142 St Marks Road

142 St Marks Road (also known as Marcus & Marcus) is a supported living service providing personal care. The service provides specialist support and personal care to people with a learning disability, autistic people and people with mental health needs. At the time of our inspection there were 112 people supported with personal care, living in 41 different properties.

People’s experience of the service and what we found:

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.

Right support

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. Restrictions were reviewed and creative solutions sought to reduce their use.

Staff maintained exceptional focus on people's strengths and promoted what they could do, this meant people had a fulfilling and meaningful everyday life and opportunities for new experiences. People were supported by staff to achieve their aspirations and pursue their interests. Staff sought opportunities for people to increase their choice and control through environmental and equipment changes, improved communication tools and strategies and skill development. Staff enabled people to access specialist health and social care support in the community. Staff worked collaboratively with people and their circles of support to review progress and find solutions to obstacles.

The service made reasonable adjustments so people could be fully involved in discussions about how they received support.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes. People played an active role in maintaining their own health and wellbeing. All restraint and restrictions were recorded and reviewed. Staff learned from these incidents and actions were taken to reduce the chances of people becoming distressed.

Right care

Staff demonstrated effective skills in communication and behavioural support strategies. Staffing levels were adjusted to suit the needs and choices of people. People’s needs were assessed holistically and modelled on best practice, considering individualised approaches to deliver the best outcomes for people.

People's equality and diverse needs were consistently promoted. Staff understood people's individual needs and a multi-cultural workforce provided culturally appropriate care. Staff protected people from poor care and abuse and worked well with other agencies to do so.

People's care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right culture

People led fully inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the provider, management and staff team. It was very clear staff were enormously proud of the work they did in supporting people. People received exceptionally good quality care and support because trained staff and specialists who genuinely cared about people, could meet their needs and wishes.

People were supported by staff who fully understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received exceptionally compassionate and empowering care that was tailored to their individual needs.

Feedback from external professionals about the management team was extremely positive. There was a clear leadership structure, focused on supporting people to develop strategies to rehabilitate and achieve success in life. Staff were focused and inspired to achieve the aims of the service, for people to live as independently as they could whilst championing their rights for equal opportunities.

Staff ensured risks of a closed culture were minimised and people received support based on transparency, respect and inclusivity.

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 19 December 2017).

Why we inspected

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

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for 142 St Marks Road on our website at www.cqc.org.uk.

Follow Up

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

We told the provider two days before our visit that we would be coming. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. At our last inspection on 10 August 2015 the service was rated as good.

People experienced high quality care and support. They were supported to live safe, fulfilled and meaningful lives in the way they wanted to.

Staff told us they really enjoyed working for the organisation and spoke very positively about the culture and management of the service. Staff told us that they were encouraged to openly discuss any issues. Staff described management as extremely supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided.

The registered manager had been in post since the service opened in 2009. 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 and associated Regulations about how the service is run.

People, relatives, staff and health and social care professionals spoke highly of the registered manager; they found her to be dedicated, approachable and supportive. The provider, via their managing director demands excellence and the managers of the service were provided with the resources needed to aim high and to achieve the best possible results for all. The registered manager understood their responsibilities and ensured people, relatives and staff felt able to contribute to the development of the service. People were supported to be valued members of their local community. The continued development of the skills and performance of the staff was integral to the success of the service.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were cared for. Staff listened to them and knew their needs well. Staff had excellent training and support.

Staffing levels were sufficient to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The service was meeting the requirements of the Deprivation of Liberty Safeguards(DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act 2005, DoLS and associated Codes of Practice.

The registered manager and staff ensured everyone was supported to maintain good health. They took a very proactive approach to ensuring people's complex health needs were always met, and consistently ensured that when people needed specialist input from health care professionals they got it.

People had excellent, meaningful relationships with the staff. People were treated with respect and dignity and staff were very kind and caring towards them. Staff understood the importance of providing dignified care and support and did so to a high standard. People were encouraged to lead independent lives and care and support was tailored to enable people to do so. Innovative methods were used to communicate with people and there were individualised processes in place to help people understand and contribute to, decisions about the care. All people were treated equally with staff having an excellent awareness of how to respect people's rights.

People received excellent person centred support focused on what mattered most to them. Clear processes were in place to ensure that people had a smooth transition when moving into the service. People's care and support needs were frequently discussed with them and progress on achieving their goals was regularly reviewed. People were encouraged to take part in activities that were important to them and staff provided as much or as little support as people wanted. People were provided with the information they needed, in a format they could understand, if they wished to make a complaint.

People were supported with healthy eating and to maintain a healthy weight, with specialist diets when required. People who needed assistance with meal preparation were supported and encouraged to make choices about what they ate and drank. The support staff we spoke with demonstrated an excellent knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences.

The service employed a dedicated compliance Co-ordinator and had a quality assurance policy which detailed the robust systems they had in place to monitor and improve the quality of the service.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A senior manager told us that when people were referred to the service a needs assessment was carried out by two senior members of staff.

One person's relative said "We find the service excellent and as far as we are concerned they are very good." Another relative said "It seems to be working and my relative is getting used to them, but it is still early days, they do take my relative out and are getting my relative back into the community."

We saw in the folders of the eight people who used the service, evidence that where treatment had to be followed based on recommendations from other providers, this was done.

We spoke with the relatives of three people and they told us that people's homes were always clean and tidy when they visited and they had no concerns.

Staff told us that each person had a home file and this contained information such as people's PCP, medication administration records, daily notes and shift handover lists. These were used to keep people's records up to date.

Relatives confirmed that the agency involved them in people's care and kept them informed about their relative on a regular basis. Relatives comments included, 'I have a lot of cultural involvement,' and 'we listen to each other. If there are any issues they always listen to me.'

Relatives and people using the service were positive about the care and treatment they received from staff at the agency. Comments from relatives included, 'the staff are fantastic,' 'the staff are considerate of our culture,' I'm very happy,' and 'I'm in constant contact.'

Relatives said they had no concerns or complaints about the care but would speak with the manager or the key worker if they needed to. Comments from relatives included, 'as soon as I express concerns there is an immediate response.' We looked the last quality monitoring survey which included many positive comments such as, 'staff work in a person centred manner.'

Staff told us they felt supported by the management and that there were very good training opportunities available within the organisation.