SCC Adult Social Care Supported Living and Mallow Crescent short breaks service

Mallow Crescent is a supported living and residential short stay respite care home service for people with learning disabilities and autistic people who may have additional physical support needs. The supported living homes and the residential home are located close by in one residential area. The care home can accommodate up to six people and at the time of the inspection only one person used this service. There were 28 people receiving support with personal care in the supported living services and in the local community. The whole service supported 29 people at the time of the inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People received person-centred support which encouraged them to work towards their own goals and to live the life they wanted. Where people wanted to move on, this was supported despite the challenges posed by the COVID-19 pandemic. People’s needs were discussed with them and their representatives before they started using support at Mallow Crescent. The provider was reviewing their assessment processes to continue to improve them and how they were aligned with the Right support, right care, right culture guidance.

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.

Right Care:

People and their relatives told us staff were kind, compassionate and caring. We observed staff treating people with respect and involving them in their support. Staff were sensitive and patient when people experienced difficulties. People’s support records included guidance for staff how to support them to feel valued, secure and comfortable.

Right Culture:

People and their relatives knew the staff team and management. They told us management were approachable and visible and they felt comfortable raising any concerns, trusting they would be listened to and appropriately addressed. People were encouraged and supported to raise complaints and had regular opportunities to be involved in reviews of their support. The management team supported staff to be competent for their roles and reviewed the quality and safety of the service, creating a culture of speaking up and positive challenge to improve people’s experiences.

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 outstanding (published 30 January 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Mallow Crescent is a supported living service offering care and support to people. There are five houses located at the end of a quiet residential crescent. The service supports people with a learning disability or autistic spectrum disorder, older people, physical disability and younger adults. Mallow Crescent also has one residential care home providing personal care for up to 6 people for short term respite support. Mallow Crescent also operates an outreach service providing support to people in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. 26 people were being supported with personal care at the time of our inspection.

Services for people with learning disabilities and or autism are supported

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

People, their relatives and health and social care professionals described the staff as knowing people exceptionally well, and the care people received as being excellent.

Innovative and creative ways were used to deliver personalised care and support to people. People's health and wellbeing was closely monitored to ensure they received timely and appropriate treatment.

People were encouraged to live as full a life as possible and supported to achieve the best possible outcomes. Staff had formed positive relationships with the people they supported and looked for ways to make them feel valued. People were genuinely encouraged to express their hopes and dreams and the service looked for ways to make these a reality. Staff knew people really well and used this knowledge to support them achieve their goals. Staff were considerate of people's feeling at all times and treated people with the utmost respect and dignity.

People received highly personalised support. People's confidence, independence and health outcomes had improved since they began using the service. People were enabled to maintain relationships with those who mattered to them.

Staff were aware of safeguarding procedures and knew the correct action to take if they suspected abuse had occurred. There were enough staff to meet people's needs. Recruitment procedures were thorough and safe. People were supported by a consistent staff team who were aware of the risks to people and knew how to manage these safely. Medicines were administered, stored and disposed of safely. Infection control practices were robust.

The level of care and support given to people enabled them to have an excellent quality of life. Staff understood and knew how to apply legislation to help people make decisions and give their consent to treatment. Where restrictions were in place this was in line with appropriate guidelines.

People were supported by staff who had exceptional skills and knowledge to meet their assessed needs. People had enough to eat and drink and arrangements were in place to support people who had been identified as being nutritionally at risk.

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.

People had access to a wide range of personalised and group activities and were supported to have a say in all aspects of how the service was delivered. People were supported to have as many opportunities as possible, so they could gain new skills and live more independently.

People benefitted from a service that had a dedicated manager whose experience was used to support people to lead full and meaningful lives. The values of the provider were consistently demonstrated by staff in their interactions with people and with each other. People's views were sought out and acted upon.

Thorough quality assurance processes ensured the safety, high quality and effectiveness of the service. People and relatives felt listened to and their views were taken into account. These were used to shape the service.

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 6 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mallow Crescent provides accommodation and support for up to 33 people who have a learning disability. There are six houses located at the end of a quiet residential crescent with five houses providing long term accommodation and one house providing short term respite support. Mallow Crescent also operates an outreach service providing support to people in their own homes.

The home had 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.

People using the service felt safe and spoke positively about the support provided to them. They said staff treated them with kindness and respect.

People were supported to lead active lives and maintain relationships with those who matter to them. Their relatives gave positive feedback about the service provided and praised the caring supportive nature of the staff working there. They felt the service was outstanding.

There was strong leadership at Mallow Crescent. An experienced registered manager communicated a strong person centred ethos focusing on valuing each person as an individual and ensuring they had a good quality of life.

Staff completed MCA and DoLS training that helped them to understand issues around capacity and support people effectively. The staff provided information to people in different ways to help them understand and, where possible, make decisions for themselves.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept records that were accurate.

The staff were well trained and supported. A tailored induction programme focused on ensuring that new staff had the right skills and values, ensuring they were person centred not task orientated in their approach. There was an open positive culture within the service where staff felt valued and appreciated for the work they did by the management team.

Risk assessments were in place that reflected current risks for people at the service and ways to try and reduce these. Support plans were regularly reviewed and updated to ensure the care provided met people’s changing needs. Each person had an ‘All about me’ document produced using photographs that reflected their preferences and what was important to them as individuals.

People and their relatives told us that they felt able to raise any issues or concerns and these were dealt with promptly and satisfactorily. There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these.

The way the service was structured and the processes in place ensured staff were clear about their responsibilities and that important information was shared across the six houses in Mallow Crescent. There were effective systems to ensure the quality of the service and obtain feedback from people, their relatives and other stakeholders.

We found that there were processes in place to gain the consent of people or their representatives to the care provided and that people's rights were upheld.

We spoke with a relative who told us, 'I have no worries at all. I'm very happy with the manager and consider myself lucky that my relative lives in such a 'family' environment'.

The service had daily cleaning schedules in place to reduce the risk of infection and the houses appeared hygienic and well maintained. The service was deep cleaned annually by a specialist cleaning contractor.

We found that staff were supported in their roles in terms of training, supervision and opportunities for professional development. One member told us, 'One of the great things about working here is that the training is superb and the manager supports you and makes sure that your training needs are met

We found that there were effective systems in place to monitor the quality of the care and support provided and that the registered manager kept procedures under review.

We noted that people who used the service were treated with dignity and respect and were involved in making decisions about their support.

One person who used the service told us, 'I've been here a long time and it's very good. The staff are nice'.

A relative of a person who used the service wrote, 'The house is run very efficiently. All the staff, including the new ones, know my relative well. Pastoral care is excellent'.

We found that support planning and risk assessments were detailed and that care was delivered in line with each individual's needs.

A relative wrote to the registered manager saying, 'I am very satisfied. The staff are wonderful and my relative is always happy to come there'.

We also found that the service had effectively identified areas where people might be vulnerable and had introduced plans to manage the risk of abuse.

During the inspection we saw that the service had a comprehensive staff selection procedure in which people who used the service were involved.

We found that people were made aware of the complaints system and material was provided in a format that met their needs. Complaints were fully investigated and resolved, where possible, to the satisfaction of the complainant.