About the service:

Mental Health Residential Limited – 71 London Road is a residential care home for nine younger adults who need support to maintain their mental health. At the time of this inspection nine people were living in the service.

For more details, please read the full report which is on the CQC website at www.cqc.org.uk

People's experience of using the service:

People were positive about the service. A person said, "I’ve got what I need here and I’m okay.”

People received safe care and treatment in line with national guidance from care staff who had the knowledge and skills they needed.

People were safeguarded from the risk of abuse and had been supported to take medicines safely.

Lessons had been learnt when things had gone wrong.

People had been helped to receive medical attention when necessary.

People and their relatives were consulted about the care provided and their consent had been obtained.

Care staff were courteous and polite and confidential information was kept private.

People were supported to be as independent as possible and to enjoy occupational and social activities in the community.

There were robust arrangements to manage complaints.

Good team work was promoted and regulatory requirements had been met.

Rating at last inspection:

The service was rated as ‘Requires Improvement' at the inspection on 31 January 2018 and 7 February 2018 (the inspection report was published on 24 April 2018). At the inspection in January and February 2018 there were two breaches of regulations. This was because the registered persons were not operating a safe recruitment and selection procedure. Also, the registered persons had not made suitable provision to operate, monitor and evaluate the running of the service. At this inspection in April 2019 both of the breaches of regulations had been put right. More robust pre-employment checks had been completed to ensure that applicants fully demonstrated they were trustworthy and suitable people to work in the service. In addition to this, the registered persons had strengthened existing quality checks and introduced new audits to enable them to more closely monitor the operation of the service. As a result of these changes the overall rating of the service has improved to ‘Good’.

Why we inspected:

This was a planned inspection based on the rating we gave the service at the inspection in January and February 2018.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 31 January and 7 February 2018 and was unannounced. At our previous inspection in November 2016 we found five breaches of regulation relating to the management of risks, person centred care, consent, good governance and safe recruitment practices. 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, Effective, Responsive and Well led to at least good. At this inspection we found that some improvements had been made and the breaches for person centred care, consent and risks had been met. The breach for safe recruitment was still unmet and there was still work to do to fully meet the breach for good governance. In addition we also found some issues with the environment which needed addressing so the key questions for Safe, Effective and Well led remain rated at requires improvement.

Mental Health Residential - 71 London Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mental Health Residential - 71 London Road provided support and accommodation for nine adults with a mental health need. At the time of our inspection seven people were accommodated within the main house and two within an adjoining flat. The service is based in a residential area of Tunbridge Wells in easy reach of transport links and local shops.

There was a registered manager at the service. 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.

There were unsafe recruitment practices in place at the last inspection and although the registered manager had changed recruitment practices for new staff, retrospective action to conduct checks of staff already employed had not taken place. You can see what action we told the provider to take at the back of the full version of the report.

Quality auditing systems had not been fully implemented and embedded in to practice. You can see what action we told the provider to take at the back of the full version of the report.

People were kept safe from abuse and harm and staff knew how to report suspicions around abuse. Risks were minimised through the use of effective control measures. There were sufficient numbers of staff deployed to meet people’s needs and ensure their safety.

People received their medicines when they needed them from staff who had been trained and competency checked. Staff understood the best practice procedures for reducing the risk of infection; and audits were carried out to ensure the environment was clean and safe. The service used incidents, accidents and near misses to learn from mistakes and drive improvements.

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 support this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful and the least restrictive option.

People had effective assessments prior to a service being offered. This meant that care outcomes were planned for and staff understood what support each person required. Staff were trained in key areas and had the skills and knowledge to carry out their roles. Staff could request additional training and had been supervised effectively by their managers. People were supported to receive enough to eat and drink and staff used nationally recognised guidance to ensure people had a balanced diet and adequate nutrition.

The s

We inspected Mental Health Residential Limited on 28 November 2016. This was an announced inspection. The provider was given 48 hours’ notice because the location was a small care home for adults who are often out during the day and we needed to be sure that someone would be in. At the last inspection in April 2014 the service was found to be meeting the regulations we looked at.

Mental Health Residential Limited is a care home providing personal care and support for people with mental health needs. The home is registered to care for up to nine people. At the time of the inspection they were providing personal care and support to eight people.

The service had 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.

Risk assessments were completed for people who used the service however they were not always robust. Risk assessments contained minimal information and did not always give clear guidance to staff how to support and protect people. Risk assessments were not regularly reviewed.

Recruitment and selection procedures were not always carried out in line with the provider’s policy and procedure and may have placed people using the service at risk of harm by unsafe recruitment and selection practices. The provider was not recording proof of identity for new staff. The provider’s policy gave no guidance on what identification was needed for recruitment.

The registered manager and staff understood their responsibilities under the Mental Capacity Act. There were no restrictions on people using the service. However the provider was not recording signed consent from people.

Care was personalised and delivered to a good standard. People received good support to make sure their nutritional and health needs were appropriately met. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. However some care plans were not updated regularly.

Systems were not robust to ensure the delivery of high quality care. During the inspection we identified failings in a number of areas. These included recruitment, staff not receiving annual appraisals, recording of initial assessments, missing care plan documentation and recording consent to care. This showed there was a lack of robust quality assurance systems in place.

Formal supervision to provide staff support and development required to carry out their role was not being provided by the service. Staff told us they received regular training and felt supported. However the provider was not completing annual appraisals for staff. We have made a recommendation about staff receiving annual appraisals.

There were enough staff on duty to meet people's needs however staff and people who used the service had mixed views about staffing levels provided on weekends.

Staff had undertaken training about safeguarding adults and had a good understanding of their responsibilities with regard to this. The service had arrangements for the management of medicines to protect people against the risks associated with medicines.

Staff knew the people they were supporting and provided a personalised service. People felt supported and cared for.

The registered manager was open and supportive. Staff, people who used the service and relatives felt able to speak with the registered manager.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

There were nine people living in the home at the time of our visit. The inspection was conducted by one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Our report is based on our observations during the inspection, speaking with people who used the service and the staff supporting them, and from looking at records.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

People who used the service were assessed for any risks associated with the support they received and the environment in which they lived. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

The service was safe. Equipment and facilities were well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

People’s needs were assessed before they moved into the service. This helped to give a comprehensive picture of the person and made sure they received the right care and support.

Support for people was planned and delivered in line with their individual care plan. The care plans gave staff clear and current guidance about how to support each person with their personal, social, mental health and health care needs. Specialist support had been identified in care plans where required.

People were involved in writing their own plans of care. Care plans were reviewed regularly and reflected their current needs.

The manager and staff were appropriately qualified and trained to meet the needs of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. Staff were clear about their responsibilities and showed a good knowledge and understanding of how to meet people’s needs. People told us that staff were kind and always there if they needed help with any problems. People told us “The staff are good and supportive”.

People who used the service, their relatives, friends and other professionals involved with the service had completed satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. We saw that people’s rooms were highly personalised with their own belongings and according to their interests. One person told us “I like my room, it’s home”.

Is the service responsive?

Staff supported people who used the service to take part in social and recreational activities of their choice. Records showed that people were involved in a variety of activities within the local community. Staff supported people to keep appointments or contacts with professionals to make sure their needs were met. People experienced support improved their skills towards living independently.

We saw that regular meetings were held for people who used the service, where staff would listen to and take action about their views.

We saw that people were relaxed and able to easily communicate their wishes to staff, who acted upon these. People we spoke with were happy with the service provided. People knew how to speak with staff or how to make a complaint if they were unhappy.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified issues were addressed promptly. As a result the quality of the service was continuingly improving. The structure within the service for decision making and accountability made sure that people’s care and support needs were met consistently.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service at all times.

The manager had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We spoke with three of the nine people using the service. They were positive about the service, and the interactions we saw between staff and people using the service were friendly and respectful. One person told us that the home was “a nice place to live”. They said they liked their room, the other people using the service were friendly, and they kept occupied. People told us they felt supported by the staff, and one person said “they go out of their way to be decent.”

People had their needs assessed and were involved in their care planning. People were supported to follow their interests, and participate in fulfilling activities. We saw that people had routine meetings with their community nurses and social workers to ensure that their mental health and support needs were reviewed.

People were able to prepare their own food and drinks. Staff made the evening meals, but encouraged people using the service to participate in this. Some of the people using the service prepared all their own meals.

There were enough staff to meet people’s needs. There were no staff vacancies, and staff worked flexibly to accommodate the needs of people using the service.

People were aware of the complaints process, although there had been no formal complaints. People were able to raise their concerns, and these were addressed.

We spoke with four of the nine people who lived in the home. They were all positive about the service. One person told us “I love it here.” Other people said “it really is, really good”, “I like everything about it” and there were “lots of things to do.”

The interactions we saw between staff and people using the service were respectful and friendly. One person told us “they just haven’t got any bad staff” and another that the manager “is very thorough, she likes to see things through, and make sure they’re done properly.” One person said that the staff were “easy to approach”, and that they “leave us on our own” but that there was “always someone to go to” if they needed help.

The activities people carried out reflected their preferences and their healthcare needs. Many of the activities took place outside the home, and included voluntary work, computer courses, swimming, visiting the cinema, and shopping. We saw that people had been on trips to London and Hastings, and on holiday supported by staff. Each person in the home had their own room which they had personalised.

Records showed that staff had been recruited appropriately. The people we spoke with all said they felt safe in the home, and that they could go to the staff or manager if they had any concerns.

People in the home were supported to manage their own medication where they were able to. Two people described to us how they managed their medication, and said that they were satisfied with the process.

We were told that independence and individuality were promoted within the home. People living there told us they were supported and enabled to do things for themselves. They said they were encouraged to express their views and make or participate in making decisions relating to their care and treatment.

People told us “The manager and staff are lovely.” “Everyone’s like a family. I’m not treated as a service user or resident but like we’re in a family. It’s not like being in a hospital or in a care home but like being with your family.”

People told us how they make day to day choices about their lives and plans for the future and described how staff supported them to do this.

“I can choose and buy my own food and what I want to eat; I like to go shopping in Tonbridge and Tunbridge Wells.” “I make my own meals. I am a vegetarian and always get something I like.”

One person described how they enjoyed photography and had entered competitions and exhibitions. “I like music TV and photography.” “I see my best friend and we go to the cinema. I go out for a meal with friends once a week.”

“I went on holiday with my keyworker and with another resident and their keyworker. We were staying nearby – it was good, during the day I could do my own thing and then we had evening meals together.”

One person said “I went to college and got a health and social care qualification, which I enjoyed. I did courses in art and maths as well. I had a work placement looking after elderly people.” “Being here is a stepping stone, I’m looking for my own flat and am on the housing list.”

“My care plan is focussed on self-medication, cooking and finding a new place to live. I have copies of my care plan and can see it whenever I want.” “I get enough support and my care plan’s reviewed. Me and my key worker meet up and talk and go through it. I sign it.”

People said that they liked living in the home and enjoyed having their own room. People told us “I enjoy living here, I like it.” “Everything you need is always done. Staff put my hooks and pictures up for me.”

People told us the staff were kind and caring. People explained that staff and their key workers helped them. “The manager is lovely and there are nice staff here.” “Staff are very good, supportive and friendly. I have a keyworker” “I get on with all the staff.”

People told us that they felt safe and were well cared for by staff. People told us that they could speak with staff if they had a problem or were worried about anything. People told us that they were asked for their views about the support they received.