This first comprehensive inspection of the service took place on 7 September 2017 and was unannounced. St Matthews Unit provides care for up to 58 people with complex mental health needs and people living with dementia. At the time of the inspection 57 people were using the service.

An unannounced quality inspection of St Matthews Unit was carried out on 30 and 31 August 2016 by the Mental Health Act (MHA). Since the inspection, the regulated activity assessment or medical treatment for persons detained under the Mental Health Act 1983 has been removed from the provider’s registration and the service had ceased to be a hospital.

A registered manager was 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 addressed specific areas individual to each person using the service. Staff understood their responsibilities to safeguard people from abuse and knew how to raise any concerns if they suspected or witnessed ill treatment or poor practice.

The Recruitment systems were robust to make sure the right staff were recruited to keep people safe. There was enough competent staff available with the right mix of skills to meet the needs of people using the service. Systems were in place for the ordering, receipt, storage, administration and disposal of medicines.

Staff received training that was relevant to their roles and responsibilities, ensuring they had the skills and knowledge required to support people effectively. Capacity assessments had been carried out for all people using the service, the assessments identified where people required help to make decisions, and where they lacked the mental capacity to make particular decisions. Deprivation of Liberty (DoLS) applications had been submitted to the local authority as required.

People were supported to maintain a healthy diet and have access to healthcare services in response to ill health and had routine health checks. People had developed positive relationships with the staff. The staff protected people's privacy and dignity and advocacy services were available for people if required.

Detailed care plans in place, they contained information about people’s needs and aspirations and short term goals. People were encouraged to develop their independence and were supported to follow their interests and hobbies. The staff knew how to support people when they became anxious through using individual coping strategies. Systems were in place to receive and take appropriate action to address any complaints.

Established quality assurance systems were being used to monitor the service to continually drive improvement.

During our inspection visit we spoke with four people who used the service, two relatives and two health professionals. We also spoke to the manager and five members of staff.

People we spoke with told us that they were happy with the service and liked living at St Mathew’s unit. They also told us that staff were friendly and supported their needs.

During our observation we noted that people's relatives provided positive comments about the home and the level of care that was given by staff to their family member. Some of the comments included "Seems to have a good relationship with all staff and they are great to him”, and “I am pleased he is here and they have settled in well”.

Several people were not able to hold meaningful conversations with us, but we saw from their responses and body language that they were happy with the way staff were supporting them. We observed that all staff on duty had a calm and kind manner when working with individual people.

We spoke with people that use the service and they gave us mixed reviews. Some people told us staff were friendly and helpful and others told us that staff spoke in different languages which they didn't like. People told us that they were regularly involved in different activities and that they could do whatever they wanted. We found concerns in relation to the care and welfare of people using the service, supporting of staff and record keeping.

People we spoke with told us that they liked living at the home and felt safe. They told us they would talk to staff or tell their family if they were not happy. One person told us that they would tell any of the staff or the manager if they had any complaints to make. This person told us that they were happy at the home and did not have any complaints to make. The people told us that the staff were very helpful and listened to them. They called the doctor out when they felt ill. They also helped them with their personal care needs. All the residents we spoke with told us that they did lots of activities at the home, and enjoyed doing this.

The relatives we spoke with told us that they were very happy with care that their family member received from staff. The staff were said to be skilled in the work they did and they were very nice and listened to them.”

The staff we spoke with told us that they enjoyed working at the home and with the people. They told us that they received good training and support from management

We carried out an unannounced inspection of St. Matthews Unit on 30 and 31 August 2016 due to concerns that were raised with the Care Quality Commission. During the inspection we found that:

• The provider placed mental health patients and care home patients together across both wards with no separation.
• Staff did not always update risk assessment’s following incidents. Staff recorded some incidents on the risk summary but did not update care plans when risks had changed.
• Staff were not following safe management processes on the storage, disposal and dispensing of medication.
• The managers did not ensure that staff had received the necessary training to ensure that carry out their role effectively.
• Care plans were not individualised, holistic, or recovery focused. Care plans for specific needs were not routinely followed, reviewed, or updated.
• Individual sessions with patients to discuss care and treatment were not taking place.
• Access to psychological therapies was minimal.
• Staff did not ensure that all areas of the ward were clean, well maintained, and safe for patents use.
• Information governance systems were not robust and learning from investigations or incidents was inconsistent.
• The managers did not ensure that staff received mandatory training.
• The managers did not ensure that regular supervision was taking place in accordance to policy.
• The managers allocated two qualified nurses to each shift across both wards for up to 58 patients. There was no evidence of nurses spending one to one time with patients.