What life is like for people using this service:

Leadership and management of the service had not ensured people always received a high-quality service. The quality assurance systems in place identified shortfalls in the service, but there was not always effective action to make the necessary improvements.

The provider did not have effective systems to plan how the risks people faced were going to be managed. Risk assessments were not always kept up to date and reviewed when people’s needs changed.

Staff did not always keep accurate records of the medicines they supported people to take. Systems in place to check medicine records at the end of each shift were not effective and did not always identify errors.

Despite the shortfalls in risk management records, staff demonstrated a good understanding of people’s needs and how to meet them.

People were confident that staff had the right skills and felt safe in the service. People felt staff treated them in ways that maintained their dignity and privacy.

Staff were well trained and there were enough of them to provide the support people needed. Staff were thoroughly checked before they worked at the service.

People were confident any complaints would be investigated and action taken to resolve them.

More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 2 June 2016).

About the service:

St Patrick’s House is a care home for people with a learning disability. Six people were living in the home at the time of the inspection. 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.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have told the provider they must improve the service.

St Patrick’s House is a care home which provides accommodation and personal care for up to eight people with learning disabilities. At the time of our inspection seven people were living at the service.

This inspection took place on 30 March 2016 and was announced. We gave the service short notice of the inspection to ensure people would be available to speak with us.

There was a registered manager in post at the service. 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 the last inspection in January 2015 we found medicines were not always securely stored. The provider wrote to us following the last inspection and said they would take action to store medicines safely by May 2015. At this inspection we found the provider had taken action to address this and medicines were safely stored.

At the last inspection we found incidents in which staff had provided physical interventions when people were distressed or angry were not always accurately recorded and followed up to ensure people were safe. The provider wrote to us following the last inspection and said they would take action to keep accurate records of physical interventions by May 2015. At this inspection we found the provider had taken action to address this and ensure clear information was recorded when any physical interventions were used.

At the last inspection we found support plans had not always been kept up to date and accurate. Some of the plans contained contradictory information. The provider wrote to us following the last inspection and said they would take action to update all of the information in support plans and introduce a clearer process by July 2015. At this inspection we found the provider had taken action to address this and support plans were accurate and up to date.

At the last inspection we found the provider had not notified the Care Quality Commission about changes to the management of the service. The provider wrote to us following the last inspection and said they would appoint a new manager who would submit an application for registration. An application for registration by the new manager was successful and the new registered manager was in post and available throughout this inspection.

The provider had taken action to address all of the breaches of regulations associated with the Health and Social Care Act 2008 that we identified at the inspection of January 2015.

People who use the service were positive about the care they received and praised the quality of the staff and management. Comments from people included, “I feel safe and like living here” and “The staff here are very good and know my needs”. People appeared comfortable in the presence of staff. We observed people smiling and laughing with staff.

People told us they were involved in developing and reviewing their support plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were supporting. People told us staff provided the support and care they needed in a kind way.

Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

There was strong management in the service and the registered manager was clear how they expected staff to support people. The provider assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used

St Patrick’s House is a care home which provides accommodation and personal care for up to eight people with learning disabilities, some of whom also have mental health needs. At the time of our inspection seven people were living at St Patrick’s House.

This inspection took place on 12 January 2015 and was unannounced. We returned on 15 January 2015 to complete the inspection.

There was no registered manager in post at the service. 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. The previous registered manager had left the service without cancelling their registration and we had not been informed of the arrangements for the management of the service.

The service did not securely store all medicines they held for people. This increased the risk that people’s medicines may be misused.

People’s care plans and risk assessments were not up to date, and some documents contained contradictory information. This increased the risk that staff would not know people’s current needs or how to meet them.

People who use the service were positive about the support they received and praised the quality of the staff and management. Comments included, “ I feel safe and staff treat me well”; and “They (staff) provide the support that I need”.

Relatives told us they felt people were safe when receiving care and were involved in developing people’s support plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. One relative commented, “I am satisfied that they know (my relative) extremely well, and are able to offer him the security and consistency of care which he requires in order to take part in community life”.

Staff understood the needs of the people they were supporting. We saw that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They received a thorough induction when they started work at the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values of the service. Staff had completed training to ensure they had the knowledge and skills to meet people’s needs.

People were confident they could raise concerns or complaints and they would be listened to. The provider and management team assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

During our visit to the service we were able to meet with seven of the eight people who lived at the home. One person was away on a fishing trip.

We saw some people were able to access the community independently. One person told us they “went out every day.” They said they travelled on public transport and kept the staff team informed of their whereabouts, using their mobile phone.

People spoke positively about the food they received at the home. People were able to choose meals for the menu and there were alternative choices available, if required. Staff told us people were encouraged to make healthy choices.

We toured the building and some people invited us to see their bedrooms. We saw people kept their rooms in the way they preferred. One person explained they liked their room to be “in a bit of a mess.” They said “it’s how I like it.”

People told us they had what they needed in their rooms, such as televisions and CD’s.

The manager said they had recently experienced some issues with staffing levels. They told us the staff team were flexible and had all “pulled together” to cover any shifts. Staff said staffing levels rarely impacted on people attending social activities.

Systems were in place for people to be able to raise any concerns or complaints, if needed. People told us they would speak to the manager or their key worker.

People told us they liked living at the service. One person told us “I like it; I have a nice room and everything I want”. Another person said “I rate this like a 5 star hotel”. A relative said “it is brilliant, I have no worries”.

People we spoke with said they were able to choose what time they went to bed and got up in the morning. One person explained how all of the people using the service were involved in choosing meals for the week.

During our visit we observed there was a good rapport between staff on duty and the people living at the home. People looked comfortable and relaxed in their environment. We saw people making conversation with each other in the lounge.

Care plans covered all aspects of the person’s life. We saw some of the care plans were not dated or signed. This made it difficult to ascertain when they were last reviewed.

We spoke to three people about the medicines prescribed to them. Each person was able to describe why they took medication.

The staffing rota showed staff were flexible in their working hours. The manager said the rota was devised around the needs of people on any particular day.

One person told us they would speak to the staff if they had any concerns or worries. Another person said they would talk to a family member if they were concerned about anything.

We saw from the training matrix the majority of staff were up to date with their training and refresher courses.