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Inspection carried out on 11 November 2020

During an inspection looking at part of the service

Mather Fold House is a residential home providing accommodation for up to six people with autism, learning disabilities and complex needs. At the time of our visit six people lived at the home. There was one house for four people and two single person units attached to the house.

We found the following examples of good practice.

The provider and management team had developed highly person-centred strategies to support people living in the home to understand and respond safely to the risks posed by the pandemic. Easy read social stories had been developed which helped people understand Covid 19 testing and the use of PPE.

Individual risk assessments for people living in the home included information about how to support people who may find it difficult to tolerate testing. Where a person declined a test the home responded by ensuring a small group of staff supported them to minimise the number of contacts they had.

Some people living in the home found staff wearing masks distressing. The risks associated with this were being fully assessed and risk mitigation plans developed which included; maintaining good social distancing and hand hygiene.

The staff had developed a programme of activities based in the home to support people who would normally go out a lot. This included, exercise sessions, movie nights and a take away night.

The provider and management team had developed a new standard operating procedure in response to the pandemic. Regular calls helped ensure everyone was kept up to date with policies and procedures.

The provider and management team had reviewed their contingency plans in the event of a reduction in staff at short notice. Managers were clear about how to manage and prioritise potential risks.

Inspection carried out on 5 February 2020

During a routine inspection

About the service

Mather Fold House is a residential home providing accommodation for up to six people with autism, learning disabilities and complex needs. At the time of our visit six people lived at the home. There was one house for four people and two single person units attached to the house.

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 were protected from the risk of abuse and avoidable harm. Relatives told us they were confident people were safe in the home and staff understood how to support people manage risks. Staff were well supported to understand and manage risks and felt safe when supporting people. People's medicines were managed safely.

People's needs had been thoroughly assessed and plans of care developed which helped ensure their needs were met effectively. Staff had received training and support to ensure they had the appropriate skills and knowledge to support people achieve good outcomes. People were supported to meet their health needs. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible and in their best interests.

People were supported by kind and compassionate staff who were committed to understanding and supporting people. People were supported respectfully in ways which upheld their dignity. People's communication needs were assessed in detail which helped ensure they were able to express their views.

People received person-centred care which reflected their needs and preferences. The provider had made a marked effort to understand how people experienced the world around them and used this information to update plans of care and develop activities. Relatives told us they had seen significant improvements in people's quality of life. People's concerns had been responded to and relatives told us they were content with any issues they had raised.

The service was well-led. The manager demonstrated good leadership which had helped staff to develop their skills and confidence. The manager followed good governance systems which helped ensure the quality of both care practice and record keeping was maintained. Relatives commented on the improvements achieved and told us they were confident this had been sustained.

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

Rating at the last inspection

The last rating for this service was Requires Improvement, published (07 February 2019) with a breach of regulations in relation to the safe management of medicines. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on our 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.

Inspection carried out on 8 January 2019

During a routine inspection

We carried out a comprehensive inspection of Mather Fold House on 08 and 09 January 2019. The first day was unannounced.

Mather Fold House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to six people. At the time of the visit there were four people who lived at the home.

The registered manager had left the service following our last inspection and a new manager had been appointed and was applying to register with the CQC. 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.

At the last inspection on 08 and 09 July 2018, we found five breaches of the regulations. This was because there were shortfalls to the safe management of people’s medicines, people were not protected against the risk of abuse and improper treatment including the appropriate use of physical restraint. In addition, risks associated with receiving care including, prevention of infections had not been adequately managed and staff had not been adequately supported with supervision and ongoing training. People were not treated with dignity by care staff. The governance and quality assurance systems were not effective in identifying shortfalls to generate improvements to the quality of the service. These were breaches of regulation 10,12,13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our last inspection of 08 and 09 July 2018, we met with the provider to discuss what actions they intended to take to improve the quality of the care and address the shortfalls. We asked them to take immediate action to address the shortfalls and regularly submit evidence of their actions to CQC. The provider was also asked by the local authority’s contracts monitoring team to complete an action plan under their quality performance and improvement planning process. We have met regularly to monitor their progress.

During this inspection, we reviewed actions the provider told us they had taken to address the breaches in regulations identified at the previous inspection on 08 and 09 July 2018. We also looked to see if improvements had been made in respect of the breaches. We saw that significant work had taken place to improve the safety, effectiveness and quality of care provided. However, we found ongoing shortfalls in relation to the safe management of medicines which meant the service was still in breach of Regulation 12 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 version of the report.

The work to improve the service was still in its early stages. There were areas where further improvements were required to ensure a consistent delivery of safe care and treatment that could be evidenced in the longer term.

People were not adequately supported to ensure they received their medicines safely and as prescribed. We found there had been a number of preventable medicine administration errors and there had been a lack of robust action when people routinely refused their essential medicines. While some people’s GPs had been informed and engaged, this was not always consistent. The refusal of medicines was noted to have had an impact on one person living at the home. The management at the home took immediate action to resolve the matter and involved the relevant professionals.

People who lived at the home were not able to share their views with us due to their complex needs. We recei

Inspection carried out on 9 July 2018

During a routine inspection

We carried out an unannounced inspection at Mather Fold House on 09, and 11 July 2018.

Mather Fold House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mather Fold House is a six-bed residential service in Higher Walton, Lancashire. This specialist autism service is for male and female adults aged 18 years and over but can also accommodate people who are 17 years and are going through transition from children to adult services. At the time of the inspection, there were four people accommodated in the home.

The care service is aware of 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. However, we found on this inspection that the service was failing to deliver these values.

There was a registered manager at the time of our inspection. However, they were not present during the inspection. 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.

At the last inspection carried out on 06 and 07 July 2017, we asked the provider to make improvements to arrangements for protecting people against improper treatment. This was because people were not protected against the inappropriate use of physical restraint. Following the inspection, the provider sent us an action plan and told us they would make the necessary improvements by November 2017.

During this inspection, we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found continuing shortfalls in the safeguarding of people against abuse and improper treatment. In addition, we identified further shortfalls in the way risks to people’s health, safety and welfare were managed, medicines management, infection control practices, staff training and development, procedures for treating people with dignity and the governance arrangements.

At the last inspection, the service was rated as overall ‘requires improvement’, at this inspection the rating had deteriorated to overall ‘inadequate’.

We are considering what action we will take in relation to these breaches. Full information about the CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rat

Inspection carried out on 5 July 2017

During a routine inspection

This unannounced inspection took place on 06 and 07 July 2017.

Mather Fold House is a six bed residential service in Higher Walton Lancashire. This specialist autism service is for male and female adults aged 18 years and over, but can also accommodate people who are 17 years and are going through transition from children’s to adult services. Located in the village of Higher Walton which is positioned between Blackburn and Preston, the service is close to the town centre and within walking distance of local amenities. There were three people who lived at the service at the time of our inspection.

The service 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.

This inspection was the first inspection since the service was registered with the Commission on 20 November 2015.

During this inspection we found the service to be in breach of one regulation under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breach was in respect of Regulation 13, safeguarding service users from abuse and improper treatment. This included shortfalls in the systems and arrangements for protecting people from abuse and improper treatment associated with use of physical restraint. We also made a recommendation in relation to staff training, supervision and development. You can see what action we told the registered provider to take at the back of the full version of the report.

There were policies and procedures on how the service protected people against bullying, harassment, avoidable harm and abuse. Majority of the staff had received introductory training in safeguarding adults. We found evidence to demonstrate that physical restraint had been used disproportionately in response to risks of harm posed to one person. Staff had not always explored other less restrictive ways of reducing risks before using physical restraint. This had been noted by the registered manager and processes for learning from this had been implemented but needed to be imbedded.

Staff had sought advice from other health and social care professionals where necessary. There were risk assessments which had been undertaken. Plans to minimise or remove risks had been drawn up and reviewed in line with the organisation’s policy. These were robust and covered specific risks around people’s care and specific activities they undertook in a person centred manner.

People were protected against the risk of fire. Building fire risk assessments were in place including personal emergency evacuation plans (PEEP’S).

There was a medicines policy in place and staff had been trained to safely support people with their medicines.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service. Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met.

We found care planning was done in line with the Mental Capacity Act, 2005. Staff showed awareness of the Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. They had received mental capacity training.

People who used the service had limited ability to provide us with feedback on the service due to their needs. Feedback from relatives about care staff was positive.

People using the service had access to healthcare professionals as required to meet their needs. Staff had received some training deemed necessary for their role. However there were sh