MacIntyre Hertfordshire

Updated 17 October 2023

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Inspection team

This inspection was carried out by 1 inspector, 2 medicine inspectors. 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.

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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 26 July 2023 and ended on 21 August 2023. We visited the location’s service on 26 and 27 July 2023.

What we did before the inspection

We reviewed information we have received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We communicated with 4 people who used the service and 7 relatives about their experience of the care provided. In some cases people who used the service were unable to talk with us, so we used different ways of communicating including using Makaton (a type of sign language), pictures, photos, symbols, objects and their body language. We are improving how we hear people's experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method, and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. For this inspection, we used this communication tool with 1 person to tell us about their experience. We spoke with 12 members of staff including the registered manager, managers and support workers. We reviewed a range of records. This included 3 people's care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 17 October 2023

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

About the service

MacIntyre Hertfordshire is a supported living service providing personal care to people in their own homes. At the time of the inspection, they were supporting 13 people.

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

Right Care:

Risk assessment and care plans needed further development to be clear on individual support needs. There were examples where in places they were not coordinated, which caused confusion with staff.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. The service worked well with other agencies to ensure people’s health needs were met.

People who had individual ways of communicating, such as using body language and pictures, could interact with staff and others involved in their care and support because staff had the necessary skills to understand them. Further consideration needed to be taken with how to have meaningful conversations with people and gaining their views.

We have made a recommendation that the registered manager looks at different forms of communication to help people to express their views taking into consideration the resources readily available from the provider.

Right Support:

People’s mental capacity assessments were not always clear as to whether the assessment and decision was in the person’s best interest and if this was the least restrictive measure.

Staff supported people to keep a clean, well equipped, well-furnished and well-maintained environment that met their needs.

Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines and encouraged them to play an active role in maintaining their own health and wellbeing.

Staff respected people’s choices and supported them to make decisions about their day-to-day care.

Right Culture:

Governance systems were not always effective to ensure it provided quality oversight of the service. Staff were not supported to receive all of the training and development they required to fully understand their roles.

However, people received reliable care because staff placed people’s wishes, needs and rights at the heart of everything they did. Staff knew and understood people well and were responsive. People and those important to them, were able to share their views about the care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

This service was registered with us on 23 March 2022 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.