We carried out an unannounced inspection at Oswald House on the 1 August 2016.

Oswald House is registered to provide accommodation, rehabilitation, care and support for up to nine people with complex mental health issues. The home is a large detached cottage located in the village of Oswaldtwistle, Accrington.

Over the four days of the last inspection which took place on the 29, 30 October 2015 and 02, 08 November 2015 we found the provider to be in breach of three of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one of the Care Quality Commission (Registration) Regulations 2009. We asked the provider to make improvements around individual environmental risk assessments and make adjustments and adaptations to the premises to recognise and mitigate any risk based behaviours. We also asked the provider to ensure that necessary referrals were made to the Commission and local authority informing of any safeguarding concerns and to review and follow procedural guidance in relation to pre admission and admission of people to the service.

The Commission is continuing to investigate matters connected to a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as stated in the previous inspection report. As such the Commission is still not yet in a position to determine the actions that may be taken at the conclusion of those investigations. However during this inspection we found the provider had taken steps to ensure they were now compliant with all of the regulations that were reviewed.

At the time of this inspection there was a manager in post. The manager had started the application process to become registered manager with the Commission. 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 provider had ensured an acting manager was in post with oversight from the area manager, until a new registered manager was recruited.

People indicated satisfaction with the service provided and spoke positively about the staff team who supported them. People looked relaxed in the presence of the staff team. People told us they had “Settled in well”. We saw evidence of people leaving the service without any restrictions placed on them.

We noted the service had developed processes and procedures to maintain a safe environment for people using the service and for staff and visitors. This included individual environmental risk assessments and daily ‘housekeeping’ and health and safety checks were also completed.

Fire audits were in date and compliant. Fire safety checks and fire exercises were carried out and staff had received fire training. The service had clear procedures to follow in case of an emergency. All people using the service had a personal emergency evacuation plan (PEEP).

Staff displayed knowledge of the various signs and indicators of abuse and were clear about what action they would take if they witnessed or suspected any abusive practice. Training in safeguarding and whistle blowing had been completed and procedural guidance was evident to support this.

We saw an adequate staffing level at the time of inspection and throughout the rotas we reviewed. People corroborated this by telling us they had the support they needed when needed. We also observed a good level of staff interaction to support this. Staff told us they had the time to carry out daily tasks and support people safely on a day to day basis.

Safe and robust recruitment systems were in place which ensured the service took appropriate steps to verify people’s previous employment and conduct, identity and any criminal record before being successfully appointed. Induction processes were

We carried out an unannounced inspection of Oswald House on the 29 and 30 October 2015 and 2 and 18 November 2015. Oswald house provides accommodation, rehabilitation and personal care for people with complex mental health issues. The premises are located in Oswaldtwistle, Accrington. At the time of our visit there were 9 people accommodated at the home.

The service was last inspected in March 2013 and was found compliant in all areas inspected. At the time of this inspection there was no registered manager employed. However there was a deputy manager who provided management cover alongside the directors. 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 this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, and one breach of the Care Quality Commission (Registration) Regulations 2009. These were related to safeguarding, premises and equipment, failing to provide safe care and treatment, and failure to notify the Commission of notifiable incidents. You can see what action we told the provider to take at the back of the full version of the report.

The Care Quality Commission is continuing to investigate issues related to an incident at the home. As such the Commission is not yet in a position to determine the actions that may be taken as the investigation has not concluded.

People told us they felt safe living at the home. They referred to the home as a safe place. Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. However, we found that the manager had not referred safeguarding incidents to the relevant Authority and had not notified the Commission.

We saw that in most cases the service had created adequate detailed risk plans for each person. These identified risks such as self-harm, suicide and fire setting. However for one person these had not been completed.

The service had an admission policy but this was not consistently followed. The policy failed to provide a robust admission procedure. However, following the inspection, management have reviewed the policy and have provided the Commission with a more robust policy.

We found environmental risk assessments and policies were in place to protect staff and people using the service. However these policies needed reviewing and updating. We found in some cases the risk assessments did not reflect the individual risk that people using the service may have posed to themselves. This meant the location was not adequately risk assessed for people who may be at risk of ligature. Subsequent to the inspection the service provider has carried out internal and external work on the premises to ensure these risks are now being managed more effectively.

We saw overall detailed care plans which gave clear information about the people’s needs, wishes, feelings and health conditions. These were reviewed monthly and more often as needed by the manager. Staff told us they were required to read care plans to familiarise themselves after an absence from work of two weeks or more.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safe Guards (DOLS). These provide legal safeguards for people who may be unable to make their own decisions. The manager also demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who uses the service in their best interests. We saw two people using the service were subject to DOLS documentation and referral process relating to these people had b

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 good", "I like everything about it" and "there are 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,

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from harm good staff recruitment.

People told us they were satisfied with the quality of care and support they received. We were told the staffing levels were sufficient to meet the needs of people living in the home and that the staff were professional, caring and friendly.

People made various positive comments about the staff team. Comments made to us included:

"I love being here. I think it's the best place I've ever been in."

"I've never had a complaint I'm happy just as it is. I am able to keep in touch with my children."

"They treat me with respect kindness and help me do things I never thought I would be able to do."

People were provided with care plans which were reviewed regularly and updated when

required.

People said they felt safe living in the home and were able to discuss concerns or issues

with the staff if they wished to. We were told that the service provided enjoyable and varied activities for people.

There were comprehensive auditing and reviewing procedures in place to identify any

areas where improvements could be made.