Meadow Court

Meadow Court is a domiciliary care agency. It provides care and support to people living in their own flats in a supported living complex on the outskirts of Taunton.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

The service specialises in supporting people who have mental health and/or learning disabilities. At the time of the inspection the service was supporting 13 people with personal care. Care provided ranged from a few hours a day to 24-hour care and support.

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People lived in individual flats which had been adapted to meet their specific needs. The supported living complex was situated on the outskirts of Taunton, within walking distance of a bus route.

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.

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

People were able to follow their own routines and were helped to make decisions about their day to day lives.

People were supported by staff to pursue their interests and take on new challenges to enhance their quality of life.

Right Care:

People were supported by staff who knew them well and understood their needs. However, care plans and risk assessments were not always comprehensive and up to date.

People received their medicines safely from trained staff. However, there were no individual protocols in place for medicines which were prescribed to be given ‘as required.’ This could place people at risk of receiving these medicines inconsistently which may not always promote their comfort and well-being.

People were kept safe from avoidable harm because staff knew how to recognise and report any indicators of abuse. Staff spoken with said they would be confident to report any concerns about possible abuse or poor practice

People felt safe with the staff who supported them. We observed good interactions between people using the service and staff.

People’s needs were assessed, and they received person-centred care to meet their needs. Staff worked with other professionals to make sure people received the care and support to meet their individual needs and wishes.

People’s legal rights were protected and, where needed, appropriate legal authorisations were in place.

Right Culture:

Improvements were needed to make sure there were effective systems to monitor the quality of the service and plan improvements. The lack of effective quality monitoring systems is a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The ethos of the service was to provide person-centred care and promote people’s independence and well-being. People were encouraged to try new activities to enhance their enjoyment and quality of life.

Some people using the service did not use verbal communication. Staff used their knowledge of people and skills to support people to make choices. Staff told us about how different people expressed themselves and their wishes. This all helped to make sure care and support was tailored to each person’s needs and preferences.

People and those important to them, including advocates, were involved in planning their care.

There was an open and inclusive ethos within the service. People and staff told us they would be comfortable to discuss any worries or concerns with the provider and the management team.

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 good (published 20 March 2018.)

Why we inspected

This inspection was prompted in part due to concerns raised with us about how people were supported to manage their personal finance and how people were offered choices about their meals. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. We have identified a breach of regulation in relation to quality monitoring and planning improvements.

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

This service provides care and support to people living in a ‘supported living’ setting so that they can live in their own home 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.

Meadow Court is made up of 18 self-contained flats within one building and one shared house at another location. Each person has an individual tenancy agreement and receives personal care and support according to their individual needs. Packages of support ranged from a few hours a day to 24 hour a day support. People required minimal physical support with personal care but most required prompting and supervision with personal care tasks such as washing and showering. The majority of people were receiving emotional and practical support to maintain and develop daily living skills and to access the community.

The service specialises in supporting people who have mental health and/or learning difficulties. At the time of the inspection the service was supporting 20 people.

The provider works in accordance 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.

At our last inspection 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 on-going 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.

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At this inspection we found the service remained Good.

Why the service is rated Good

The provider had systems and practices to minimise risks and people told us they felt safe with staff who supported them. There were adequate numbers of staff employed to make sure people could receive their support at times of their choosing.

People were supported by kind and caring staff who had undertaken training to make sure they could effectively support people. Staff monitored people’s health and helped people to access appropriate healthcare services.

People were fully involved in planning their care and were able to make choices about who supported them. The service was flexible to meet people’s changing needs and preferences. People had individual flats and their privacy was respected.

Care provided to people was very personalised and took account of people’s wishes, culture and beliefs. People were supported to follow their interests and to learn new skills. People told us they would be comfortable to make a complaint if they were not happy with the service provided to them.

The service was well led by a management team who were committed to providing care to people in a way that valued their individuality and respected their choices. The provider monitored standards and supported staff to ensure the standard of the service was maintained. They worked in partnership with other professionals to make sure people’s needs were met.

Further information is in the detailed findings below

Mr Frederick John Eaton is registered to provide personal care to people who live in their own homes. People who use the service have individual tenancy agreements for self-contained flats within a shared building. This type of service is often referred to as supported living accommodation. At the time of this inspection there were 14 people using the service.

The service specialises in providing care and support to people who have learning difficulties and mental health needs. People required minimal physical support with personal care but some required prompting and supervision with personal care tasks. The majority of people were receiving emotional and practical support to maintain and develop daily living skills and to access the community.

The service is run by Mr Frederick John Eaton as a sole provider. As a sole provider he is not required to employ a registered manager. Instead he has opted to manage the service himself. 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 service was well led and there were systems in place to monitor quality and seek people’s views. People said the registered provider was open and approachable and we saw this throughout the inspection visit.

People were very complimentary about the staff who supported them. People said staff were kind and they felt safe with them. One person told us “I feel safe here because I know there’s always someone to talk to if I get nervous about things. Staff are nice to you.” People said they had been able to build relationships with staff and other people who used the service.

Staff received training and support to make sure they had the skills and knowledge to effectively support people. One person said “Staff are all pretty good and they know what they are doing.”

The service was flexible to accommodate people’s wishes and preferences. People told us they got the support they needed to learn and develop independent living skills and safely access community facilities.

Staff offered advice and support to people about healthy lifestyle and food choices. They also assisted people to make and attend appointments with healthcare professionals.

People continued to make choices and were fully involved in planning and reviewing their care and support. Where risks were identified staff worked with people to minimise risk to enable them to take part in activities with minimum risk to themselves or others.

We spoke with four of the six people who used the service. All were very happy with the support they received. Comments included; 'It's super. The staff are really good and always there when you need them,' ; 'They are really helping me to be independent' and 'It's much better than I expected and I think I'm doing really well.'

People we spoke with told us staff were always kind and polite. One person said 'Staff are always friendly and polite.' Another person told us 'Staff are really helpful but they treat you like an adult.'

The agency had systems in place for receiving, handling and responding to complaints. The service user handbook gave information about how to make a complaint and what action they could expect the provider to take. It also stated that the agency encouraged complaints because it gave them an opportunity to improve the service offered.

There was a lockable office which enabled records to be securely stored. This ensured that all personal information about staff and people who used the service was kept confidential.

We found that the agency had very clear guidance for providing the agreed personal care with each person. We saw that there were systems in place to ensure people could continue to be involved in planning their care and with who provided the care.

We found that there were systems that ensured staff were supported and received training appropriate to their role and the needs of people. However as the manager/provider was the only person who provided care at the time it was difficult to see this in practice.

We also found the agency assessed the quality of the service provided and protected the health and safety of people who received a service and others.