About the service: 32 South Street is a care home providing personal care to 20 people primarily living with mental health support needs. At the time of the inspection 18 people were receiving care and support.

People’s experience of using this service:

People living at 32 South Street participated in activities, involvement in the local community, and some people were involved with voluntary work roles. Staff showed kindness and compassion and placed value on their caring role and involvement in people’s lives. People were offered a choice of meals and staff closely monitored people assessed to be at risk of poor food and fluid intake.

The service had completed end of life care training to ensure people received high standards of care and support and were involved in the planning of their care at that stage of their life. The service had good working relationships with the local GP practice and mental healthcare professionals.

The service worked in partnership with people and encouraged feedback on the care provided. We received positive feedback from people about the staff and service received. Staff told us they enjoyed working at 32 South Street and spoke highly of the support and encouragement provided by the registered manager.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout, with risk management plans in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good governance arrangements in place, and completed internal quality checks and audits. Findings from these were regularly reviewed by the registered manager and provider.

Rating at last inspection: 32 South Street was rated overall Requires Improvement, with Requires Improvement for responsive and well-led, and good for the remaining three key questions. The report was published June 2018.

The service was in breach of regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service sent us an action plan to provide assurances on how the service would address the breaches. This action plan was reviewed as part of this inspection.

Why we inspected: This was a scheduled, comprehensive inspection, completed in line with our inspection schedule for services rated as Requires Improvement.

Follow up: We will continue to monitor this service and will reinspect in line with our schedule for those services rated as Good.

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

The inspection of Prime Life Limited – 32 South Street took place on 10 April 2018.

Prime Life Limited – 32 South Street 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.

Prime Life Limited – 32 South Street accommodates up to 20 people in one adapted building. On the day of our inspection there were 20 people living in the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

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 2008 and associated Regulations about how the service is run.’

At our previous inspection in October 2016 we found that the provider was in breach of Regulations 12 and 17 of the the Health and Social Care Act (Regulated Activities) Regulations 2014. The provider had addressed some of the concerns and was no longer in breach of Regulation 12. This was because improvements had been made to the premises. However, we identified a continued breach of Regulation 17.

People were not given the opportunity to be involved in the development and review of their care plan. Care plans were not always reflective of people’s current needs. Information relevant to people’s care and support was not always included in the care plan.

The provider had audits and quality assurances in place. However, when deficiencies were identified action to address these was not taken in a timely way with the allocation of appropriate resources. This was a concern which had been identified at the previous inspection.

We have made a recommendation about end of life care planning.

Since our last inspection the provider had made improvements to the environment with the installation of new sanitary ware, curtains and window blinds. This meant that care and support was provided in a way which supported people’s privacy and dignity.

People were protected from abuse and avoidable harm. People living at the service confirmed they were kept safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people. People received their medication as they should. Risks to people were identified and managed to prevent people from receiving unsafe care and support. People were protected by the registered provider’s arrangements for the prevention and control of infection.

People’s nutritional and hydration needs were met and they received appropriate healthcare support as and when needed from a variety of professionals and services. The service worked together with other organisations to ensure people received coordinated care and support.

People were supported to be as independent as possible and engaged in activities both inside and outside the service. Medicines were administered safely and appropriately.

32 South Street is a residential home that provides care, support and accommodation for up to 20 people with mental health needs. There were 17 people living in the home at the time of this inspection.

The service had a registered manager in post. 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.

This inspection found that the provider was in breach of two regulations. These related to safe care and treatment and governance.

People did not live in a consistently safe environment because safety hazards were not always managed appropriately and the premises were not consistently clean and hygienic.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively and minimise any risks. However, some risks were not always managed and mitigated appropriately.

There were a number of systems in place to monitor the quality of the service. Regular audits were also carried out by the manager and provider, in order to identify any areas that needed improvement. However, some of the improvements identified as required were taking a long time to complete and some audits were not effective.

People were supported by staff who were skilled and knowledgeable in their work and new members of staff completed an induction. Staff were supported well by the manager and the manager was being supported well by their direct line manager. There had been an increase in the level of support from the provider, in respect of improving and maintaining the service, although provider level decisions and subsequent improvement actions were slow.

People were helped to keep safe by staff who knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. In addition, staff received training that was relevant for their roles and appropriate recruitment checks were carried out before staff began working in the home.

Medicines were managed and administered safely in the home and people received their medicines as prescribed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance.

People had enough to eat and drink and enjoyed their meals. When needed, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals, when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Visitors were welcomed and people who lived in the home were encouraged and supported to be as independent as possible. People were also supported to follow pastimes or hobbies of their choice.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved in planning their care and received care and support that was individual to their needs.

People and their families and friends were able to voice their concerns or make a complaint if they felt they needed to. People were listened to and appropriate responses and action were taken.

The manager was well intentioned and people’s needs were being met to the best of the manager and staff’s ability. Communication between the manager, staff and people living in the home was frequent and effective.

On the day of our inspection 18 people lived at 32 South Street. We spoke with six people who used the service, the registered manager and three members of staff. We looked at the care records of seven people and at the records for three members of staff.

People who used the service told us that they were informed about proposed changes to care plans, such as changes to medications, and given explanations about why such changes were necessary. We saw staff asking for permission before entering people's rooms.

We looked at care records for seven people. Each record included an assessment of needs and a care plan based on the assessment. People were free to come and go as they wished. One person told us “If I feel like going out, I’ll go out.” People we spoke with were positive about the care and support provided by the staff. One person said “I’m cared for lovely. I do like it here.” Another person told us that the staff at 32 South Street were “…the best of any care home I’ve lived in.”

People we spoke with told us that they felt safe living in 32 South Street. We saw the provider’s policies on safeguarding and on bullying and harassment, both dated August 2011. We also noted that staff had received training on safeguarding of vulnerable adults.

All staff had attended training courses in the previous 12 months, on a range of subjects including mental health, alcohol awareness and medicines management. There was a suitable complaints system in place.

Three people we spoke with told us that they knew what information was in their care plans and that they were involved in making decisions about their care and support.

People said they were able to talk about things in the home and give feedback about the service during regular 'residents' meetings. We were told that staff responded to any issues or concerns that were raised.

Everybody we spoke with told us that their privacy and dignity were respected by staff.

Four people we spoke with told us that they were happy with their rooms in 32 South Street. People told us that their rooms were individual and that they were able to have their personal possessions in them.

Everyone we spoke with made positive comments about the staff and the manager.

People we spoke with said they knew how to make a complaint or raise any concerns. Each person told us that they believed any concerns would be listened to and that they would be taken seriously by staff.

Following the closure of one of Prime Life's other homes, some people had recently moved into 32 South Street. The people who were already living in the home told us that they had been informed about the new people moving in and had met them when they visited.

One of the new people with whom we spoke told us that the closure of their previous home had been explained to them and that they had a choice about where they wanted to move to.

One person said they didn't like living in 32 South Street. Another person told us that the staff were brilliant and helped them if there were any problems.

One person with whom we spoke said the food at 32 South Street was 'Alright' but each of the six other people we spoke with told us they didn't really like the food there.

One person said they would like more pasta meals and another told us that they would like to have salads more often and that, when they did have salad, they would like to have a dressing with it. However, the provider told us that 32 South Street has a four week menu choice, which is contributed to by the people living in the home during the monthly 'residents' meetings and that there are three choices for every lunch and evening meal, often containing salads, pastas and healthy options. We were also told by the provider that salad creams and sauces are available in sachet form for every meal.

People with whom we spoke did say they could have something else if they didn't like the main meal option and people told us that some of the main meals they had were chilli, liver and bacon, chicken pie and shepherds pie. The people we saw during our visit on 25 May 2011 all had cheese on toast for lunch, which they said was 'Alright'.

People with whom we spoke told us that they felt safe living in 32 South Street and that they could talk to their keyworker or the manager if they had any concerns.

Everybody said they knew how to make a complaint. One person did add that there was no point saying anything because nobody listened, although everybody else said their keyworkers and the manager did listen to them when they had a problem.

All the people with whom we spoke told us they liked the new kitchenette.

One person, who had recently moved in, didn't know about the new Jacuzzi style bath but said they wouldn't like it anyway as they preferred a shower.

One person said it was a shame they weren't allowed to feed the birds in the springtime and pointed to the empty feeders, which they said was "Sad". The provider explained that the home was following advice from Environmental Health, which suggested the bird feeders were attracting rats or mice due to the very hot weather and that this has since been reviewed.

We did not speak with people living in 32 South Street about supporting staff but a member of staff told us that they felt well supported by the manager and the provider.

The member of staff also told us that there was a good staff team at 32 South Street, who work well together.

We were also told that there are good staffing levels in the home, with more bank staff being available now and that agency staff were never used.