MK Supported Housing Limited

MK Supported Housing Limited is a care home providing personal care to up to 4 people with learning disabilities and autism. At the time of the inspection, 4 people were living at the service.

People’s experience of using this service and what we found

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received safe care and felt safe within the service. Staff we spoke with understood safeguarding procedures and felt confident their concerns would be listened to and followed up. Relatives we spoke with told us they felt their family members were safely supported within the service. Risk assessments were in place to manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing levels were sufficient and consistent within the home, and people got the support they needed from staff promptly.

Medicines were stored and administered safely, and staff were trained to support people effectively. Staff were supervised well and felt confident in their roles.

The service was clean, and staff understood infection control procedures and followed them.

Audits of the service were detailed and any issues found were addressed promptly. Staff felt well supported by the manager, and were motivated to provide good care to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 19 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service on 2 September 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for MK Supported Housing Limited on our website at www.cqc.org.uk.

MK Supported Housing Limited is a small residential home providing care and support for people with a learning disability or autistic spectrum disorder, mental health and physical health needs. At the time of inspection, they were providing personal care to two people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

There was a lack of effective oversight and governance in place to enable the provider and registered manager to assess, monitor and improve the quality and safety of the service. Systems and audits had not resulted in timely action to improve the service in the areas needed.

The provider had not ensured appropriate procedures and risk management plans were in place where people’s behaviour posed a risk to themselves and others. The provider’s policy of no physical intervention had left people and staff vulnerable to harm when people were distressed, and risks associated with their behaviour increased. People did have suitable risk assessments and risk management plans in place for other areas of their lives and these were followed by staff.

Improvements were required to the storage of medicines and medicines recording. People did receive their medicines as prescribed and staff were trained in medicines administration and had their competency regularly checked.

The arrangements in place for food safety had not been consistently implemented as food was not always stored safely. The environment was clean and well maintained and suitable for people’s needs.

The provider and registered manager took prompt action to rectify all the areas of concern identified during the inspection.

There were enough staff to meet people’s care and support needs and to ensure people were as active as they wanted to be. Staff mostly received the training they needed to provide people’s support appropriately and safely. The provider had not implemented the Care Certificate for staff new to care but recognised the need to do this. Staff were provided with supervision and were well supported by the provider.

There was no end of life care being delivered at the time of the inspection. However, the provider’s policies required further development to detail the support that staff would provide to people in preparing for the end of their life.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's needs, and wishes were met by staff who knew them well. People were treated as individuals and were valued and respected. Staff ensured that people's privacy and dignity was protected and spent time getting to know people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider actively sought feedback from people, their families and staff to continually look at ways to improve the service and was receptive to ideas and suggestions.

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 requires improvement (published 6 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections. At the last inspection the provider was in breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance and safety of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

This was the first comprehensive inspection of the service since it was registered with the Care Quality Commission (CQC).

MK Supported Housing Limited is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. MK Supported Housing provides personal care support to people with an acquired brain injury, learning disabilities or autism; it is registered to provide accommodation and personal care for four people. At the time of the inspection there were two people living at the service and one person regularly accessing the service for respite care.

The 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 complex needs using the service can live as ordinary a life as any citizen.

There was a registered manager in post. 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.

The quality assurance processes in place to monitor the quality and safety of the service and drive improvement required strengthening. The provider and registered manager had not identified the concerns highlighted at this inspection. Following the inspection, the registered manager sent us an action plan detailing when the deficiencies identified would be rectified.

People's capacity to consent to their care and support was not always assessed. People supported by the service were not able to consent to some aspects of their care. However, written capacity assessments and best interest checklists were not in place. Staff did demonstrate that they understood the principles of the Mental Capacity Act 2005 (MCA) and gained people's consent when supporting them. The registered manager had made applications under the Deprivation of Liberty Safeguards (DoLS) for people as necessary.

Improvements were required to maintain the safety of the environment and to ensure all health and safety checks were completed as planned. Some areas of the home required refurbishment and re-decoration. The provider needs to ensure that all planned maintenance and refurbishment is completed in a timely manner.

There were gaps in medicines record keeping and some necessary checks of controlled medicines had not been carried out. The provider could not demonstrate that staff had received all required training and had access to regular supervision.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff were employed at the service. However, the provider was using high numbers of agency staff and had not consistently monitored that appropriate employment checks had been carried out for these staff.

The agency staff that were used in the home, were deployed on a regular basis to ensure that people’s support was consistent. Staffing levels were suitable to meet people's needs.

People were supported in a safe way. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by senior staff. People had risk assessments in place to cover any risks that were present within their lives, but also enabled them to be as independent as possible.

Staff supported people in a way which prevented the spread of infection. Staff used the appropriate personal protective equipment to perform their roles safely.

People could choose the food and drink they wanted and staff supported people with this. Staff supported people to access health appointments when necessary. Health professionals were involved with people's care as and when required.

People were involved in their own care planning as much as they could be, and were able to contribute to the way in which they were supported. Care planning was personalised and considered people's likes and dislikes, so that staff understood their needs fully. People were in control of their care and listened to by staff.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff supported them, and they provided their care in a respectful and dignified manner.

The service had a complaints procedure in place. This ensured people and their relatives were able to provide feedback about their care and to help the service make improvements where required.

The service worked in partnership with other agencies to ensure people’s needs were met. Communication with other agencies involved in people’s care and support was open and honest.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full details regarding the actions we have taken can be found at the end of the report.