23 December 2014
During a routine inspection
We inspected Creative Support - Redcar and Cleveland Rehabilitation Hostel on 23 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
Creative Support - Redcar and Cleveland Rehabilitation Hostel is a 12 bedded residential home providing support for people with mental health needs. The service has facilities to provide support for people during crisis and also respite facitilities. People who use the service need assistance to manage their mental health needs but not normally their personal care needs.
The home had a registered manager in place and they had been in post for over five years. 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 time of the inspection seven people resided at the home, of which two were using the service for respite. The people who lived at the home required staff to provide support to assist them manage their reactions to their emotional experiences. People experienced symptoms of mental health disorders but with the support of staff these conditions had not prevented them leading everyday lives. People’s current level of distress caused by their mental health condition meant they did not need nursing care. But staff were adept at identifying changes in individual’s conditions and when the home could no longer effectively support them.
People we spoke with told us they found that the service met all of their needs and ensured that they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.
People told us that the staff worked with them to see how to reduce the negative impact of their mental health disorders and how staff had supported them to develop the skills they needed to live independently. We found that people were encouraged and supported to take responsible risks and positive risk-raking practices were followed.
We observed that staff had developed very positive relationships with the people who used the service. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity. People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
We saw that people were supported to maintain good health and accessed a range of healthcare professionals and services. We found that staff worked well with people’s healthcare professionals such as consultants and community nurses.
We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. The people we spoke with discussed their support plans and how they had worked with staff to create them.
Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as applying the recovery star model (which is a recognised model for supporting people with mental health needs). Staff had also received training around the application of the Mental Health Act 1983 (amended 2007) and were familiar with the accompanying code of practice. People who used the service had capacity to make decisions and were consulted about all aspects of their care. The registered manager recognised that at times this might not be the case so ensured staff received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training. The staff we spoke with understood the requirements of this Act.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that four support staff were on duty during the day, two during the evening and one staff member was on duty overnight.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
We found that the building was very clean and well-maintained. We heard from the registered manager that the provider had reviewed the suitability of the building and found that the design no longer met the needs of the people who used the service. The registeredmanager told us that the provider was in the process of developing a more appropriately designed building in Redcar. We heard that in the new year the intention was to move from this building to the new one.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.
The provider had developed a range of sytems to monitor and improve the quality of the service provided. We saw that the manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.