This was an unannounced inspection which took place on the 22 and 23 March 2016. We had previously inspected this service in July 2014 when we identified four breaches of the regulations we reviewed; these related to assessing and monitoring people’s nutritional needs, administration of medicines, acting in accordance with the Mental Capacity Act (2005) (MCA) and having effective quality audit systems in place for the service.Following the inspection in October 2014 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. Part of this inspection was undertaken to check whether the required improvements had been made. We found that people’s nutritional needs were assessed and monitored and medicines were safely administered. However we found that the service was not acting in accordance with the MCA and did not have robust quality monitoring systems in place.
MLDP North provides support for 55 people living in their own homes. Some people lived in their own bungalow in a complex of several bungalows together. People received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or group of bungalows had a designated staff team. The staff teams were managed by a care co-ordinator, who managed two teams. There were seven care co-ordinators in total.
The service had a registered manager in place. 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. The registered manager was not working at the time of our inspection and so the service was being managed by the Nominated Individual (NI). A Nominated Individual is a person employed as a director, manager or secretary of an organisation with responsibility for supervising the management of the regulated activity.
People we spoke with, and their relatives, said that they felt safe being supported by MLDP North. Staff told us that they had completed safeguarding training and could describe the action they would take if they witnessed or suspected abuse. We saw that referrals were made to other professionals by the care co-ordinators if relevant when concerns were raised. However these had not been followed up to ensure a prompt response from the other agencies. We were told that a new policy had been introduced to make sure any new referrals were followed up in a timely manner.
We found some risk assessments were in place to identify and mitigate risks people may face. However not all risks had been identified and they were not always up to date. Behavioural support plans were in place for people with complex needs. These gave guidance for staff to manage people’s behaviour; however they did not identify what the actual risks were.
We found agency staff were employed on temporary contracts to provide consistent support for people. However we saw that the number of incident reports increased when agency staff were used. Staff told us that some of the people they supported could not access their usual activities with agency staff due to the risk of an incident occurring when people were supported by unfamiliar staff. We were told agency staff did not always complete the necessary incident forms, meaning that a complete record of the incidents which had occurred was not kept.
We were shown the information provided to two new agency staff to support people with complex needs. The information was not sufficient to enable the agency staff to safely support the people who used the service.
We found a safe system for administering medicines was in place. Staff had received training in the administration of medicines. People we spoke with told us that they received the medicines as prescribed.
A safe system for recruiting staff suitable for working with vulnerable adults was in place.
Staff we spoke with demonstrated a limited understanding of the MCA and how this legislation was relevant to their practice. The registered manager had failed to take the necessary action to ensure the rights of people were upheld when they were unable to consent to their support.
Staff we spoke with said that they had completed training courses but we were unable to check this as training records were incomplete.
We found that people were supported to maintain their health and systems were in place to monitor people’s nutritional intake where required.
All the people we spoke with, and their relatives, were complimentary about the regular staff supporting them. We observed positive interactions between staff and people who used the service during our inspection. Staff we spoke with had a good understanding of people’s needs.
We saw care plans included people’s likes and dislikes and were written in a person centred way. However care plans had not been reviewed and updated and information was not always easily accessible.
We saw a survey was used to ask for relatives views about the service. However we did not see any evidence that these were analysed and actions taken about any points raised.
Staff said they enjoyed working at the service. However we found staff supervisions and team meetings were inconsistent across the different staff teams.
There was not a robust system of quality audits in place. Spot checks were inconsistently completed, incidents were not reviewed, training records were not complete and MCA best interest assessments had not been completed.
During this inspection we found twelve breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.
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, it 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.