Background to this inspection
Updated
28 April 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
Three inspectors carried out this inspection.
Service and service type
This service provides care and support to people living in ‘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.
MacIntyre Ampthill support also provides a shared lives scheme. They recruit, train and support self-employed shared lives carers (SLC) who offer accommodation and support arrangements for vulnerable adults within their own family homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. Inspection activity started on 09 February 2021 and ended on 04 March 2021. We carried out a site visit to the registered office on 09 February 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, Healthwatch England and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report..
During the inspection
We spoke with five people who used the service and eight relatives about their experience of the care provided. We spoke with 11 members of staff including the registered manager, the operations director, front line managers, senior support workers and support workers.
We reviewed a range of records. This included four people’s care records and medication records. We looked at four staff files in relation to recruitment and training as well as records relating to training across the service. Documents relating to the management of the service, including policies and procedures were reviewed.
Updated
28 April 2021
About the service
MacIntyre Ampthill Support is a supported living service providing personal care to people in their own homes. It also operates a shared lives scheme which provides people with long-term placements, short breaks and respite care, within shared lives carers (SLC) own homes.
At the time of the inspection they were providing personal care to 36 people.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not fully able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care was designed to maximise people’s choice, control and independence and the provider had strong systems in place to promote person centred care, dignity and human rights. However, these were not always acted on in some of the MacIntyre Ampthill support settings where people received support.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice but were not consistently used to achieve this. Some people had restrictions placed on them that were not rigorously assessed to be in their best interests.
Documentation relating to obtaining consent to care or assessing mental capacity and making decisions in people’s best interest lacked detail and was inconsistent in some instances.
Some support plans and risk assessments lacked information to guide staff about how to safely meet people’s needs. This was particularly in relation to their specific physical or mental health needs or where people required support to manage behaviours that challenge.
Documentation relating to the management and administration of as required (PRN) medicines was inconsistent and put people at risk of PRN medicines not being administered as intended by the prescribing doctor.
The provider had well documented values that put people at the heart of the service. Policies and systems supported this but were not used effectively in all settings within the service. This meant some people did not consistently receive support which reflected the provider’s values.
Systems to monitor the quality of the service were not always used effectively and did not identify issues found during this inspection.
People were supported by staff who understood how to keep them safe from abuse. Staff received training the provider considered essential to enable them to support people well, although some training in relation to people’s specific support needs had not been provided to all relevant staff.
People were supported by staff who knew them well. Support plans contained clear information about people’s preferences and matters that were important to them.
We have made a recommendation in relation to the administration and recording of PRN medicines.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published July 2019)
Why we inspected
We received concerns in relation to the management oversight and culture of the service. This included concerns about consent to care, and the oversight of systems to ensure people received safe care. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
Enforcement
We have identified breaches in relation to management oversight, how people are supported to consent to care and how practices that restrict people’s freedoms are agreed, monitored and reviewed. Please see the action we have told the provider to take at the end of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for MacIntyre Ampthill Support on our website at www.cqc.org.uk.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.