Archived: Lowther Street

Updated 31 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 3 January 2018 and was unannounced. This was the first inspection of the service since a change of provider from the Croftlands Trust to the Richmond Fellowship in February 2017.

Lowther Street is both a ‘care home’ and the location for the delivery of community based services. The service has three distinct functions. 81 Lowther Street is a care home which provides short term, crisis intervention for people who need support due to mental health issues. The provider also delivers personal care to people living with mental health problems in supported living services and to people living in their homes in the community.

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. The care home can accommodates up to six people in one adapted building. People only stay in the home for short periods of time. No one lives permanently in the building.

This service also provides care and support to people living in three ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

There were also other people being supported in their own homes across the Allerdale and Copeland areas. Only one of these people were in receipt of personal care. Not everyone using Lowther Street receives the regulated activity, personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We were informed that across all these services personal care was being delivered to seven people at the time of the inspection.

The inspection was conducted by an adult social care inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Both members of the team had experience of supporting people with mental health needs.

We reviewed the information we held about the service, such as notifications we had received from the registered provider. A notification is information about important events which the service is required to send us by law. We also spoke with social workers, health care practitioners and commissioners of care. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We planned the inspection using this information.

We visited the care home and one of the supported living services. We spoke with four of the seven people in receipt of personal care. We also spoke with two relatives of one person living in the community in their own home. We read their care files and those of the other three people in receipt of care. We looked at two care files for people who had been in receipt of care in the care home in the two months before our inspection. We read comments people had made after their stays and we saw 'exit' surveys for the care home. We looked at medicines being stored or administered on behalf of people.

We met the Cumbria locality manager, the registered man

Updated 31 January 2018

The inspection took place on 4 January 2018 and was unannounced. This was the first inspection of the service since the service was registered to the Richmond Fellowship in February 2017.

Lowther Street is both a ‘care home’ and the location for the delivery of community based services. The service has three distinct functions. 81 Lowther Street is a care home which provides short term, crisis intervention for people who need support due to mental health issues. The provider also delivers personal care to people in supported living services and to people living in their homes in the community who may be living with mental ill health.

The home can accommodate up to six people for short term care. Two people were in residence when the inspection started. A further five people were identified as receiving personal care in the supported living services and in the wider community. Other people did not need this level of care. We only looked at the care and support of people in receipt of personal care.

The service had a suitably qualified and experienced 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.

Staff had received training on ensuring people were kept free from harm and abuse. The Richmond Fellowship had suitable arrangements for staff to report any concerns.

Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and analysed and action taken to reduce risks. People had contingency plans to support them in a mental health crisis.

We saw that staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had suitable disciplinary procedures in place.

Medicines were appropriately managed. Some people were supported to take their own medicines. People had their medicines reviewed by their GP and specialist health care providers.

Staff were trained in infection control and supported people in their own environment. The care home was clean and orderly as was the environment for two people we met in supported living.

The staff team had been supported to develop appropriately. Staff were keen to learn and we saw that induction, training and supervision had helped them to give good levels of care and support. All staff had received updates to their training in line with the policies of the new provider.

Staff received good levels of training around principles of care in relation to people living with mental ill health. They were trained in specific techniques to support people with varied disorders. Restraint was not used in this service.

Consent was always sought from individuals. 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 supported to get good health care support from their own GP, specialist nurses and consultants. Staff worked with people to support and encourage them to visit health care providers.

Staff supported people to shop, budget and cook. People were helped to take good nutrition and were encouraged to eat healthily.

The care home was an older property that people felt met their needs. An upgrade to the building was being planned to reconfigure shared spaces and to provide ensuite facilities to bedrooms.

Staff we spoke to displayed a caring attitude. Staff understood how to support people to maintain their dignity and privacy. Staff showed both empathy and respect for people living with mental health issues. People in the service had access to advocacy.

Everyone supported by the service had been appropriately assessed. Person centred assessments and plans were in place. These were created in an electronic format and staff changed them when needs and wishes changed. Reviews of care were in place. In the crisis intervention house reviews were conducted by staff and the care co-ordinator during and after the stay. People living in the community or in supported living were reviewed internally and from time to time by social workers and other mental health professionals.

People were encouraged to go out and to engage, where possible with varied activities. The staff 'sign posted' people to community opportunities but were aware that people in crisis might find this difficult. We saw some good outcomes for people who were able to engage more with activities in the community.

Complaint procedures were in place. There had been no complaints received about the service.

The service had a suitably trained, qualified and experienced registered manager. Staff told us he was very visible in the service and easy to approach.

We judged that the registered manager had created a culture of openness and that staff worked in a non-discriminatory way. The atmosphere was one of enthusiasm and eagerness to continue to develop the service.

The Richmond Fellowship had a suitable quality monitoring system. We saw internal audits and records of visits by senior officers of the provider. Good monitoring and analysis of the service was in place.

Staff and other people involved with the service were satisfied that the management arrangements were appropriate and that matters of governance were being followed to give good levels of care and support.

The local mental health teams were satisfied with the joint work they did with the service.