Background to this inspection
Updated
16 February 2018
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 inspection took place on 10 and 11 January 2018 and was unannounced. The first day of the inspection was carried out by two inspectors, with one inspector returning for the second day.
Before the inspection, the provider completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law.
During the inspection, due to the nature of the service, we had limited observations of the interactions between staff and people who used the service. Some people were not able to communicate with us due to the nature of their disability and responded with gestures or yes and no answers.
We visited three properties and both bungalow complexes. We spoke with or observed 10 people who used the service. We spoke with five relatives, 13 staff members, five care co-ordinators, a union representative and the registered manager. We looked at records relating to the service, including nine care plans, three staff recruitment files, daily record notes, medication administration records (MAR), health and safety records, quality assurance records, accidents and incidents records.
Updated
16 February 2018
This inspection took place on 9 and 10 January 2018 and was unannounced. MLDP North was last inspected in November 2016 where we found a breach of legal requirements with regard to risk assessments not being robust. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question of safe to at least good. At this inspection we found improvements had been made and all legal requirements were being met.
MLDP North provides support for 48 people living in their own homes. Some people lived in their own bungalow in a complex of several bungalows together and received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or group of bungalows had a designated staff team. The staff teams were managed by a care co-ordinator. There were seven care co-ordinators in total.
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.
The service had a registered manager who had been in place since May 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
The care service has 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 can live as ordinary a life as any citizen.
At this inspection we found that the improvements seen at our last inspection in November 2016 had been sustained and built on.
Risks had been identified for each person and risk assessments were in place to mitigate these risks. All risk assessments we saw were current. Risk assessments detailed why any restrictions were in place, although one required further clarity which was evidenced as being completed straight after our inspection. Staff were aware of the reasons any restrictions were in place.
Behavioural support plans were in place and current for those people who may display behaviours that challenge staff. Person centred care plans were in place, had been reviewed and were up to date.
Quality assurance systems were in place. Trackers were used to monitor that care plans, risk assessments, staff training, staff supervisions and service audits were being completed. Incidents and accidents were reviewed by the care co-ordinators and any action taken recorded. These were logged onto a tracker so an overview of all incidents across the service could be reviewed for trends or patterns.
The registered manager had completed audits for each of the properties. A schedule of audits of MLDP North were to be undertaken by care co-ordinators form MLDP North’s sister services in the south and central areas of the city was in place. However, due to reasons outside of the registered manager’s control these audits had not been completed as planned in 2017. Action plans were produced following the audits and were signed off as the actions were completed.
The number of incidents had reduced across the service, linked to having more stable staff teams and a reduction in unfamiliar agency supporting people. People’s needs had been re-assessed by social services as part of the procedures of applying to the court of protection under the Mental Capacity Act (2005) when people had constant staff supervision or had restrictions in place. This had led to an increase in support hours for several people which had enabled people to participate in additional activities.
A system was in place to recruit staff who were suitable to work with vulnerable people. Staff training had been identified and had increased. More training had been booked for the forthcoming months. The registered manager was now able to identify and specify the training their staff required and book courses just for MLDP North staff. Previously the service had been offered places on courses booked by the central Manchester City Council human resources department.
Relatives we spoke with were very complimentary about the staff teams and care co-ordinators. We observed positive interactions between the staff and the people they were supporting. Information about people’s likes, dislikes and preferences was recorded meaning staff were able to form meaningful relationships with the people they supported.
People were supported to maintain their independence where possible, for example travelling to activities on their own.
Medicines were well managed by the service. Protocols were in place for any ‘as required’ medicines.
Staff said they felt well supported and that morale had improved. Care co-ordinators were more visible in the properties, staff had supervisions with their line manager and regular team meetings were held. Staff focus days had been held where staff discussed what was working well and where improvements were needed.
An out of hours on call system was in place so staff were able to speak with a manager outside of office hours. Staff told us this system worked well; however a care co-ordinator said there had been some occasions when the on call manager had not responded to a call in a timely manner which had affected the administration of an ‘as required’ medicine. The registered manager told us the ‘as required’ medicine policy was being re-written so that senior staff were able to make the decision as to when an ‘as required’ medicine was needed.
Capacity assessments had been completed and applications to the court of protection made through the relevant social service department where people had been assessed as not having the capacity to consent to their support. Where people lacked capacity and did not have any family members involved in their care advocates were used to ensure that people’s best interests were taken into account. We have made a recommendation to follow best practice guidelines to record where people are assessed as having the capacity to consent to their support.
People were supported to maintain their health. Health action plans were in place to record the support each person required with their health needs. People were supported with their nutritional needs.