Macadamia Support

Updated 15 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008

Inspection team

The inspection was carried out by two inspectors and a member of the CQC medicines team.

Service and service type

Macadamia Support provides care and support to people living in six supported living settings, so they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support only.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service a short period of notice of the inspection. This was because people are often out, and we wanted to be sure they would be at home to speak with us.

Inspection activity started on 12 May 2022 and ended on 22 June 2022. We visited people in three of the supported living settings on 30 and 31 May 2022.

What we did before inspection

We reviewed information we held about the service. We sought feedback from the funding authorities and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with/or observed the support provided to eight people who used the service, to understand more about their experience of the care provided.

We also spoke with two professionals who work with the service and eight members of staff including: the registered manager/nominated individual*, HR manager, deputy manager, two area managers and three support workers. In addition, we received written feedback from a further six professionals and another member of care staff.

*The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records including care, risk management and medicine records for ten people using the service. We also looked at a variety of records relating to the management of the service, including policies and procedures, staff files in relation to recruitment and staff supervision, complaints and compliments, audits and meeting minutes; so we could corroborate our findings and ensure the care and support being provided to people were appropriate for them.

Updated 15 July 2022

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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Macadamia Support is a supported living service providing personal care for adults with a learning disability, autistic people and people with mental health needs, in their own homes.

Not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of this inspection the service was supporting 15 people. Of these, 14 people were receiving personal care.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture:

Right support

Staff supported people to have the maximum possible choice, control and independence over their own lives.

People were supported by staff to pursue their interests. Staff supported people to achieve their aspirations and goals.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there were no alternatives.

Staff enabled people to access specialist health and social care support in the community.

Staff supported people to make decisions following best practice in decision-making.

Right care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs.

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.

People who had individual ways of communicating, using body language, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them.

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

We found some areas of the service that required improvement such as: improving the content and quality of some people’s care records, enhancing existing staff recruitment processes and ensuring staff consistently followed government guidance in terms of COVID-19. However, the provider responded positively to our feedback. They confirmed they would be taking action to address all the areas we had identified for improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 11 March 2016, followed by a period of dormancy which ended on 29 January 2021. This is the first inspection.

Why we inspected

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

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

For more details, please see the full report which is on the CQC 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.