Midway Care Midway Support Services

Midway Care Midway Support Services provides personal care for younger adults with learning disabilities, autistic spectrum disorder or mental health needs. People received support in their own homes or supported living services. At the time of our inspection the service was supporting 25 people living in 17 houses or flats across Warwickshire and Worcester.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do will also consider any wider social care provided.

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

There was a lack of provider oversight which meant risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were not always effective and placed people at the risk of harm. The systems in place failed to identify the areas for improvement found at this inspection.

Risks to people were not always robustly managed. Care records and risk assessments were not always reviewed following an incident or change in a person’s need.

Infection control systems were in place but needed to be consistent throughout the service and required strengthening to limit the risk of infection.

Most staff felt supported in their role. Training updates were needed, and plans were in place to address this. Staff were kind and caring and spoke in a person-centred way about the people they supported.

Relatives had mixed views, some were happy with the service and felt their family member was well cared for. Some relatives felt improvements were needed. Most relatives told us communication needed to be improved.

The provider was aware that improvements were required to the service. They were strengthening the systems in place and reviewing the structure of 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 and update

The last rating for this service was good (published 28 September 2017).

Why we inspected

The inspection was prompted due to concerns about the service in relation to allegations of unsafe practice, not reporting incidents, staff conduct issues, poor staff culture and not following infection protection and control guidelines. The local authority had also let us know they had concerns. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. We only looked at safe and well led during this inspection. We did not look at the key questions of effective, caring and responsive. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Midway Care Services on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have identified two breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

There was a registered manager in place who was present during our 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.

Prior to our inspection visit we had received several notifications that people had been put at risk of harm. We received information of concern regarding medicines, staff behaviour, suitability of agency staff and how people were supported from the risks associated with their specific conditions. We found that the provider was taking effective action to keep people safe and minimise any risks of harm.

People were protected from avoidable harm by staff who knew how to protect them from the risk of abuse. There were enough suitable staff to meet people’s care needs and keep them safe. Assessments had been undertaken to identify the support people required to take their medicines safely. Medicines were administered by staff who were trained to do so.

The needs of people were met consistently by staff who had the right competencies, knowledge and skills. Staff felt confident they could meet the needs of the people they were supporting. People were supported in line with the Mental Capacity Act 2005. Staff offered people choices and respected their decisions. When relatives were involved in making decisions about peoples care, further action was required by the provider to identify they had the legal authority to do so. People had been supported to eat meals they liked and achieve a healthy body weight when they wanted. People were supported by a variety of mental and physical health professionals including the provider’s other services which supported people whose behaviour could challenge.

People were supported by regular staff who knew and understood their likes and preferences. Staff understood peoples preferred communication styles so people would be supported to express their views and feelings. Staff respected peoples lifestyle choices and helped them to explore and recognise their individual personalities.

Staff knew the activities that people enjoyed and had supported people to engage in things they liked. There was a range of ways for people to feed back their experience of the care they received and any concerns they may have. People’s experiences were used to improve the service they received.

The registered manager was aware of their responsibilities to the commission. Action had been taken to ensure the service would be compliant when changes to how the service is inspected are introduced in the near future. The provider monitored the quality of care people received and drove a culture of continual improvement.