About the service: 20 Leonora Street is a nursing home, providing personal and nursing care for up to 16 people with long term, complex mental health needs. At the time of the inspection there were 14 people living at the home.

People’s experience of using this service:

People who used the service were supported safely. People accessed a range of activities and attended day trips. People were supported to be independent. People’s choices and preferences were known to staff and respected. Staff were caring, kind and respectful. People’s privacy and dignity was promoted.

People had care plans and risk assessments in place which gave staff guidance to effectively support them. Staff supported people, with their individual preferences and people’s needs were met. The provider had plans in place to improve the environment.

The provider had systems in place to monitor the service and ensure risks to people and the environment were reduced. Lessons were learnt went things went wrong and systems were updated or improved if needed. The managers were responsive and approachable to both people that used the service and staff. They had a clear understanding of their responsibilities of their registration with us.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection:

At the last inspection the service was rated as; Requires Improvement (report published 10 February 2017)

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

We inspected this service on 11 January 2017. This was an unannounced inspection. At our previous inspection in June 2015, we found there were Regulatory breaches and improvements were needed to ensure people received care that was safe, effective, responsive and well-led. The service was rated as ‘requires improvement’.

The service is registered to provide accommodation and personal care for up to 16 people. People who use the service have enduring mental health needs. At the time of our inspection 15 people were using the service. One of these people were receiving inpatient care at a local hospital.

The service had a 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 and associated Regulations about how the service is run.

At this inspection, we found that that the service was no longer in breach of the Regulations as many improvements had been made. However, further improvements were still required to ensure people consistently received care that was safe and well-led.

Systems were in place to assess, monitor and improve quality. However, these systems were not yet consistently effective.

The information staff needed to keep people safe from harm was not always accurate and up to date. This placed people at risk of harm.

Staff knew how to identify and record abuse. However, effective systems were not in place to ensure all incidents of alleged abuse were reported to the registered manager and local authority as required.

People received their medicines as prescribed, but improvements were needed to ensure all medicines were labelled appropriately and promptly destroyed when they exceeded their use by date.

Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing. Staff were recruited safely to ensure they were suitable to work at the service.

Staff received training that provided them with the knowledge and skills to meet people’s needs.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals when needed.

Staff knew people well which meant they could interact with them positively and effectively. People were treated with kindness and respect and staff promoted people’s independence, dignity and right to privacy.

People were involved in the assessment and review of their care and staff supported and encouraged people to participate in leisure and social based activities that met their personal preferences.

People knew how to complain about their care and an effective system was in place to manage complaints.

Feedback from people was sought to enable the provider to identify if improvements to care were needed.

The registered manager understood the requirements of their registration with us and they reported notifiable incidents to us.

We saw that people in the home look well and were dressed appropriately. The home provided a clean, relaxed and homely environment. A person told us, "I am happy here".

People had been encouraged to personalise their rooms with their own pictures and furniture. A relative told us, "This is X's home and X has been able to have their own things around them".

We saw that people had developed friendships and companionship with each other. People were relaxed in the company of staff. We saw staff providing care with compassion.

Our observations during this inspection supported that there was enough staff available to ensure people received the right care, at the right time. We found that minimum staffing levels identified and planned for were being met. The recruitment and planning of staff ensured that staff had the required knowledge and skills needed to meet people’s needs.

People were treated as individuals and supported to be involved in all aspects of their life as much as possible. We observed that staff treated people with respect, communicating in a way that maximised their involvement in their care. We spoke with three people at different times during the inspection. They all expressed that they were treated with respect and having the freedom to make choices. One person told us, “We have a good quality of life here.”

We spoke with four members of staff. They all demonstrated a good understanding of the types of concerns that could constitute abuse and what their responsibilities to protect and keep people at the home safe. The people we talked to told us that they felt safe at the home and had no concerns about how staff treated them.

We reviewed the care and support plans in place for three people living at the home. We found there was sufficient information provided on how to support people. There was evidence that learning from incidents took place and appropriate changes were made. One person we spoke with told us that the staff, “Understand us and what we need.”

We carried out this review because we had not visited this service for sometime and did not have recent information about the service.

This is a home for up to 16 people who have been diagnosed with a severe mental disorder and need a level of care and support to maintain their quality of life.

We spoke with eight people during our visit and asked them about the support and service the home provided. People said that they were happy living at Leonora Street.

People said that staff treated them well, they were able to decide what they wanted to do each day and that they used the nearby community services as they wished.

Some people attend a nearby social club specifically catering for people who have mental health needs. One person told us that they had a job there and helps to run the club. Several people talked about going home to see their family, or family members visiting.

We were told that each person sees their consultant psychiatrist regularly. Two people confirmed this saying they had care planning meetings with them twice a year.

We inspected this service on 17 and 18 June 2015. The inspection was unannounced. At our previous inspection in October 2013, the service was meeting the regulations that we checked.

The service provided accommodation and nursing care for up to 16 people who have long term, complex mental health needs. Sixteen people were living at the home on the day of our inspection.

There was a registered manager in post at the time of our inspection. 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 was not at the home on the day of our inspection. On the second day of our inspection, we met with the service director who had been allocated to take responsibility for the home in the absence of the registered manager.

The provider had not informed us of some important events that had occurred in the service. The provider did not always notify us of referrals made to the safeguarding authority or when incidents were reported to the police and failed to notify us of a deprivation of liberty safeguard approval.

The provider did not monitor and review staffing levels to ensure there were always enough staff to meet people’s needs. There were no systems in place to ensure staff received effective induction, training and support to meet people’s needs. Staff received supervision but this was not sufficient to meet the needs of nursing staff that required feedback and support regarding their clinical practice. Some staff felt the manager did not promote a positive, open culture at the home that encouraged all staff to raise concerns and question practice.

Staff understood the provisions of the Mental Capacity Act 2005 (MCA) but did not always recognise that people were being restricted. One person was under a Deprivation of Liberty Safeguard at the time of our inspection and one application was pending.

Most people did not have a personalised care plan to address their identified social needs and people were not supported to engage in activities and maintain links with the local community.

The provider’s monitoring systems in relation to infection control, medicines and the environment were not always effective. The provider had not reviewed complaints and had failed to identify that the procedure was not effective in supporting people living at the home to share their experiences or raise concerns.

People who were able to tell us their views said they felt safe living at the home. Staff understood their responsibilities to keep people safe from harm. Risks to people’s health and wellbeing were assessed and plans were in place that minimised the identified risks. The provider followed appropriate recruitment procedures to ensure staff were suitable to work in a caring environment.

People received their medicines as prescribed and had access to health professionals to support and maintain their health. People’s relatives were made welcome when they visited and staff kept them informed of changes in people’s care and support.

Staff were patient and responded to people in a caring manner. People’s privacy and dignity was promoted and supported by staff. Staff gave people some choice and independence over day to day decisions but people were not always supported to be involved in decisions about their care and support.

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