St Jude’s provides accommodation for up to 14 people with mental health conditions in two connected Victorian terraced houses located on the outskirts of Middlesbrough. All bedrooms are single occupancy with en-suite facilities. The home has been extended and there are a number of communal areas. At the time of our inspection 14 people used the service.

At the last inspection in July 2015 the service was meeting the regulations we inspected and we rated the service as ‘Good'. At this inspection we found the service remained 'Good'.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risks and minimise them occurring. Medicines were managed safely with an effective system in place. We have made a recommendation about medicines that staff responsible for the administration of medicines have an annual review of their knowledge, skills and competencies relating to managing and administering medicines

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People told us there were enough staff on duty to meet their needs. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people.

People were supported by a team of staff who were knowledgeable about their likes, dislikes and preferences. A training plan was in place and the registered manager monitored this to make sure all staff were up to date with their training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were able to pick meals of their choice. Staff supported people to maintain their health and attend routine health care appointments.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information about meeting people’s care needs. People were actively involved in care planning and decision making. People who used the service had access to a range of activities and leisure opportunities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met.

We carried out this inspection on the 28 July 2015. The inspection was unannounced which meant the staff and registered provider did not know we would be visiting

St Judes provides lifelong accommodation for up to 14 people with a mental health condition. It consists of two connected Victorian terraced houses located on the outskirts of Middlesbrough. All bedrooms are single occupancy with en-suite facilities. The service has been extended and there are a number of communal areas including two lounges with access to Sky Sports and games consoles, a large dining room area and a pool room. At the time of our inspection there were 13 people living at the service. All 13 people were males.

The service had a registered manager in place and they have been registered with the Care Quality Commission since February 2012. 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 also owned the service.

Risks to people’s health or well-being had been assessed and plans put in place to protect people. People had access to medicines and these were stored and administered safely.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005. Staff gained consent from people where appropriate. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). No-one living at the service was currently subject to a DoLS, however, the registered manager understood when an application should be made.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose. The provider followed safe processes to help ensure staff were suitable to work with people living in the service.

Staff had completed a range of training which was updated yearly and felt supported by the registered manager. The quality of the care and support provided in the service was monitored by the registered manager

There were sufficient staff to provide the support needed and staff knew people’s needs well. Staff had regular supervisions and appraisals to monitor their performance.

Staff provided individualised care for people. They showed respect to people and spoke with them in a kind and caring manner. The provider supported people to be as independent as they could be, to be in employment, education and to remain a part of the community. People’s privacy was respected and people said they felt safe and cared for.

People felt involved in the way their care was planned and delivered. They were able to provide feedback on the service they received and their concerns were addressed.

People were supported to access healthcare professionals and services.

People who used the service had freedom to come and go as they pleased and all enjoyed their own hobbies such as gardening, photography and listening to music.

People’s care records were person centred. Person centred planning (PCP) provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person. The care plans were found to be detailed outlining the person’s needs and risks. Risk assessments were in place. Care plans provided evidence of access to healthcare professionals and services.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents were too few to identify any trends.

We saw that the service was clean and tidy and there was plenty of personal protection equipment [PPE] available. All furniture and fittings were of a high standard.

We observed a lunchtime and teatime meal. People were provided with choice and enjoyed the food on offer. Food was prepared and cooked at the service.

Staff were supported by the registered manager and were able to raise any concerns with them. Lessons were learnt from incidents that occurred at the service and improvements were made if and when required. The service had a system in place for the management of complaints.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety.

The registered provider had developed a robust quality assurance system and gathered information about the quality of their service from a variety of sources.

One inspector carried out this follow-up inspection. During the inspection, we spoke with the manager and the deputy manager.

In our scheduled inspections we always 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? However, we were not able to answer all these questions during this follow-up inspection, because we were only looking at assessing and monitoring the quality of service provision and records.

This is because we had identified non-compliance with assessing and monitoring the quality of service provision and records at our last inspection in May 2014. This meant that audits were not taking place and records were not accurate and up to date. We went back to check that the home had taken action to ensure that audits were now taking place and records were now fit for purpose, accurate and up to date.

The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and from looking at records.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that audits were now in place to check the cleaning schedule, health and safety, infection control. Information on how to make a complaint had been updated with the correct contact details and although there had been no complaints received since our last inspection; the manager now understood the need to document these no matter how small.

There were weekly audits in place to check that people’s personal allowance was being managed safely. Written protocols of what to document when money was added or removed had been put in place and all staff had been trained on these.

Some records such as the behaviour that challenges policy, which had been unavailable during the last inspection had been located and stored appropriately.

Signatures or initials of the person checking in medication was now documented on the Medication Administration Record (MAR) although quantities were just ticked to say they were correct. Handwritten entries onto the MAR chart still did not have two signatures, one for the person who had written the information and a witness to verify what had been written was correct.

There were now stock records of homely remedies. Audits took place weekly for all medication stock.

Is the service well-led?

Minutes from staff and resident meetings were now available for us to see. Daily handovers were fully documented with what was discussed and not just a tick. The manager was carrying out monthly audits and was delegating more responsibility to staff.

Is the service effective?

The home responded quickly to the areas of non-compliance identified with assessing and monitoring the quality of service provision and records during the last inspection. The home promptly sent us an action plan which set out the action which they were going to take.

We found that the home had made significant improvements to the audits and quality of record keeping. We saw that a small amount of work was still needed in some areas but overall the standard of record keeping had significantly improved.

Both the manager and the deputy told us that they had become complacent, doing the work but not fully documenting it and also not making staff more accountable for their actions. They felt that the inspection process had been very helpful and resulted in meaningful improvements.

The inspection team consisted of one inspector. During the inspection, we spoke with five out of 12 people living at St Jude’s Residential Care Home, the deputy manager and five staff; the manager was on holiday at this time. We looked at three sets of care records. We also observed care practices within the home. We found the home had a positive environment for people and staff.

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

Is the service safe?

People told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe.

The service was clean, hygienic and well maintained. There were processes in place that ensured infection prevention and control of the home. There were no audits in place to check these processes were working.

We saw gaps in financial records, medication records and quality assurance records. Records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because records were incomplete. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been submitted to the local authorising authority, the home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults, dealing with behaviour that challenges and had an understanding of the actions to take. This meant that people were safeguarded as required.

Is it caring?

Peoples care plans provided information on their medical and personal life history. The care plans detailed ‘what I can do for myself,' ‘what support I need’ and ‘how will the home meet my needs in this area.’

Care plans were individualised and included people's preferences, interests, aspirations and diverse needs. Our observations of the care provided showed that staff were very knowledgeable about people's needs and wishes. Care records listed people's wishes and wishes that had been granted, such as one person who used the service wished for a bike and that wish was granted.

People told us that they were happy with the care and support provided to them.

People who used the service were supplied with an easy read document for each medication they were taking, stating what the medication was for, why they needed to take it and how it should be taken.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs. It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew them well. Assessments included mental health, medication compliance and behaviour that challenges.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

People had access to a range of health care professionals such as the dentist, podiatrist and social workers, some of which visited the home and all was documented in the care files.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to. The home was responsive to people's needs, wishes and preferences. We saw that the people who used the service could come and go as they pleased.

There had been no accidents or incidents reported since 2008. The service did have a reporting tool ready if there were to be an accident or incident with an action plan and lessons learned section.

Is the service well led?

We did see a cleaning schedule but there were no audits in place to make sure this schedule was adhered to and was working.

We looked at the finance records for the people who used the service's personal allowance system. We looked at the finance records for 10 people and found that there were discrepancies with five of them.

The service did not have any records of quality assurance systems in place. Therefore the registered manager was not protecting the people who used the service and others against the risks of inappropriate or unsafe care and treatment. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

What people said:

People who used the service were very happy with the care they received. One person we spoke with said, “We are spoilt, I love it here.” Another person said, “I am really pleased with the care I am receiving,” and “It is excellent here and exciting, I love the trips, I love Liverpool.”

Staff members told us they loved working at St Jude’s Residential Care Home. Staff members we spoke with said, “The lads and staff are lovely,” and “I have a good bond with the person I one to one with, he trusts me,” and “I am always itching to get to work, I love it, I often pop in on my days off to see the lads.”

During this inspection we looked at the care/support records for two people, spoke with the manager and two members of staff. We also spoke with two people who used the service and spent time observing daily life within the service.

We saw that St Judes provided an extremely relaxed and homely environment for people, which promoted people's confidence and independence.

People we spoke with told us that they were always treated with dignity and respect by the staff. Comments included, “It is marvellous, I have a good life.” “I can do what I want to do.” “There is definitely enough staff, they are all really nice.”

We found that care/support plans provided staff with the information they needed to meet people's needs.

We found the service worked well with a range of health and care professionals ensuring that people physical, mental and social care needs were met.

We found that people had access to all of the equipment they needed and the provider had procedures in place for ensuring safety of equipment in use.

There were sufficient staff with an appropriate skill mix to meet people's health and social care needs.

Records were accessible and stored securely.

We spoke with two people who used the service. They told us they were treated well and the staff were very good. One person said, “We are treated like family”, another person said, “I love it here.”

We found that people were treated with dignity and respect. We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. People we spoke with talked enthusiastically about activities and holidays they had been on. One person said, “We are off to Liverpool in March, I am really looking forward to it.” This contributed to maintaining people's welfare and promoting their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable and that people were supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the home.