Mather Fold 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.

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.

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 received mixed feedback from visiting relatives. Some relatives told us that they felt there had been notable improvements in the safety of their family members and that there was sufficient staff available to help people when they needed this. While other relatives felt improvements had been made, they did not think it would be sustained.

Improvements had been made to the management of risks to people receiving care. This included risks associated with abuse and improper treatment, disproportionate use of physical restraint, undignified treatment from care staff and the spread of infections. Staff had received training in the management of behaviours that could challenge and treating people with dignity. The systems for reviewing risk levels and ensuring lessons learnt were shared in the service had also improved. Reflections had been held following incidents to identify what went well and what could be done better in the future.

Management and governance systems in the home had improved. We acknowledged that this was at an early stage. Further improvements were required to ensure that changes made could be fully established and embedded within the staff team and the governance systems in the home. There was a new manager who had been employed since July 2018. We noted an improvement in the systems designed to assess, monitor and improve the service. There was an increased oversight on the service from the provider’s representatives and senior leadership.

A significant number of audits and quality assurance processes were in place; they were supported by an action plan. However, action plans had not been signed off to show action had been taken and timescales had not been set to show when actions on any identified shortfalls were expected to be completed. Medicines management was also not robust and needed further improvements. The shortfalls we found indicated the quality assurance and auditing processes needed further improvements. There was a continuing breach of regulation in relation to medicines.

Records showed that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

There had been improvements to staff training arrangements. Staff had received induction and appropriate training. However, induction records had not always been signed off to show that inductions had been completed.

We observed people being supported in a sensitive and caring manner. Staff and the manager had awareness of people’s privacy and dignity. We noted improved outcomes for some individuals in the home, however we also saw further improvements were required to improve other people’s outcomes through stimulation and offering a variety of activities to keep them engaged.

Referrals were made to community healthcare professionals where required to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. The service had taken appropriate action in line with the Mental Capacity Act 2005.

People received care that reflected their individual needs and preferences. Staff told us they knew people well, respected and followed their preferred routines. There had been improvements in involving people, their relatives and professionals in the review of their care. There were improvements in the way care records were maintained and how staff recorded people’s outcomes in care records.

People were supported to take part in activities and events. Improvements were required to ensure activities were varied in line with people’s needs. There was a policy on how people could raise complaints about care and treatment. This had been followed when complaints were raised.

There had been improvements in the way staff communicated with people. They supported people sensitively and spoke to them appropriately when providing care. The manager had engaged with other health and social care stakeholders such as the local authority, clinical commissioning groups and local health care professionals to improve the quality of care provided to people.

There was a business contingency plan to demonstrate how the provider had planned for unplanned eventualities which may have an impact on the delivery of regulated activities. The equipment and premises had been maintained and improvements had been made to the premises.

The provider had sent notifications to the Care Quality Commission for notifiable incidents, such as allegations and incidents of abuse and significant events that affected the smooth delivery of services.

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 rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We received mixed feedback from relatives regarding the safety of their family members. One relative felt the care was unsafe and some felt the care provided was safe but needed improvements.

Safeguarding adults’ procedures were in place and staff spoken with understood how to safeguard people from abuse. However, we found two instances where staff had failed to recognise serious incidents as safeguarding concerns and delayed completing an incident report and reporting to the authorities. Whilst there was evidence to indicate the circumstances of one of the incidents had been investigated there was no evidence seen to confirm the incident had been reported under safeguarding adults’ procedures.

We saw people’s care files contained individual risk assessments, however, not all risks had been assessed and recorded and consistent action had not always been taken to mitigate risks. One person had no care plan to guide staff. Staff did not always follow risk management plans such as allergies and did not wear protective clothing.

People were not adequately protected from improper treatment and abuse from staff and disciplinary policies were not adequately followed.

We found measures for protecting people against the risk of infection were not robust and there were shortfalls in the management of medicines. Improvements were required to the maintenance of the premises.

We found significant shortfalls in the training that staff were required to complete as part of their role. A significant number of staff had not completed induction training when they commenced work in the home. Furthermore, not all staff had received supervisions as directed by the provider’s policies and procedures.

The arrangements for monitoring and assessing quality in the home to ensure people's safety and compliance with regulations were inadequate. There were various audit tools to assess the quality of care which identified shortfalls. However, the shortfalls were not addressed in a timely manner and internal audit and quality assurance systems had not been effectively implemented to assess and improve the quality of the service. There was a lack of robust governance and leadership. Managerial oversight of staff and the care that people received was inadequate.

Two relatives told us the staff were caring and kind. However, some of the practices in the home demonstrated people had not always been treated with dignity and respect.

Each person had an individual care plan, however, we noted one person did not have a complete care plan also known as a behaviour support plan. Relatives were not involved in the planning or review of care plans.

Relatives informed us communication in the home was not effective and some did not feel they were listened to or that actions were taken if they raise a concern.

The provider was working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people's rights were protected.

People had access to healthcare services, and staff had responded in a timely way to seek medical advice. Staff had been safely recruited.

There was a complaints procedure in place and we saw evidence complaints had been investigated and responded to. Relatives did not always know who to approach if they had a complaint.

There were adequate number of staff to meet people’s needs. There was an end of life policy however staff had received training in this area.

People were supported to undertake activities of their choice in the community on a regular basis. We saw one person had thrived and made progress from our last inspection.

The provider and their relatives responded positively to the shortfalls and took immediate action to take corrective action.

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 shortfalls in induction, supervision and some of the training deemed necessary for the role. Record keeping around training and development needed some improvement to ensure the service identified training needs and shortfalls effectively. Staff competences were checked regularly in various areas such as medicine administration. They had also been provided with annual appraisals.

We found that people’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs. Care plans showed how people and their relatives were involved in discussion around their care. People were encouraged to share their opinions on the quality of care and service being provided. People’s nutritional needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed. There were a variety of activities provided to keep people occupied.

We received mixed feedback from staff regarding management of the service and shared the feedback with the registered manager.

There were established management systems at the service. There had previously been instability in leadership however this had improved. The Regional manager had been involved in the day to day management of quality at the service. The registered manager had provided oversight on duties they delegated to other staff.

Quality assurance systems were in place and various areas of people’s care been audited regularly to identify areas that needed improvement. We found audits had been undertaken of care records, and medicine administration records, finances, health and safety and the overall quality of the care provided by the service. There were areas of improvement in respect of completion of action plans for areas identified to require improvement by the audit processes. There was a business contingency plan to demonstrate how the provider had planned for unexpected eventualities which may have an impact on the delivery of regulated activities.

Feedback from relatives showed they felt their relatives received a good service and they spoke highly of the staff. Relatives told us the staff were kind, caring and respectful and were considerate in their approach to dealing with some challenging situations. Professionals we spoke to confirmed this.

We found the service had a policy on how people could raise complaints about their care and treatment. Relatives told us they could raise concerns and felt listened to.