Archived: The Mowhay

The Mowhay is a care home for up to five autistic people. At the time of the inspection four people were living at the service. Two people had their own self-contained accommodation, one in a separate annexe and one in a basement flat. The other two people shared a kitchen and lounge in the main house. The service is part of the Spectrum group who run several similar services throughout Cornwall.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, effective and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

People living at The Mowhay had different needs and required variable levels of support. Peoples experience of living at the service varied.

When some people experienced periods of distress there was a lack of guidance on how to support them to manage this.

The Mowhay was a pleasant, well-furnished and welcoming environment that met people’s physical and sensory needs.

The registered manager and staff had recently started working with specialist external healthcare professionals to develop strategies for supporting people.

Staff encouraged and supported people to pursue their interests in their local area.

Right Care

There were enough staff to meet people’s needs. Staff respected people’s diverse needs and recognised their individuality.

Staff recorded when people had become distressed and put themselves at risk of harm. The information was collated by the organisations behavioural team but this had not led to practical guidance for staff to help them support people when they were distressed.

Staff continually assessed risks in the community to try and help people avoid situations which might lead to them becoming distressed.

Right Culture

Some people were at risk of harm because effective strategies had not been developed to support them when they were anxious.

People were supported by staff who knew them well and put their needs first.

People were at ease in their environment. They approached staff freely and there was a relaxed and friendly atmosphere.

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

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 requires improvement (published 4 September 2019). 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 some improvements had been made and the provider was no longer in breach of the regulations identified at the last inspection.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 monitor the service.

We have identified a breach of the regulations in relation to supporting people to stay safe.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Mowhay provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. Two people had their own self-contained accommodation, one in a separate annexe and one in a basement flat. The other two people shared a kitchen and lounge in the main house. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

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's support focused on them having control over their daily lives and opportunities to take part in everyday routines.

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

Processes to ensure people’s safety were not always followed. When risks were identified, robust actions had not been taken to help protect people from the risk of abuse.

Systems for overseeing the service at all times were not robust. A member of the senior management team carried out audits of the service but this had not been completed since September 2017. The registered manager had been away from work for four weeks during April and May 2019. There was no deputy or senior support worker in post to manage the service in their absence. Records showed the regional manager had only visited once during this period. Notifications about significant events had not been submitted to the Care Quality Commission (CQC) as required by law.

On the day of the inspection people were busy and occupied, and everyone went out for part of the day on walks, shopping trips and to attend health appointments. People and staff told us there were plenty of opportunities for people to take part in hobbies and pastimes that interested them. People were encouraged to try new things and widen their experiences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

People were in control of their routines and day to day decisions. They told us they decided when to get up and go to bed and staff supported them to make decisions about how they spent their time.

Staff and relatives told us the staff team worked well together and communicated effectively. Care plans were regularly reviewed and updated and were an accurate reflection of people’s needs.

The registered manager carried out checks on the service to help drive improvement. This included gathering the views of all stakeholders and regular audits.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 (report published 6 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the oversight of the service and how people were supported. A decision was made to bring forward our planned inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

We found no evidence during this inspection that people remained at risk of harm from this concern. The provider has told us of action they will be taking to help ensure notifications are submitted appropriately in future. Please see the well-led section of this full report.

This announced comprehensive inspection took place on 9 May 2018. This was the first time the service had been inspected since it registered in April 2017.

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.

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.

The service requires a registered manager and there was one 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.

People received care which was responsive to their individual needs. Staff were highly motivated to ensure people led full and meaningful lives doing things which interested them. People, relatives and staff all told us people’s quality of life had improved since moving to the service. People had access to a range of activities on a day to day basis both in and outside of the service. This meant they were protected from the risk of social isolation because of their continuous positive contact with the local community.

Activities were varied and met people’s individual preferences and interests. People were supported to try new pastimes as well as develop their established interests. For example, two people had signed up to take part in a local Race for Life event the weekend following the inspection. They were clearly looking forward to this and were planning their fancy dress outfits.

People were comfortable and at ease in their environment. All were happy to show us around and demonstrated a sense of ownership and belonging within their surroundings. The premises provided people with opportunities to have privacy and time on their own as well as with each other or staff as they chose. The building was well maintained and there were photographs and personal possessions on display throughout. This created a feeling of homeliness and there was a relaxed and friendly atmosphere. During the day we spent time in the office and people popped in from time to time to offer us drinks and ask if we wanted to speak with them or look round the garden. They were obviously used to entering the office and were comfortable and confident approaching us.

Staff were considerate and respectful when speaking with people. They allowed people to lead the conversation and make choices about where and how they spent their time. Relatives told us they were confident their family members were safe and well supported by staff who knew them well and understood their needs.

People were supported to have their medicines as prescribed. Systems for recording when people had received their medicine were robust. The organisation was committed to the principles of STOMP which advocates for stopping the over medication of people with a learning disability or autism.

Staff told us they were well supported and confident in their abilities to fulfil their roles and responsibilities. Staff roles and responsibilities were clearly defined and understood by all.

People are supported to have maximum 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. DoLS applications or authorisations were in place for everyone living at The Mowhay. Where relevant best interest processes had been followed to help ensure any restrictive practices were necessary and proportionate.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager and staff. Relatives and people’s views about how the service was operated were sought out.