The inspection took place on 16 and 17 April 2018 and was announced.

At the last inspection in August 2016 we rated the service ‘Requires Improvement.’ This is because we needed to be assured that improvements made following the February 2016 inspection were sustained. At this inspection we found the service had sustained these improvements and further developed the service.

Redburn House provides personal care and support to people living in their own homes with mental health needs. Until March 2018 Redburn House had been registered as a care home, but was now one of 11 supported living settings where staff provided personal care and support. Supported living settings allow people to live in their own home 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. In addition, the service provides a domiciliary care service to people. Most people received minimal personal care comprising of prompting with washing, showering and continence. At the time of the inspection, 26 people were receiving personal care from the service including the prompting of personal care.

A registered manager was not in place. The provider had made the decision to become the registered manager for the service and submitted an application which was in the process of being assessed by the Commissions registration team. 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 said they felt safe using the service. Staff knew how to identify and report any concerns. Risks to people’s health and safety were well managed by the service. Following adverse events, action was taken to improve the safety of the service. Medicines were managed safely and people received their medicines as prescribed.

There were enough staff deployed to ensure people received a consistent level of care and support. Staff were recruited safely to ensure they were of suitable character to work with vulnerable people. Staff received a good level of care and support to enable them to meet people’s individual needs.

People’s nutritional needs were assessed and people were supported to ensure they ate and drank appropriately. The service worked with a range of professionals to help meet people’s healthcare needs.

The service was compliant with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Care was delivered in the least restrictive way possible and people were involved in decisions relating to their care and support.

Staff were kind and caring and treated people well. People spoke positively about the staff that supported them. Staff had developed strong relationships with people and people were cared for by familiar faces. People were encouraged to develop and maintain relationships with other people who used the service. People’s views and opinions were sought and used to make improvements to the way care and support was provided.

People’s care needs were met. Care and support plans were detailed and demonstrated a thorough assessment of people’s needs. We found appropriate care was delivered in line with these plans. People’s care needs were subject to regular review.

People were encouraged to maintain links with the local community and undertake a range of activities.

Complaints were recorded, investigated and responded to in a timely way. People said they were happy with the way the service was provided.

People spoke positively about the way the service was managed. They knew the management team and said they were approachable. There was

The service consists of Redburn House which provides accommodation and personal care for up to ten people with mental health needs. At the time of the inspection eight people were living in Redburn House.

The provider has an additional registration for personal care which allows it to provide services in the community. Supported living services are provided at seven properties, where staff support people to rehabilitate and develop life skills. In addition, the service provides a domiciliary care service to people in their own homes. The vast majority of this is out of the scope of registration with the Care Quality Commission as it consists of social inclusion and emotional support. At the time of the inspection, we identified one person was receiving a small amount of personal care from the domiciliary service.

At the last comprehensive inspection in March 2016 we identified four breaches of regulation, rated the service as 'inadequate’ overall and placed it in special measures. At this inspection we found significant improvements had been made driven by a service improvement plan. Increased management support had been provided and we found the provider to be no longer in breach of any regulations. This means the service is no longer in special measures.

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.

People provided positive feedback about the service. They said they were treated fairly by staff and staff had provided a good level of support in helping them to increase their independence.

Improvements had been made to the medicine management system. Medicines were better organised and people were consistently receiving their medicines as prescribed.

People told us they felt safe using the service. Risks to people’s health and safety had been fully assessed and clear and person centred plans of care put in place which were understood by staff.

Where incidents had occurred, we saw evidence of clear preventative measures being put in place to help keep people safe. Staff and management were clear about their role in reporting and investigating incidents.

There were enough staff deployed to ensure people received appropriate support and interaction. Safe recruitment procedures were in place with staff files now better organised.

Following the last inspection, improvements had been made to staff training provision. Staff had received training specific to their role working for example in ‘Challenging Behaviour.’ Staff were provided with regular support, appraisal and supervision.

The service was working within the legal framework of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Care and support was delivered in the least restrictive way possible.

People were supported appropriately to eat and drink. People were encouraged to prepare meals for themselves to help develop independence and life skills.

People told us staff treated them with dignity and respect. This was confirmed in the observations of care and support that we witnessed.

People’s needs were assessed by the service and clear and person centred plans of care put in place. These were now easy to navigate and well structured.

People were told how to complain and any complaints were logged, investigated and measures put in place to prevent a re-occurrence.

People were supported to undertake a range of activities and maintain links with the local community.

Significant improvement had been made to the systems in place to assess, monitor and improve the service. A range of audits and checks were now undertaken in a structured way and these were effective in identifying issues

The inspection took place on 21 March 2016 and was an unannounced inspection. This meant the provider had no prior notice of our inspection. The service consists of Redburn House which provides accommodation and personal care for up to ten people with mental health needs. In addition, the provider had a separate registration for personal care which allows it to provide services in the community. Supported living services are provided at seven properties, where staff aim to support people to rehabilitate and develop life skills.

On the date of the inspection there were 29 people using the service.

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.

During our previous inspection in August 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to Good Governance, Safe Care and Treatment and Staffing. As part of this inspection we checked whether improvements had been made in these areas as well providing an updated rating for the service under the Care Act 2014. At this inspection, we identified the provider had not made the required improvements and was still in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were still not managed in a safe way. Stock levels of medicines did not match with what was recorded as present, meaning some medicines were unaccounted for. Some medicines were not given in line with the prescribers instructions.

Safeguarding procedures were in place which staff had a good understanding of. People we spoke with told us they felt safe living in the home and when cared for in the community. Some risks to people’s health and safety were assessed with clear plans in place. However there were some notable admissions with a lack of risk assessments in place detailing how staff supported people safely whilst taking them out in the community.

Incidents were not always managed in a safe way. We saw where medication errors and behavioural incidents had occurred robust preventative measures were not always put in place. We were concerned that behavioural incidents had occurred where staff had not received appropriate training.

There were sufficient staff to ensure people received an appropriate level of care and support whilst allowing them to maintain a level of independence.

Although recruitment procedures had been improved shortly before the inspection, we were concerned that a staff member had been recruited in an unsafe way in November 2015.

Some areas of the premises were not safe as they had not been adequately checked and maintained by staff.

We were concerned about the managers understanding and application of the Mental Capacity Act and Mental Health Act (MHA). There was a lack of monitoring of a person’s care and as such as change in their circumstances had not been identified by the service.

People had access to a range of health professionals and we saw their advice was regularly sought for example over behaviours that challenge or health conditions.

Staff had received basic training in a number of subjects. However there were a number of key omissions with a number of staff not receiving even basic training in subjects such as behaviours that challenge and mental health awareness.

We observed the lunchtime and saw the food looked appetising. However we identified that nutritional risks associated with one person were not well managed by the service.

Staff were kind and caring and treated people with a good level of dignity and respect. Care was delivered by a stable group of staff who knew people well. We observed car

The inspection took place on 11 August 2015 and was an unannounced inspection. This meant the provider had no prior notice of our inspection. On the date of the inspection there were 48 people using the service. The service consists of Redburn House which provides accommodation and personal care for up to ten people with mental health needs. In addition, the provider had a separate registration for personal care which allows it to provide services in the community. Supported living services are provided at seven properties, where staff aim to support people rehabilitate and develop life skills. Domiciliary support is also provided to a small number of people in their own homes.

During our previous inspection in May 2014 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches related to Records and Assessing and Monitoring the Quality of Service Provision. As part of this inspection we checked whether improvements had been made in these two areas as well as to provide a rating for the service under the Care Act 2014.

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.

We found the provider had failed to make sufficient improvements in the two areas where we identified breaches of regulation in May 2014. Some aspects of record keeping were now improved. For example care plans were more concise with less repetition and no blank pages were present. However documentation showed that two people’s weights were not being recorded in line with the frequency set out in their care plan. This was similar to an issue identified in May 2014 showing action had not been taken to address previously highlighted risks.

We also found deficiencies in quality assurance systems operated by the service still remained. Medicine management audits were not sufficiently robust and had not identified the issues we found during the inspection. There were no audits of care plans and overall care quality despite the provider’s policies showing these should be periodically undertaken.

We found the provider had not reported all required notifications to the Commission as it had failed to notify us of all allegations of abuse.

People told us they felt safe using the service and did not raise any concerns with us. Routine risks to people’s health and safety were assessed in a range of areas to help staff support them to lead their daily lives in both a safe and enabling manner. However following safety related incidents, we found robust investigations were not always undertaken to review the root cause of incidents and help prevent re-occurrences.

At Redburn House, we found most aspects of the premises were safely managed. However we found no radiators at the home were covered or were of a cool panel design. We identified this meant some people who used the service were potentially at risk of sustaining a burn injury.

Medicines were not safely managed. Controlled drugs were not administered in a safe manner as one staff member was administering them with no checks or supervision from other staff. There was a lack of robust stock control measures to ensure all stocks of medicines were accounted for.

Staffing levels were sufficient to ensure people received the required care and support. We saw staffing levels allowed staff the time to interact positively and form good relationships with people.

People spoke positively about the food provided by the service. Some people were independent and could make their own food and drink and we saw these people were provided with appropriate guidance and support where required. At Redburn House a cook was employed and provided a varied menu based on people’s choices and preferences.

We found gaps in staff knowledge and skill, for example around restraint and safeguarding. There were no regular checks on staff skill and knowledge to ensure they had the required skills to effectively undertake their role. Although staff received mandatory training, some of this was overdue an update. Some training was also not provided to staff despite policies stating it should be.

People’s healthcare needs were assessed and clear plans of care put in place to help provide effective healthcare support. People had access to a range of health professionals.

The service had not been fully acting within the legal framework of the Mental Capacity Act as for one person a Deprivation of Liberty Safeguards (DoLS) authorisation had been incorrectly transferred from another location. However during the inspection immediate action was taken to rectify this with an urgent authorisation sought. In other cases, DoLS had been correctly applied for and the service was following the conditions of the authorisation showing it was acting within the correct legal frameworks.

We found staff and management to be dedicated to providing a caring, person centred service to the people they supported. Staff were kind and caring and treated people with dignity and respect. Care plans contained detailed information on people’s likes and dislikes and the staff we spoke with knew people’s preferences well. People were involved in their care and support and told us they felt listened to.

People were supported to undertake activities and live an active life with community involvement and social interaction encouraged. We found more could have been done to support people to set and achieve measurable goals relating to rehabilitation and developing life skills.

People and staff told us the management were effective and took action to address any issues. People’s feedback was regularly sought through service user meetings, care plan reviews and quality questionnaires. We saw evidence the service acted on feedback to improve the service.

We found three 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 this report.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Safe

People told us they felt safe at the home and nobody raised any concerns regarding their safety or wellbeing. We saw evidence that risk assessments were produced where harm to people was identified. These contained control measures to guide staff in how to keep people safe.

The manager understood their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). No DoLS applications had been made by the home. The manager had been on a management course on MCA and DoLS and other staff had received basic training in the subject. We did not see any restrictions of people’s freedom during the inspection, with people free to leave the home as they pleased.

The provider had effective systems in place to log, and investigate incidents in order to keep people safe. These were reviewed by the manager to monitor for any themes or trends.

We found the premises were adequately maintained, with spacious living and bedroom areas. We identified one risk during the inspection, concerning access to one of the staircases. Following the inspection we received confirmation that action had been taken to restrict access to this staircase, to keep people safe.

Effective

People told us they were happy with the care they received. The staff we spoke with understood the needs of the people they were caring for, which allowed them to deliver effective care.

People had choices with regards to their daily lives, for example we saw people were involved in the creation of the weekly menu.

It was clear that people’s needs had been assessed and staff knew the habits, preferences and needs of the people they cared for. This allowed them to deliver effective care. Care plans contained information on people’s likes and personal preferences and it was clear they had been produced in conjunction with people who used the service. Goals and objectives were in place for people and we saw examples of how people’s independence had improved since they started using the service.

People had access to a range of health professionals and there was evidence their advice was recorded to enable staff to deliver appropriate care.

Caring

The feedback about staff from people who used the service was overwhelmingly positive, with people saying they were treated with dignity and respect. One person told us “staff sympathise with me if I had a bad day.”

Observations during the course of the day, confirmed to us that people were treated well by staff with staff providing a mixture of support, and encouragement for people to do tasks for themselves to improve their independence.

Responsive

We found the service was responsive to people’s changing needs. Where people had raised minor concerns about the home or their care, we saw these had been fully investigated by the management and robustly documented. This included any agreed actions and changes in care and support to meet people’s changing needs.

Most people had been using the service for around 6 months. Mechanisms for care plan review involving people who used the service were in place, although these had not yet been completed.

A range of activities and events were available for people to participate in. These included “ladies mornings”, walks and trips out , for example to a theme park. People were encouraged to be involved in the organisation of events to improve their life skills, for example one person was organising a charity event.

Well Lead

People who used the service spoke positively about the manager and owner and said they were good at addressing any concerns they raised. Staff we spoke with also said management were effective.

We found systems and processes were in place to investigate concerns, complaints and incidents such as safeguarding to ensure concerns were addressed and continuous improvement to the service was made.

Policies and procedures and documentation were in place setting out the audits the service would do to access the quality of the service. However, these monthly audits such as medication, spot checks, infection control and care plan documentation had not been completed. This risked that people did not receive appropriate care as audits and checks on the quality of care were not in place.

We found care records required improvement. Records were bulky and many sections were missing information, and had not been updated consistently. This made it difficult to locate relevant and current information on people’s care. This risked that people received inappropriate care or treatment as proper and accurate records were not in place.