Moore Care (Registered) Limited, 4 Manchester Road

Moore Care (Registered) Limited 4 Manchester Road is a residential care home providing personal care to up to 12 people. The service provides support to people with a learning disability and autistic people, those with a physical disability, older people, people with a mental health diagnosis and people with dementia. At the time of our inspection there were 12 people using the service. People are cared for within 4 different areas of the home, the ground, the middle, the flat and the cottage. The service is located near to the local town centre.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service was undergoing a refurbishment, however at the time of inspection it did not always give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. Medicines were not always managed safely.

The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including support to travel wherever they needed to go. The service had good links with the local community.

Right Care

People’s care, treatment and support plans did not always reflect their range of needs, in order to promote their health and well-being outcomes. Risks were not always suitably assessed. Some people’s care and support had been assessed using positive behavioural support (PBS), whilst others hadn’t. This meant we could not be assured staff were following a consistent and evidence-based approach to supporting people with a learning disability.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture

Governance processes were not always effective in making improvements to the quality of care and support people received.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the staff. Staff knew people and their aspirations and supported them to live a quality life of their choosing. People and those important to them, including advocates, were involved in planning their care. The service enabled people and those important to them share their views and work with staff to develop the service.

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

The last rating for this service was Good (published 12 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, and good governance. We have made a recommendation in relation to consistent use of an evidence-based model of care for people with learning disabilities.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in May 2016 we rated the service, good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Manchester Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 remained safe. People were protected from the risks of abuse because the staff understood where harm may be caused and knew what action to take. The staff supported people to understand any risks to prevent avoidable harm. Where people were concerned about their safety they knew who to speak with. People’s medicines were managed safely and staff had received training to help ensure people had their medicines when these were needed. The provider reviewed how the service was managed to ensure any lessons were learnt and improvements were made.

The care people received remained effective. People received consistent care from a team of staff who knew people and understood their needs. They received care and support from staff who were trained and confident to meet their individual needs. People chose what they wanted to eat and drink and were helped to prepare meals and supported to maintain a balanced diet. People were assisted to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals, which ensured people received the care and treatment they needed in a timely manner.

People were 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 support this practice. People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

The service remained caring. People were treated with kindness, compassion and respect and the staff promoted their independence. People liked the staff who supported them and they had developed good relationships. Information was available to ensure people could make informed choices and understood information what was important to them. People were supported to maintain relationships with their friends and families.

The service remained responsive. People’s care was regularly reviewed and amended as necessary to ensure it reflected their changing support needs. People received support from staff to enable them to be involved with activities and do the things they enjoyed. People chose to work, continue with their education and be involved with activities they enjoyed. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required. People and their relatives were encouraged and supported to express their views about the care and support provided and staff were responsive to their comments and any concerns.

The service remained well led. The registered manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us and informed us of information that we needed to know.

4 Manchester Road is a residential care home situated in Buxton. It is a large house which is divided up into four smaller shared flats, within the larger accommodation, each with its own kitchen, lounge, bedrooms and bathrooms.

The service offers personal and social care to a maximum of thirteen adults with a learning disability. Some people have associated conditions that may include, autism, sensory and communication difficulties. At the time of the inspection there were twelve people using the service.

4 Manchester Road is required to have a registered manager and at the time of our inspection, 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.

We found staff encouraged people to make day-to-day decisions; staff respected people’s decisions whilst ensuring and being aware of people’s safety. The service was focused on each person and accounted for personal likes, dislikes, needs and preferences.

People were cared for and supported by staff who had demonstrated their suitability for their role. Recruitment procedures were safe and included Disclosure and Barring service (DBS) checks. Staff understood their role and responsibilities in keeping people safe and how to report any concerns they may have.

Medicines were stored, administered and disposed of safely and in accordance with current guidance.

The principles and requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been met. Best interest decisions and capacity assessments had been completed when required and were in people’s care plans. People were given support and choices in their daily life from staff who knew them well. Staff received training and support to ensure people received care to meet their needs.

Staff treated people in a kind, compassionate and caring manner. People were supported to maintain relationships with family and friends. Positive and caring relationships had developed between people and staff.

Effective auditing systems were in place to assess and monitor the quality of the service. Meetings took place with the people living at the service to collect their opinions and views. Staff were invited to voice their opinions about how to improve the service; managers provided feedback to staff about their suggestions.

There was an open door culture. People and relatives were supported to maintain relationships.

of what we found.

Is the service safe?

One person we spoke with told us that they felt safe and that they liked the staff. Other people who used the service communicated by their behaviour and conversation that they were happy and felt safe. There were enough staff on duty to meet the needs of people who lived at the home. The provider ensured that medicines were administered in a safe and effective way. Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm.

People were also protected from the risk of abuse as staff demonstrated that they had received appropriate training .We saw evidence that the provider had recognised their responsibilities and had taken action to report concerns about the safety and well-being of vulnerable people using the services and had implemented actions to manage the risk of further abuse occurring.

The provider was taking appropriate action to ensure that practices to protect a person from the risk of harm were lawful and in keeping with the Mental Capacity Act and the Deprivation of Liberty Safeguards.The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes and preferences have affected the decision and how they were involved in the decision making process.

Is the service effective?

People we spoke with told us, and our observations confirmed that people were happy and confident living at 4,Manchester Road. Many of the staff had worked at the home for a long time and those we spoke with told us they really enjoyed their job. One staff member said, "It's brilliant here. The staff are really helpful." we found that staff knew people's needs well. Support plans in people's care files we saw gave staff detailed guidance about the ways in which each person preferred to be supported.

Is the service caring?

We saw that people got on well with the staff, who supported them with respect but also in a friendly manner. One of the advocates we spoke with said, 'Staff are very understanding. It is a very person-centred service.' An advocate is a person who is independent of the service provided and who is asked to speak on behalf of a person who is not able to speak for themselves. Person-centred means that staff provided care and support in a way which was based around the needs and wants of each individual person. We saw that personal care was offered and delivered discreetly so that people's privacy and dignity were respected. The staff who we spoke with had a thorough understanding of the needs of people who used the service and demonstrated a desire to help people to enjoy a good quality of life.

Is the service responsive?

People's care needs were regularly re-assessed by the staff at the home. Support plans included people's preferences and their likes and dislikes, to ensure care and support were delivered in the way they wanted them to be. People participated in a range of activities of their choice, both at the home and in the local community. The design of the staff rota was led by the needs of people who used the service. People were supported to maintain contact with friends, relatives and advocates.

Is the service well-led?

There was effective leadership in place. This ensured that people's needs were met and they were kept safe and the service provided was of a high quality. Staff were well supported. One member of staff told us, "The management team are very approachable." The provider had a range of quality assurance and audit systems in place to ensure that all aspects of the service were monitored and improvements made where necessary. We found that the provider was compliant with the regulations in all the areas we assessed.

We spoke with two who lived at 4 Manchester Road they said that they were happy with the care that they were receiving. One person said: 'I lived at home but I kept getting in trouble, and now I have the staff to help me, and I've got my own room and things.' A second person said: 'I go to the gym every Friday, and I like going into town to do some shopping.' The first person also said: 'I chose the colours for my bedroom, and it's how I like it.'

We also spoke with a staff member who said that: 'People who live at 4 Manchester Road were encouraged to be a part of the local community. We use local facilities like the gym, and the library, and we regularly get out and about with people.'

We found that people received care and support that protected their rights and met their needs from staff that were properly trained and supported.

The atmosphere in the home was calm and relaxed and all the people we spoke with seemed to be at ease and appeared to enjoy living at Manchester Road.

People told us that they are involved in lots of day to day tasks around the home, including shopping, cooking, laundry and cleaning. One person said 'I enjoy the food; we can choose and cook it ourselves. It's good. We go out and buy the food and cook it on our cooking nights.' Another person told us 'staff encourage us to do things independently'.

Everyone we spoke with knew about their care plan and where it was kept. Although people told us they didn't have a copy of their care plan, they said they were kept in the office and that they could look at them whenever they wanted to.

Regular quality monitoring reviews were completed by members of staff and the provider. This included a range of aspects of the service being provided at Manchester Road such as, reviewing medication charts and care plans, communication with staff and people living in the home and team working.