Background to this inspection
Updated
7 February 2019
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 comprehensive inspection took place on 22, 23 and 28 November 2018 and was announced. We gave the registered manager four days’ notice of the inspection visit because a focus group of people using the service needed to be arranged. The organisation provided care and support to people living in supported living services out in the community.
Inspection site visit activity started on 22 November 2018 and ended on 28 November 2018. It included a focus group with four people using the service and visits to six people living within three supported living services. We visited the registered office location on 22 and 23 November 2018 to see the registered managers and staff; and to review care records and documentation relating to staff and quality assurance.
Before our inspection we reviewed the information available to us about this service. The registered managers had completed a Provider Information Return (PIR). The PIR is a form that we ask providers to complete at least once annually to give us some key information about the service, what the service does well and improvements they plan to make. We looked at the previous inspection report and notifications which had been submitted to us. A notification is information about important events which the provider is required to tell us about by law. We took this into account when we inspected the service and made the judgements in this report.
The inspection team consisted of two inspectors, an assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using this type of service.
The inspection was informed by feedback from questionnaires completed by a number of people using the service, relatives, staff and health care professionals. This confirmed people were supported to live a fulfilled life and were supported to live the life they wanted. We contacted 11 commissioners and health care professionals for their feedback about the organisation.
During the inspection we spoke to 10 people receiving support from the organisation. We spoke with two relatives. We spoke with ten staff which included, the two registered managers, a senior operations manager, three managers of services and three care staff. We looked at records that related to how the service was managed including five staff recruitment files, staff training and quality assurance. We looked at six care and support records including, risk assessments, support plans, medicine records, health records and maintenance records.
Updated
7 February 2019
This inspection took place on 22, 23 and 28 November 2018 and was announced.
MCCH (Hermitage Court) provides care and support to people living in ‘supported living’ settings, so that they can live in their own home 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. At the time of our inspection 111 people were receiving support from the organisation across the South East and London areas. It provides a service to a range of people including adults that have learning disabilities, physical disabilities, profound and multiple disabilities and autism spectrum disorder.
At our last inspection on 16 and 17 February 2016 we rated the service good overall with the safe key question rated as requires improvement. We recommended that gaps in staff’s employment records were explored and recorded. A comprehensive audit of the entire workforce recruitment records had been completed. At this inspection we found that additional improvements had been made, sustained and embedded; the service was now rated as ‘outstanding’ overall and in the responsive and well-led key questions. The safe key question had improved to good. The evidence continued to support the rating of good in the effective and caring key questions.
The individual services had 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 autism using the service could live as ordinary a life as any citizen. These values were seen in practice throughout each service.
There were two registered managers in place that covered different geographical areas. 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.
People receiving support from MCCH (Hermitage Court) received highly individualised person-centred care. There were innovative and creative ways of promoting people’s well-being and self worth. People were supported to achieve positive outcomes and fulfil their dreams and aspirations, such as moving on to independent living and overcoming communication barriers.
Support plans were detailed and personalised to meet people’s needs. People were supported to have a full and meaningful life. People were supported to fulfil their goals to enhance their well-being. Staff went over and above to make sure people had opportunities to meet new people, make friends and build relationships.
People were empowered to take ownership over their safety. The safety of people was promoted and links were made with the local community professionals to protect people. Keeping people safe and protecting them from harm and abuse was at the forefront of people and staffs’ minds. Staff worked alongside the local authority safeguarding team to promote people’s understanding about their safety.
The vision and values of the organisation played an integral role to ensure people were at the heart of the organisation. These had been integrated into everyday practice, people living with learning disabilities were able to achieve what they wanted in their lives and had the right support overcame obstacles to achieve positive outcomes.
People were supported to make decisions about their care and support. People were given maximum choice and control over their lives. There was clear and detailed guidance for staff on how to meet people’s individual needs and to support them to develop their confidence and have their preferences met.
The recruitment of staff was individualised and people were involved in the recruitment of their staff so they had a say about who might support them. There were enough staff to meet people’s needs and staffing levels were based around people’s social and health appointments and were flexible and responsive. Staff were trained to meet people’s needs including their specific needs. The organisation promoted a supportive, inclusive and open culture amongst its workforce.
Staff were highly motivated and were passionate about providing people with high quality, compassionate care with regard to people’s individual wishes and support needs. We saw that people were relaxed and staff demonstrated a caring attitude.
There were robust quality assurance systems in place, which monitored the individual services, identifying potential areas for improvement, and actions were taken to improve these.
A large variety of communication methods and techniques were used to promote people’s choices about their lives. People’s emotional support had been clearly documented and was followed by staff.
People’s privacy and dignity were highly respected, and this also was reflected in the detailed guidance provided within people’s support plans.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA). We observed staff treated people as equals and individuals, offering them options whenever they engaged with them. Staff always endeavoured to enable people to maintain their independence and to make their own decisions.
People were supported to follow healthy diets, and this had a positive impact on their wellbeing. They were also supported to access healthcare services when they needed to.
People were actively encouraged to raise any concerns or complaints they had. People’s views were actively sought and acted on to improve the quality of the service that people received.
Further information is in the detailed findings below.