inspection, we observed that care staff were present to ensure that people were alright and their needs attended to. Care staff were attentive and talked in a gentle and pleasant manner when communicating with people. We observed good interaction between care staff and people and they appeared comfortable around care staff.

Care records included information about people and their care needs. However, we found there was limited information in care support plans about the support that people required in respect of various areas of their care such as personal care, mobility and communication and we made a recommendation in respect of this. Care plans contained some information about people’s preferences and routines. However, we noted that the level of detail in respect of this information varied in people’s care records. Some people’s care records included more information than others.

All people we spoke with who used the service told us that there were enough activities in the home. During the day of the inspection we did not observe a formal activity taking place. However, we observed people interacting with one another in the lounge where there was a pool table.

Meetings were held monthly for people living at the home where they could give their views on how the home was run.

There was a complaints policy which was displayed in the home. There were procedures for receiving, handling and responding to comments and complaints. People told us they would not hesitate to raise concerns with staff and management.

People spoke positively about the atmosphere in the home and said there was a homely atmosphere.

There was a management structure in place with a team of care staff, domestic staff and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. The majority of staff we spoke with said they felt supported by management. They told us management was approachable and the service had an open and transparent culture.

There was a quality assurance policy which provided information on the systems in place for the provider to obtain feedback about the care provided at the home. The service undertook checks and audits of the quality of the service in order to improve the service as a result. We saw evidence that regular audits and checks had been carried in areas such as health and safety, cleanliness of the home, fire procedures and care documentation. However, there were some areas where the quality of the service people received was not effectively checked and the service failed to identify failings. We found a breach of regulation in respect of this.

We spoke with three people who used the service. One person told us "I am very happy, staff are second to none. I thought I would never be able to control my problem, but for people with my problem this place is perfect."

Records showed that the provider worked along with various other agencies such as the GP, hospitals, opticians, dentist and the local authorities who had placed people in the service.

The provider ensured that arrangements were in place to maintain a safe environment for people who used the service. Records showed that various repair works had been discussed with people during resident meetings and people had been kept informed on work which was being undertaken.

Three members of staff told us about the staffing arrangements and we found that there were enough staff on duty to meet people's needs.

We visited the office for both staff and the managers and found that records were kept securely. We found during our visit that most records we requested were located promptly.

People told us that staff treated them with dignity and respect and that they were fully involved in all decision making that affected their care. We observed staff supporting people in a friendly and professional way and saw that

people were being offered choice with regard to menus, activities and care preferences.

Care plans showed us that care was personalised and that people had good access to health professionals. People that we spoke to explained that they felt safe at the home and would feel confident to talk to staff or management if there were any issues of concern.