Archived: Mediline Supported Living Swallow

Mediline Supported Living Swallow is a residential care home that provides care and accommodation for up to five people with a learning disability, or with autism. It is part of the wider Mediline Supported Living Limited group, who have other care homes and supported living premises in and around the Greater Manchester area. At the time of the inspection four people were living at the service.

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.

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

The quality and assurance systems in place to monitor the safety and quality of care provided had not identified the concerns we found. More robust levels of monitoring and oversight were required by the provider, so that the service improved for people living in the home.

Based on our review of the key questions; safe, effective, responsive and well led, we found the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support: The service did not support people to have maximum choice, control and independence. Staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. Staffing levels were not always aligned with people’s support needs, particularly during the night. There was no evidence of staff engaging people in meaningful activities when in the home, as staff were busy with other tasks during the inspection. One person had access to a mobility car, but no support staff were able to drive. People had exclusive use of their own bedrooms and living spaces and were able to personalise these accordingly.

Right care: People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood people's needs and provided appropriate care. Where appropriate, staff encouraged and enabled people to take positive risks. Staff understood how to protect people from potential abuse. The service worked well with other agencies. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture: Staff knew most people well and were responsive to their care needs. Care was not always fully person-centred due to constraints within the service. People and those important to them were involved in planning their care. Staff communicated with families and other professionals. People had access to independent advocates to help represent their wishes. Best interest decisions were documented, and people's dignity was respected. Staff felt supported in their roles and felt able to report concerns to management if they should arise.

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 3 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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.

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

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, effective, responsive 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.

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

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.

We found the following examples of good practice.

The home had mechanisms in place to communicate to people about the pandemic, the use of personal protective equipment (PPE) and why safety measures were necessary. Staff used pictures and social stories to inform and give reassurance. People were also encouraged to follow good hand hygiene practice.

There were safe and effective arrangements for visitors to the home, although contact was mainly via the telephone and post.

Procedures were in place to reduce the risk of infection entering the home, for example, a log of all visitors, temperature monitoring and lateral flow tests. In the foyer of the small care home visitors had access to personal protective equipment (PPE), hand sanitiser and antibacterial wipes.

Staff had received additional training on infection control, donning and doffing PPE and hand hygiene. The manager regularly reminded staff of the importance of good infection control practice, including the correct donning and doffing procedures for PPE, to prevent complacency.

The staff followed enhanced cleaning regimes, including deep cleans. There were cleaning procedures and recording systems in place for audit purposes. These helped staff maintain a high standard of cleanliness and hygiene in the care home.

As this was a small care home no admissions had taken place during the pandemic and the service had no plans in place to fill a vacancy at the home.

The registered manager had set up a Covid-19 file. This contained all the relevant government guidance, information and company processes introduced during the pandemic. This could be easily accessed by staff in the event of the manager’s absence.

Visiting health professionals did not visit communal areas but carried out necessary clinical care in people’s bedrooms.

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.

At our last inspection the service was rated good overall with requires improvement in the caring domain. 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.

The service had a registered manager. “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.’

Staff received training appropriate to their role and were supported through regular supervisions and annual appraisals.

Medicines were administered as prescribed. People’s health and nutritional needs were met by the service. We have recommended that the service records the daily ambient room temperature, for the room in which the medication is stored (this was visually checked but not recorded).

A safe system for recruiting new staff was in place. The number of staff on duty varied depending on the needs of the people of the people.

At our last inspection we found that not everyone had a Personal Evacuation plan (PEEPS) in place. At this inspection all PEEPS were in place. The service was well maintained and clean throughout.

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

Person centred care plans and risk assessments were in place to guide staff on the support people needed and how to reduce any identified risks. For those who needed support with communication separate communication plans were in use.

At our last Inspection the service was rated requires improvement in caring. During this inspection we saw positive and caring interactions between staff and the people living at the service.

Information about people’s preferences, culture, likes and dislikes was clearly documented.

The registered manager had a thorough auditing system in place to monitor the quality of the service. All incidents and accidents were recorded and reviewed if required. The provider, through the area manager, also undertook quality checks and audits at the service.

This inspection was announced because we were aware that the registered manager was taking a period of planned leave and the people using the service were often out at their daily activities. We needed to be sure that someone would be available to speak with us. The acting manager was given 36 hours notice prior to the inspection taking place.

Swallow Street is registered to provide care and support for up to five adults with a learning disability and / or a mental health problem. The house is a purpose-built bungalow situated within a residential area of Longsight in Manchester. Accommodation comprises of single occupancy bedrooms and spacious communal areas including a lounge, kitchen and bathrooms. At the time of our inspection the house was fully occupied.

The registered manager was on a period of planned leave at the time of this inspection. The post was being covered by a registered manager from a similar service and this person was present for most of the inspection.

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.

Staff ratios were adequate to meet the needs of the people living in the home. People were able to access the community with support and pursue their own interests.

We found robust recruitment processes were in place to ensure the right people were recruited to the posts of support worker. Staff accessed mandatory training during their induction along with other relevant specialist training for the role. Staff were also encouraged and supported by the company to undertake courses for personal development and staff spoke highly about the training on offer.

Accident and incident reporting mechanisms were in place and we found medication administration and management was safe. There were appropriate controls and procedures in place to manage and prevent the spread of infections and both the registered manager and acting manager were nominated infection control champions.

Staff had completed training on the Mental Capacity Act and the Deprivation of Liberty Safeguards and best interest meetings were taking place.

Staff were able to tell us about the different preferences of individuals and recognised the importance of this in order to provide person-centred care. We heard people being asked for their consent before receiving support .

Staff had good relationships with people living in the home and treated them with dignity and respect although on occasions staff did not always engage with people and people were left to their own devices. Staff were always friendly, patient and polite in their interactions with people.

Support plans were person-centred and contained relevant assessments of risk tailored to individual’s specific needs. Support plans were up to date and contained sufficient detail to enable staff to meet people’s care and support needs. They contained information about the individual’s personality, their likes and dislikes and preferences around methods of communication.

Personal goals had been identified for individuals and these had been reviewed after a six month time frame. Staff encouraged people to be actively involved in their local community and those that wanted to go out were supported to do this.

People were involved with choosing the décor for their own personal spaces and we saw bedrooms in colours of pink and red with matching accessories and pictures chosen by the individual. People were given choices by staff and staff respected their decisions.

There was a mechanism in place for people to raise a concern or complaint in the form of a complaints policy. The service also made available a small, colourful leaflet so that anyone could share their compliments, comments, concerns or complaints and this contained helpful easy-read symbols and simple language.

The service was well led and both staff and professionals spoke highly of the registered manager.,

Quality assurance systems were in place and audits were carried out by the provider. We saw that where improvements could be made any actions identified were followed up by the management of the home.

People's emotional care needs were met through a range of social activities provided both in the community and in the home. Arrangements were being made for each person to go on holiday with the support of staff.

Staff consulted with health care professionals such as the person's GP for advice and guidance when necessary. This meant people's physical care needs were met.

We spoke with three support workers during the visit. They spoke about people in a respectful manner and had a good knowledge of people's individual care needs and how they were met.

Staff were trained on how to safeguard people from abuse and harm and knew to report any signs or the suspicion of abuse to a senior member of staff.

A complaint procedure was available to the people who used the service and their relatives so they knew what to do if they were unhappy with the service they received.