We carried out this inspection on 31 August 2016. The inspection was unannounced. This meant no-one at the service knew that we were planning to visit.This was our first inspection of this service.
Bell House Mews provides supported living accommodation for up to 14 adults with learning difficulties and/or mental health needs. Longley Hall Limited provides care and support to meet the needs of people living at Bell House Mews. People have individual tenancies with the housing provider. The service is located in the Shiregreen area of Sheffield and is on a bus route and close to local amenities. On the day of our inspection there were 14 people using the service.
There was a manager at the service who was registered with 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. The registered manager had been in post since June 2015. They were registered to manage both Bell House Mews and the provider’s other service, Longley Hall.
Medicines were not stored safely. We found gaps in medication administration records which meant people may not have always been given their medicines at the right time. Medication administration records were not regularly audited to check that medicines were given to people as prescribed.
We saw that safe recruitment procedures were not always followed to ensure that all the required information and documents were in place before staff commenced employment. These procedures were required to verify people employed by the service were suitable to work with vulnerable adults.
Not all the care records we looked at contained risk assessments. Where risks had been identified there was limited information as to how to recognise or reduce the risks to the person.
Care staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management.
We saw care staff had training in understanding mental capacity and care staff we spoke with understood what this meant in practice.
Care staff were not provided with regular supervisions and an annual appraisal to ensure they were suitable for their job and supported in their role.
We saw people had access to external health professionals and this was evidenced in people’s care records.
People living at Bell House Mews told us that staff were caring and supportive. We saw and heard positive interactions between people and care staff.
People’s privacy was not always respected and personal information was not stored securely.
None of the care records we looked at were complete. Where information was recorded on support plans it was recorded as an ongoing need with no completion date and no evidence of a recent review being undertaken. None of the support plans we looked at had been signed or dated by the person it concerned.
Some people living at Bell House Mews told us they were bored. Where people had expressed a desire to partake in an activity this was not always pursued.
We saw the service had a complaints policy and procedure. The procedure needed updating to reflect the current management structure.
We were told there weren’t currently any mechanisms in place to ascertain the views of people living, working or visiting Bell House Mews. This could include questionnaires and/or a suggestion box.
We saw evidence of staff meetings taking place monthly. There were no records any ‘resident’s’ meetings and we were told there were no meetings planned for people living at Bell House Mews.
There was no evidence of regular quality audits being undertaken to ensure safe practice and to identify any improvements required.
We found incidents had not been reported to CQC as required by regulation 18 of the Care Quality Commission (Registration) Regulations 2009.
We found the service was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 10, Dignity and respect; Regulation 12, Safe care and treatment; Regulation 17, Good governance; Regulation 18, Staffing and Regulation 19, Fit and proper persons employed.
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, the service will be inspected again in 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 up 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.