This inspection took place on 22 November 2018 and was unannounced. This meant no-one connected to the home knew we were visiting that day.

Wainwright Crescent provides step down and respite support for people with mental health conditions. The aim is to support and assist people to manage their mental health and wellbeing, develop their skills and confidence to maintain living in the community. Wainwright Crescent can accommodate a maximum of 12 people. At the time of this inspection there were eleven people using the service. Typically, people can stay at Wainwright Crescent for a maximum of 28 days. However, this can be extended depending on people’s individual circumstances.

Our last inspection of Wainwright Crescent took place on 12 September 2017. The service was rated requires improvement overall with one breach of regulation. We found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014, safe care and treatment. At this inspection we found sufficient improvements had been made to meet the requirements of this regulation and the service is now rated good overall.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 living at the service told us they felt safe. Staff were aware of their responsibilities in protecting people from abuse. We found systems were in place to make sure people received their medicines safely so their health needs were met. With the exception of October and November 2018, regular checks and audits of medicines management were undertaken to make sure full and safe procedures were adhered to. We have made a recommendation about the service’s medicine management policy as this had not been reviewed.

On the day of the inspection we found there were sufficient numbers of staff to meet people’s needs and it was evident that staff had been safely recruited. During the inspection we observed staff treated people with respect and dignity, and staff supported them in a way which met their needs.

We found very clear evidence that people’s care and support was planned and reviewed with them and not for them. The people we spoke with told us the standard of care they received was good. People’s care records contained detailed information and were recovery focussed. The service encouraged people to maintain a healthy diet and worked collaboratively with external services to promote people's wellbeing and positive discharge outcomes. Staff told us they enjoyed working at the service and had received support, training and supervision to help them to carry out their roles effectively. 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 support this practice.

People told us staff were caring and kind and as a result of the emotional support they had received from staff, they felt more confident. We saw the service promoted people’s independence by supporting people to manage their own routines, such as cooking, cleaning and washing. People who were assessed as safe to do so were supported to administer their own medicines. People were able to access their local community and the service provided regular opportunities for meaningful and stimulating social diversions, with an emphasis on improving people’s mental well-being.

We found a strong leadership framework in place. This meant there was clear lines of accountability within the organisation and systems which supported the running of the service were well-embedded.

This inspection took place on 12 September 2017 and was unannounced. This meant the staff and provider did not know we would be visiting. The service was previously inspected on 10 and 17 May 2016. At that inspection we found the registered provider was in breach of the following regulations: Regulation 12: Safe Care and Treatment and Regulation 17: Good Governance. Following the inspection, the registered provider sent us an action plan to say what they would do to meet legal requirements in relation to these breaches. At this inspection we checked that they had followed their action plan, and to confirm that they were meeting all of the legal requirements.

Wainwright Crescent provides respite support and step down support for people with mental health conditions. It can provide a service for up to twelve people. At the time of the inspection there were eleven people using the service. One person was admitted on the day of the inspection. Wainwright Crescent was in the process of changing its function and the proposed new model was to increase step down provision and reduce the respite provision. The service would also provide short stays for people using the Community Enhancing Recovery Team (CERT) service.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

At the last inspection we found people were not always protected against the risks associated with the management of medicines. At this inspection we found sufficient improvements had been made to ensure medicines were managed safely at the service.

At this inspection we found new concerns about some people’s risk assessments. An assessment of risk had been completed prior to a person being offered a place at the service, but this required improvement.

We also saw the assessment of people’s individual potential risks and/or the measures in place to reduce and manage the risks to the person required improvement. Although we did not find this had negatively impacted on people using the service; this presented a risk that staff may use inconsistent and ineffective practices to support people. We spoke with the registered manager at the time of our inspection, and they assured us immediate action would be taken to review people’s risk assessments and care plans.

This was a continued breach in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At the last inspection we found that ineffective systems were in place to monitor and improve the quality of the service provided. This was a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we saw a plan of action had been completed by the registered provider to improve the systems in place to monitor and improve the quality and the safety of the service provided. We saw these systems had been embedded in practice. We saw sufficient improvement had been made to meet the regulation. However, our findings during the inspection showed the system in place to audit peoples care plans required additional improvements. We shared this feedback with the registered manager; they assured us immediate action would be taken to make these improvements.

People we spoke with told us they felt ‘safe’ and had no worries or concerns.

Staff recruitment procedures ensured people’s safety was promoted.

Staff had undertaken safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm.

People and staff we spoke with did not express any concerns about the staffing levels at the service.

We did not find any concerns about i

This unannounced inspection took place on 10 and 17 May 2016. The home was previously inspected on 24 November 2014 when we found one breach of regulations. This was regarding a lack of effective systems being in place to monitor the quality of the service delivery.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link

for 'Wainwright Crescent' on our website at www.cqc.org.uk'

Wainwright Crescent provides respite support and step down support for people with mental health needs. It can provide a service for up to twelve people.

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

At this inspection we found improvements had been made. However, although systems were in place to monitor the quality of the service these were not always effective and we found a continued breach in regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

People we spoke with, that used the service told us they were very happy with how care and support was provided at the home. They all spoke extremely positively about the staff and the way the home was managed.

People told us they felt safe living at the home. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people, and management plans to reduce the risks were in place to ensure people’s safety.

People were not always protected against the risks associated with the unsafe use and management of medicines. Policies and procedures did not ensure appropriate systems were in place for the recording, safe keeping and disposal of medicines.

We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

There was predominantly enough skilled and experienced staff on duty to meet people’s needs. However, some staff felt additional staff would be beneficial at key times, such as weekends and bank holidays when management were not at the service. Although this was being addressed at the time of our inspection.

There were robust recruitment procedures in place. Staff had received formal supervision and an annual appraisal, although this was not always documented in line with the provider’s policies. Staff received training to be able to fulfil their roles and responsibilities.

People’s nutritional needs were met. People purchased and cooked their own food during their stay and support was provided by staff as required.

People’s needs had been assessed before they went to stay at the home and we found they had been involved in planning their care. The care files we checked reflected people’s main needs and preferences so staff had clear guidance on how to care for them. However, we found these were not always reviewed.

People had access to activities which provided regular in-house stimulation, and people accessed the community independently during their stay.

There was a system in place to tell people how to make a complaint and how it would be managed. However, complaint outcomes wer

Our inspection visit was unannounced and took place on 24 November 2014.

Wainwright Crescent provides short stay respite accommodation for people with mental health difficulties. The service has 12 registered beds. Five of these beds are for planned respite stays. One bed is for emergency respite stays and the remaining six beds are step-down beds. These are beds for people who have been identified as ready for discharge from hospital, but are waiting for appropriate accommodation or for essential repairs to their existing accommodation to be competed.

The service was last inspected by the Care Quality Commission (CQC) in January 2014 and was found to be meeting regulations relating to consent to care and treatment, care and welfare of people who use services, cleanliness and infection control, staffing and complaints.

As well as speaking with each person using the service, we also undertook a number of informal observations in order to see how staff interacted with people and see how care was provided.

During our inspection visit we spoke with four support workers, the deputy manager and the 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.

We found that some checks had not been undertaken in order to ensure that people were being supported in a safe, suitable environment. For example, a review of the risks posed by the fittings and fixtures within the premise’s had not taken place since 2010. We also identified that weekly fire safety checks were not taking place. No fire safety checks had taken place in May 2014 and only one check had taken place in June and August 2014.

Our conversations with staff and our review of records highlighted that the frequency of staff supervisions far exceeded the provider’s recommended six to eight weekly timescale. For example, one member of staff had not received supervision since September 2012. Staff told us that they had undertaken a range of relevant training courses. No record was kept to comprehensively document the training courses staff had undertaken. The lack of this record together with the lack of staff supervision increased the risk of people receiving unsafe care and treatment.

Whilst checks took place in relation to some areas of the service, we identified that audits relating to certain key areas of practice did not take place. For example, the shortfalls identified during our inspection in relation to the premises, supervision and training had not been identified by an internal auditing system.

People told us they felt safe when staying at the service. Staff knew how to recognise and report signs of abuse. Staff understood the risks associated with people’s care and protected them from harm. Staffing levels were based on people’s needs. There were enough staff with the right skills and competencies on duty to meet the needs of people who used the service. An effective recruitment procedure was in place to minimise the risk of abuse.

People were positive about the premises and the way in which these enabled them to manage their mental health needs. The premises were adapted to differing needs of people who accessed the service. For example, there was a visual door bell and fire alarm to meet the needs of people with hearing impairments, as well as a low cooker and kitchen units to meet the needs of people with mobility difficulties.

People were encouraged to make healthy food choices. The provider worked closely and effectively with health and social care professionals to ensure that people’s needs were met. Staff supported people to attend and access health and medical appointments when needed. Visits to and from visiting health and social care professionals were recorded.

People’s needs were assessed before they received respite care at the service. Checks were undertaken prior to, and during people’s respite stays to ensure that information within people’s support plans was accurate. People told us they were fully involved in their support plans and were provided with opportunities to express their views about the service.

Staff were knowledgeable about the Mental Capacity Act 2005 and provided examples of when they had identified that people’s mental health needs had impacted upon, or caused their capacity to make decisions to fluctuate.

Staff treated people with kindness and consideration and understood the individual needs of people they supported. They respected people’s privacy, confidentiality and differing needs and cultural backgrounds. A range of external and internal activities were provided to meet people’s differing needs.

The service promoted a culture which encouraged people to promote, shape and develop the future direction of the service. People and staff were positive about the registered manager and the way in which she led the service.

Our inspection identified one breach 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.

We found there were effective processes in place to ensure people’s consent to treatment and capacity to make decisions had been adequately managed.

We talked with four people who used the service. They told us they were happy at the service, happy with the care they received, liked the staff who looked after them, and felt well supported. Some comments captured included, "It’s lovely here,” “I look forward to coming (for respite),” “Everybody (staff) very, very nice …very helpful,” “It’s a lifeline for me and my family,” “Staff know me and my needs,” and “Care is 100%.”

During our inspection we conducted a tour of the premises and found it was clean and tidy. There were systems in place to reduce the risk and spread of infection.

We found people’s needs had been met by sufficient numbers of appropriate staff.

We found there was a complaints process in place.

People we spoke with told us they found the service excellent. They said the staff were brilliant, looked after them, were approachable and listened to them. One person told us, “I wouldn’t manage without this service.”

Another person we spoke with said that regular meetings were held, where they discussed many things. The said if they raised any concerns they were resolved.

People also told us that staff treated them with respect, listened to them, gave them choices, made them feel safe and supported them in activities they liked.

Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed.

There was an effective system to regularly assess and monitor the quality of service that people received. There was a complaints policy that took account of complaints and comments to improve the service.

You can see our judgements on the front page of this report.

It was not possible to gain the direct views of people who use the service on this occasion as the assessment was conducted remotely. However a range of information was obtained that demonstrated how the provider ensures people who use services are involved in decisions about services and how their views are obtained. Submissions from the Sheffield LiNK (local involvement network) demonstrated how the provider has worked with and involved LiNK participants in influencing the city wide strategy for improving mental health services in Sheffield. For example, the LiNK participants work on recovery wards had been fed back to managers and staff, leading to changes in care in respect of service users' sexuality, spirituality and problems with social interaction. The LiNK has been involved in the quality reporting process with the provider and stated “we are pleased with how we have been engaged in this and we will possibly be doing some joint enter and view visits.” The provider included some views of people who use services who had fed back comments as part of its last complainants survey, for example, one comment stated, “I like the face to face contact. I felt they understood our concerns and did their best to address them”.

Through a team governance report for this location we found people who use services had been able to have input into the recruitment process, newsletter and transformation of the ‘relaxation room’ and another initiative included a women’s space for 4 nights which had received positive feedback.