Maranello Also known as Zero Three Care Homes LLP

Maranello is a residential care home providing accommodation and personal care to people who have a learning disability or autism.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. Seven people were using the service when we inspected. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. The registered manager told us that the provider had no plans to use all the capacity of the home at any one time. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There were enough staff on duty to enable people to remain safe and receive care in a timely way. Staff were safely recruited, they knew how to keep people safe from avoidable harm. Accidents and incidents were analysed to prevent re-occurrence. People were supported to take their medicines in a safe way. The environment was safe, and people had access to appropriate equipment where needed. The premises were clean and staff followed infection control guidelines.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to pursue their hobbies and interests.

People had access to health professionals when needed. People were supported to maintain a healthy diet and support was planned to meet the assessed nutritional and health needs. Staff received specialist and accredited training to ensure they could meet the needs of people living at Maranello. Staff also received intensive supervision and support so that they could learn and reflect on their practice to ensure people with very high support needs received safe care and treatment.

Staff were kind, caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

The registered manager provided staff with leadership and was visible and approachable. Staff were motivated and enjoyed strong team work. Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received.

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 6 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 03 February 2016. At the inspection in February 2016 we had found two breaches of legal requirements in relation to Regulation 15 and 18. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. The overall rating from the inspection in February 2016 was Requires Improvement.

At this inspection we found improvements had been made to meet the relevant requirements.

There was a manager in post at the time of 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.

People living at the service required staff to provide support to manage their day-to-day care needs, as well as to manage their behaviour and reactions to their emotional experiences. staff had taken appropriate steps and reviewed people’s behaviour; and analysed what worked or not; and provided consistent responses when people’s needs changed to ensure that they continue to meet the individual’s needs.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and they and the registered manager understood the requirements of the Act. This meant they were working within the law to support people who may lack capacity to make their own decisions.

Most people had difficulty discussing complex issues and thinking about the future but a few were able to share their views about day-to-day life at the service. People indicated and told us they liked living at the service and that the staff were kind and helped them a lot.

We saw there were systems and processes in place to protect people from the risk of harm.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

We found that staff worked to assist people to lead ordinary lives and looked at how to assist individuals to reach their full potential. People were supported to go out and about in the local community and routinely went out with staff.

Staff had received a range of training, which covered mandatory courses such as fire safety as well as condition specific training such as managing autism and other physical health needs. We found that the staff had the skills and knowledge to provide support to the people who lived at the service.

Relatives and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that consistent numbers of staff routinely provided support to people who used the service during the day and overnight.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We observed that staff had developed very positive relationships with the people who used the service. We saw that the staff effectively assisted people to manage their anxiety. Interactions between people and staff were warm and supportive. Staff were kind and respectful.

People made decisions about what they did throughout the day where they were able.

We saw that people had plenty to eat and that each individual’s preference was catered for and and staff had ensured that people’s nutritional needs were met. Staff monitored each person’s weight and took appropriate action if concerns arose.

We saw that people living at Maranello were supported to maintain good health and had access a range healthcare professionals and services. We found that staff worked well with people’s healthcare professionals such as consultants and community nurses.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. Where able staff worked with people to create them.

We saw staff encouraged people to develop their daily living skills and supported them with their hobbies and leisure interests inside and outside of the home. During the visit we saw staff joined people doing creative work and identified activities people would enjoy doing.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. Relatives we spoke with told us that they knew how to complain and did not have any concerns about the service.

The provider used a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager used them to critically review the service. This had enabled them to identify areas for improvement and make the necessary changes.

Maranello is a nine bed service for people with a learning disability and supports people to live within their community. On the day of our inspection there were nine people using the service. There was a second similar service located on the same site managed by the same provider.

There was a registered manager in post at the time of the inspection and they were present at this visit. 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.

People told us that they liked living at the service. The building was purpose built with a flats for some individuals created within the building. People had their needs assessed before they moved into the service and had a care plan in place known by the staff, who used and understood the associated risk assessments in place. Staff were knowledgeable about people they supported and were enthusiastic about their job.

Relatives were complimentary about the service offered and felt involved and able to approach staff and managers to discuss matters important to them and their relative. They felt able to visit whenever and were given updates and were part of regular reviews.

Medicines could be managed more safely. Records relating to medicines and the auditing was not as robust as should be. Staff understood people’s health needs well people were supported to access health professionals. Complex health conditions were well monitored and appropriate actions taken to maintain good health. Staff were trained in a range of areas including medication, safeguarding and first aid. New staff did not always have effective induction and were not trained in Studio III [techniques to support people who may be anxious and challenge] before they were placed on shift.

Individuality was respected by staff. Choices were promoted and people were involved with planning their aspirations and future. People were encouraged to be independent and to exercise choice in how they were supported. People had good access to transport and community facilities.

The managers were accessible for staff and they were motivated and staff felt well supported. Staff understood the aims and objectives of the service and worked towards and in line with these. They were clear about what was expected of them and there were systems in place to review the care provided. These could further be enhanced by developing action plans after consulting with people who have an interest in the service and people who live there. Repairs to the environment were not always swiftly dealt with and therefore could be left unsafe for longer than was needed.

We have made a recommendation about the management of medicines. We identified several breaches of regulations during this inspection, and you can see what action we told the provider to take at the back of the full version of the report.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff and the registered manager. Staff told us they were able to raise issues with their manager and that any concerns would be addressed.

We found that the service had a sufficient number of skilled staff on duty to provide care to people at all times. This ratio of staff to people was determined through a dependency needs assessment which was assessed at the time of admission and at regular reviews of care.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people's care was regularly reviewed and that additional provisions to support their care were provided where required.

We found that the provider had systems in place to ensure the safe management and administration of medication.

We found that care was provided according to very detailed needs and risk assessment of the people living in the service. We observed people's experience of being cared for and their behaviour showed us that they were happy with the care. They had the opportunity to express themselves through body language and some verbal communication with staff.

People we saw were supported by staff to manage their behaviour according to their needs. Their appearance showed the good personal care they received in the home.

The service was well supported by the provider through extensive training for staff, clear policies and procedures, and regular quality checks.