St Mary's Hospital

At the last inspection in July 2016 we found the provider had breached two regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to medicines management and overall oversight of the service including appropriate reporting of incidents. The service was rated overall Requires Improvement.

An action plan was submitted to us by the provider outlining how they would improve. We saw improvements had been made in all areas at this inspection and the provider was no longer in breach of any regulations. The service is now rated overall Good.

The service provides care and support to people living in 16 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. 91 people were supported at the time of the inspection.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and/ or autism using the service can live as ordinary life as any citizen.

A registered manager was in post. 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.

People received an extremely person centred service. Staff had excellent knowledge around how people communicated and they used this to empower people to make their own decisions and direct their own care. The use of positive behavioural support had meant people were less anxious and confident enough to access their community and live as ordinary a life as possible. Care plans reflected the person centred detail staff needed to know to support people how they preferred.

Staff training in specialist areas such as postural management meant people experienced less discomfort or pain due to their physical disabilities and improved mobility and independence. Staff felt supported by their managers and enjoyed the range of training on offer to develop their skills. Their improved knowledge helped them deliver effective support for people.

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. Staff understood how to recognise abuse and report issues of concern to protect people.

People and their families were able to describe the positive outcomes achieved because they received such high quality person centred support. Staff treated people with respect and dignity at all times. Staff looked to problem solve and worked to support people to achieve their aspirations. We saw examples of people improving their health, accessing their dream holiday, starting a new hobby and using technology to control their own environment.

The leadership and culture of the service was positive. Managers empowered their staff to have ideas and be part of developing the service. There was energy behind continuous improvement and we saw people were innovatively involved in developing the service.

New quality assurance processes were in place to help the provider ensure quality was consistent. Systems were in place to ensure staff were recruited safely and that the health and safety aspect of delivering support was well managed. The registered manager was working to ensure staffing was reviewed in conjunction with the local authority so people received a consistently responsive service.

The service is registered to provide personal care to people living in their own homes. At the time of our visit the service provided personal care to 89 people with learning disabilities and/or autistic spectrum disorder across the city of Leeds.

The current registered manager was in the process of de-registering from that role as they no longer had day to day responsibility for the service. An operations manager was in post and told us they had started to apply to become the new registered manager. 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.

Systems in place for the management of medicines were not robust enough which meant people were at risk of not receiving their medicines correctly.

There were not robust systems in place to monitor and improve the quality of the service provided. Data collated was not always analysed which meant improvements that could be made may have been missed. Not all safeguarding information was reported correctly.

The service did not use a staffing tool or risk assessment to evidence staffing levels had been reviewed based on people’s needs and that levels in place were safe. We saw that people were well cared for but that staffing levels may impact on people’s access to activities and the community.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. People and their families were involved in the assessment and review of care and support plans.

There were risk assessments in place for people who used the service. Risk assessments covered areas such as mobility, travelling independently and finances. This meant that staff had the written guidance they needed to help people to remain safe. Recognised tools for areas such as nutrition and pressure care were not used to help staff understand how to monitor and when to refer to professionals.

The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. We saw examples of the process being followed but this needed to be implemented fully for decisions.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.

Staff told us that their house manager was supportive. Most staff had received regular and recent supervision and an annual appraisal. The policy for this area was undergoing review to improve the support staff would receive. The new approach was awaiting approval at the time of this visit.

Not all staff training was up to date. Staff told us they had received training which had provided them with the knowledge and skills to provide care and support. The operations manager told us outstanding training will be completed by the end of 2016.

Recruitment and selection procedures were in place and we saw that appropriate checks had been mostly undertaken before staff began work. However some gaps in staff member’s employment history had not been investigated or recorded.

People and family members told us that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People were provided with their choice of food and drinks which helped to ensure that their nutritional needs were met.

Staff at the service worked with other healthcare professionals to support the people. Staff worked and communicated with social workers, occupational therapists, hospital staff as part of the assessment and ongoing reviews.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

We spoke with one person who used the service. They told us they were happy with the care provided and were involved with their care and support needs. They said, 'The nurses are great.'

We saw that people who used the service were responded to promptly when they asked for any support or assistance. We saw that care practices were good and all interventions were explained. We saw that people were happy, relaxed and comfortable with staff in their interaction with them. There was positive interaction and a lively and homely atmosphere in the service.

We spoke with five staff. This included the Lead Nurse and Clinical Team Manager. Staff said people who used the service received good, person centred, individualised care. One staff member said, 'Care here is brilliant, I would have any member of my own family cared for here if I could.'