Matson House

Matson House is registered to provide accommodation and personal care to up to 13 adults living with a learning disability or autistic spectrum disorder. At the time of our inspection 12 people were living at the service.

We found the following examples of good practice.

¿ The provider’s policy for managing COVID-19 and related infection prevention and control procedures had been reviewed and kept up to date. COVID-19 guidance was kept up to date for staff reference. Staff understood how to reduce risks of an outbreak in the service.

¿ The provider had adapted visiting arrangements in accordance with recognised safe visiting guidance. This included individual risk assessments for people wishing to visit their relatives. People were also supported to be in contact with their relatives through telephone and video calls.

¿ People were engaged with activities which met their wellbeing needs, whilst promoting social distancing. The staff team were committed to maintaining people’s wellbeing during the pandemic.

¿ Action had been taken to reduce the risk of an outbreak which included correct use of personal protective equipment (PPE). Staff had received training and support in relation to infection control and COVID-19. Managers ensured staff were following national PPE guidance.

¿ There had been no new admissions to the service during the COVID-19 pandemic. In line with national guidance, people returning from hospital were only admitted to Matson House following a negative COVID-19 test. They were then supported to self-isolate for 14 days, to reduce the risk of introducing infection to the service.

¿ People were not always able to understand social distancing or self-isolation requirements due to their learning disability. Staff wore additional PPE when this was predictable and worked creatively to meet people's needs. This included use of individual lounges to help people maintain physical distancing and prompt cleaning of communal areas after use.

¿ People and staff were tested for coronavirus in line with national guidance for care homes. When positive cases were detected, the provider introduced zoning and staff were cohorted to reduce the spread of infection.

¿ During the outbreak, one person continued to receive end of life care with virtual support from specialist health care professionals. Staff were complemented by professionals on the quality of care they provided.

¿ People’s health and wellbeing was monitored. People were checked for symptoms of COVID-19 and other potential infections. Monitoring results were shared with health professionals as needed, which allowed prompt clinical support to be provided to people. People and staff were being supported to receive COVID-19 vaccinations.

People’s experience of using this service:

• People received a service which was responsive to their needs and support requirements.

• Family members spoke positively about the care their relatives received at Matson House. One relative spoke fondly about their relative living at the home and said, “I can’t think of a better place for him to be.” They complimented the caring nature of staff and managers. All the relatives felt that people were treated with dignity and respect.

• Staff treated people equally and ensured they maintained relationships with those who were important to them.

• The home was actively recruiting new staff which meant people were now being supported by a consistent staff team who were familiar with their needs.

• Improvements had been made to the recording of people’s care and support needs and the daily records of their physical, social and emotional well-being to ensure they were personalised and reflected people’s needs.

• People’s care plans provided staff with the information they needed to support people. New and detailed behavioural management plans were being implemented to provide staff with additional guidance.

• People were supported where possible to have maximum choice and control of their lives. Where people were unable to provide consent to their care and support, staff acted in people’s best interests, based on their knowledge of people’s preferences.

• Effective systems were in place to manage people’s medicines.

• Staff worked with specialist health care professionals to ensure their care practices were current and people received appropriate support.

• Staff told us they worked well together as a team and felt trained and supported to carry out their role.

• There were sufficient numbers of staff available to ensure people’s safety and well-being.

• New staff were suitably vetted before they supported people.

• Staff understood their responsibility to report concerns, accidents and poor practices.

• Systems were in place to identify shortfalls in the service and drive improvement.

• People and their relative’s views were valued and acted on if any concerns had been identified.

• The registered manager understood their regulatory duties to ensure people received a safe and effective service.

The service met the characteristics of Good in all areas. More information is in ‘Detailed Findings’ below.

Rating at last inspection: Requires Improvement (Last report was published on 17 October 2017)

Why we inspected: This was a planned inspection based on the previous rating at the last inspection.

Follow up: At this inspection we have rated the service as Good. The rating of this inspection and the information and intelligence that we receive about the service will determine the timeframe of our next inspection.

The last comprehensive inspection of the service was on 21 and 22 September 2016 and there were was one breach of Regulation 18 Staffing at that time. We found that there were not sufficient members of staff to keep people safe and meet their needs and staff were not being supported effectively. Staff had also not always received supervision and appraisals. At this inspection we found improvements had been made and the provider was now meeting this regulation.

There was no registered manager in post. A manager had been responsible for the service since July 2017 who was applying to become a registered manager at the home. 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 responsibilities for meeting the requirements in Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was the subject of on-going monitoring by the local authority. This was because when they visited in 2016, they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was still in progress during our inspection.

The new manager who is to become registered with CQC had commenced employment in the role in July 2017. A senior manager had been overseeing the service since March 2016 and making positive progress with the local authority service improvement plan.

Our inspection identified areas where improvement was required such as; systems to ensure staff training is up to date and not expired and to ensure people’s care records were up to date. The manager and provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around the monitoring of staff training and had not ensured people’s records were always up to date. We made a recommendation regarding the recording of people’s goals, targets and outcomes.

Risk assessments were implemented and staff knew how to keep people safe.

Medicines were stored appropriately and people were given their medicines as prescribed. Systems were being reviewed and more regular medication audits were planned.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they liked to do and how they wanted to be supported.

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff felt integral to the process of providing effective care to people. Management and care staff had a good understanding of people’s needs and wishes and communicated effectively to support them. Where it was clear people’s needs had changed, the manager worked with the person, their families and health professionals to check if the support needed had changed.

There were some positive comments from relatives and health professionals about the care provided and the staff who cared for their family members. Relatives used words such as 'Caring' and 'Great'.

The daily notes had a section for targets and goals to promote independence and improve the quality of their lives. These were all blank and we were unable to see any records relating to targets and goals. We recommend that the provider ensures that records are available to document people’s goals, targets and outcomes.

The service was responsive to people’s needs. Support plans were person centred to provide consistent, high quality care and support. People and their relatives were able to raise concerns and were listened to.

The manager and staff had promoted a culture that put people at the centre of the work they did. The service's values centred on people's needs and wishes. Staff understood the provider's objectives of maximising people's life choices, promoting dignity and supporting people to develop life skills.

There was no registered manager in post. There was a manger who had submitted an application for registration with CQC in June 2016 and was this was being processed. 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 responsibilities for meeting the requirements in Health and Social Care Act 2008 and associated Regulations about how the service is run. The deputy manager of the home had left the week before our inspection.

The service was the subject of on-going monitoring by the local authority. This was because when they visited earlier in 2016 they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was almost completed when we arrived for our inspection.

The service was last inspected in November 2014 and was in breach of the following:

Regulation 9 HSCA (RA) Regulations 2008 Care and welfare of people who use services. The registered person had not taken proper steps to ensure each person was protected against the risks of receiving care that was inappropriate or unsafe, by means of the planning and delivery of care in such a way as to ensure the welfare and safety of people. This breach of regulation had now been addressed and people were eating safely and not at risk of choking.

Regulation 12 HSCA (RA) Regulations 2008 Cleanliness and Infection Control. The registered person had not ensured people were always protected from avoidable harm with regard to infection control. We found that the provider had put procedures in place to reduce the risk of infection control and this breach of regulation had been addressed and people were not at risk.

Regulation 18 HSCA (RA) Regulations 2008 Notification of other incidents and consent to care and treatment. The registered person had not notified the Commission with authorisations received from the supervisory body to deprive people of their liberty. The registered person did not have suitable arrangement in place for establishing, and acting in accordance with, the best interests of people. This breach of regulation had been addressed and peoples best interests were being assessed appropriately.

Regulation 20 HSCA (RA) Regulations 2008 Records. The registered person did not have accurate records including appropriate information and documents relating to the care and treatment provided to each person. People were not protected against the risks of unsafe or inappropriate care. This breach of regulation had been addressed and people had accurate records.

Regulation 23 HSCA (RA) Regulations 2008 Supporting Staff. The registered person did not have suitable arrangements in place to ensure staff were appropriately supported to deliver care and treatment safely including by receiving training, professional development, supervision and appraisal. This breach of regulation had not been met although some progress had been made.

Our inspection highlighted shortfalls where some regulations were not met. We also identified areas where improvement was required.

There were not sufficient members of staff to keep people safe and meet their needs. The use of agency staff had reduced consistency and this in turn had negatively impacted on people’s care. Some people were not being supported to reach their full potential.

People and relatives were positive about the care they received. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they like to do and how they like to be supported.

We found the service was not always effective. Staff were not receiving regular supervision or support. No appraisals had been carried out for staff within the last 12 months. Staff morale was low due to changes in working conditions and many staff had left recently. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS),

The service was responsive to people’s needs. Care plans were person centred to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. People took part in activities within the home and out in the community such as swimming, walks and going to the gym.

The service was generally well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the manager. The culture of the home was one of uncertainty and anxiety.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were not able to tell us if they felt safe in the home because of their complex communication needs. During our inspection people responded positively to staff, showed no signs of fear or distress and chose to spend time with staff. A relative told us their relative was 'in a happy and secure part of his life'.

The service was safe because risk assessments were in place to help protect people. These had been used to produce care plans with enough information to allow staff to provide safe and consistent care. Changes were made to risk assessments and care plans as people's needs or preferences changed. Learning and actions took place following incidents or complaints. This ensured that similar incidents were unlikely to occur.

We found gaps in some people's daily recordings. This would prevent staff having an accurate record of the care given and any problems that occurred during previous shifts. Monthly summaries were not being completed which meant this information was not available to staff undertaking care reviews. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The DoLS were only used when it was considered to be in the person's best interest. Following recent developments in DoLS case law, the registered manager had begun reassessing the need for an authorisation for each person. Where necessary, authorisations were being applied for in order of priority.

The service was safe because staff had received appropriate training in safeguarding, DoLS and the Mental Capacity Act 2005. They were aware of the local procedures to report a safeguarding concern and staff had access to safeguarding protocols. Concerns raised in the past had been acted on as required and information had been shared with the appropriate agencies.

Staff told us they had received adequate training when they started work and since. The registered managed showed us a list of training topics identified as mandatory by the provider. The majority of staff had completed these courses. One person living at the home needed staff to use a specialist technique to administer their medication. We found staff trained to do this had not been receiving the refresher training in line with national guidance. The registered manager told us training would be provided as a priority and until that time staff without current training would not take this person out of the home.

Is the service effective?

The service was effective because people were encouraged to be involved in decisions about their care as far as possible. Justifications were recorded where this was not possible. Each person's care plan contained a section on communication and decision making. This ensured staff knew how the person preferred to communicate and how to support them to make decisions.

The service was effective because people had a hospital assessment in place which identified information hospital staff would need to know if the person was admitted for treatment. We saw records to show people were seen by health and social care professionals when needed. This meant their health needs were being addressed.

Is the service caring?

People were not able to tell us how they felt about the support they received because of their complex communication needs. We spoke with a relative about the support offered by the home. They told us they were 'very, very happy'. They felt their relative had become increasingly settled at the home and was increasing their social skills.

The service was caring because people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us the care plans were detailed enough to give them the information they needed. Staff demonstrated a good knowledge of the information contained in the care plans. They all showed insight and knowledge about the person's needs and preferences. We observed staff following people's care plans and protocols.

Behaviour management plans identified the things that could upset a person and how staff could best support them when this happened. We observed staff following these plans during our inspection. Staff told us it was very important these plans were followed to prevent people becoming confused by inconsistent approaches.

Is the service responsive?

A relative told us staff communicated well with them and they 'talked over problems and worked together with staff'. They said they would be able to complain but had not needed to due to the 'excellent communication' which showed the service was responsive.

Some people did not have the opportunity to go out much and some staff told us they felt the activities available to people could be increased. The registered manager told us they were aware of this variation and were starting to record and analyse the activities each person took part in to see if there was scope for improvement or change.

The service was responsive because people were supported in promoting their independence and community involvement. Staff told us how they encouraged people to develop skills and independence. They knew what people were capable of and encouraged them to complete tasks themselves where possible.

The service was responsive because people's diversity, values and human rights were respected. Each care plan contained references to the person's religion, culture and what they wanted to happen when they died. The registered manager told us families had been involved in these discussions. Where relevant there was also information about managing people's sexual needs. These references showed people were afforded dignity and privacy.

Is the service well-led?

The service was well-led because quality assessments were undertaken and actions had been taken to improve the service in response to these assessments. Staff we spoke with told us they could make suggestions to the senior staff and felt they would be listened to. The registered manager told us staff were encouraged to contribute to person centred reviews, staff meetings and supervision meetings.

The service was well-led because decisions about care and treatment were made by the appropriate staff at the appropriate level. At the front of each section in the care plan there was a document for staff to use to record any changes needed and for the registered manager to highlight changes to staff. This helped to ensure the documents remained current and applicable. Staff were aware that changes to care plans could not be made without the approval of the registered manager. Staff also knew that a healthcare professional would need to be consulted if they had medical concerns.

Staff received supervision and appraisals to help them reflect on their roles and responsibilities. Supervision records showed that staff training needs had not always been addressed in a timely manner. The registered manager told us it had been difficult to secure training but this was now being rectified by the provider.

Each person had very detailed care and support plans in place that included words and pictures. Some of the pictures used related to each individual person. An activities board was in place and it listed the activities people liked to do and when.

There was a system in place to help safeguard people who lacked capacity to be able to make decisions for themselves. The service worked with other providers/professionals when people required medical care and treatment.

The service managed people's medication safely and had a system of audits in place to monitor this process.

Staff had access to ongoing training and supervision to make sure they could meet people's needs, welfare and safety.

The provider and manager had a system in place to assess and monitor the quality of service provision.