We carried out a review of the data available to us about 463 on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about 463, you can give feedback on this service.
463 is a small residential home providing personal and nursing care to seven young adults who have a life limiting condition. 463 is a fully adapted home in a residential area of Manchester.
People’s experience of using this service and what we found
People said they enjoyed living at 463 and they felt safe. They said the staff were supportive, kind and respectful. Relatives were also positive about the support their relative received.
People were supported to maintain their health and nutrition. Clear information about people’s health conditions and guidance for staff to follow if they became unwell was included in the care files. Referrals were made to medical professionals when required. People received their medicines as prescribed.
Staff knew where people required a modified diet; however, they did not always record when they added a thickener to fluids to reduce the risk of choking. A record form was implemented for thickeners following our inspection.
People’s support needs and any potential risks were assessed and guidance provided on how to support people and manage the known risks. People had the support they needed and were encouraged to be independent in the tasks they could do for themselves.
Where required, people’s communication needs were assessed and communication passports were in place to identify the potential meanings of the vocalisations and gestures used.
Staff were safely recruited and received the training and support to undertake their role.
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. People said staff offered them advice and then they were able to make their own choices.
The registered manager had oversight of the service through a combination being visible, speaking with people and staff, checking paperwork weekly or monthly and annual audits for medicines and infection control.
Incidents were recorded and reviewed to ensure actions had been taken to reduce the risk of a re-occurrence.
People continued to access 463’s sister organisation, Francis House Children’s Hospice for respite care. Trained staff at the hospice supported people in making advanced decisions for the end of their life; however, this information was not available for the staff team at 463.
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 25 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
463 is registered to provide personal care and accommodation with nursing for up to 7 young people who have life limiting or life threatening conditions. At the time of our inspection there were 4 people living at the home.
463 was taken over by the Francis House Families Limited in February 2016. The young people then living at 463 re-located temporarily to the nearby Francis House Children’s Hospice while 463 was completely re-furbished and enlarged. The provider notified the Care Quality Commission (CQC) of this temporary move. The four young people moved back to 463 in November 2016 with their own dedicated staff team. People could choose to continue to access the Francis House Children’s Hospice for respite care whilst living at 463.
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.
All the people we spoke with said they enjoyed living at 463 and felt safe with the staff support they received. People said staff knew their needs well and there were enough staff on duty to meet their needs.
The registered manager had a clear vision for the service and that the young people’s life limiting or life threatening condition should not prevent them from being independent and participating in educational and leisure opportunities. Staff were positive about their role.
People said staff were kind and caring. We observed positive interactions between the young people and staff during our inspection. People told us they got on with most staff, but not all. They had told the registered manager about this. The registered manager was working with the staff and recognised staff needing training and support to change from working in a children’s hospice environment where children visited for respite care to an residential adult service supporting the same people over a longer period.
People were active and able to choose what they wanted to do. People were supported to be independent travelling to and participating in their chosen activities. However one person said they would like to go out socially more with staff, which the registered manager was aware of.
Staff had received training in safeguarding vulnerable adults and knew the correct action to take if they witnessed or suspected abuse had taken place. They were confident the registered manager would act on their concerns.
Care plans and risk assessments were in place to guide staff on the support people required and the tasks they were able to complete for themselves. The care plans were written in a person centred way. Where required a detailed moving and handling plan was in place. The risk assessments were generic and written for all four people together, although they did cover all the identified risks for each person. The registered manager said individual risk assessments would be written as more people moved in to 463 depending on each person’s needs.
People had spoken with staff about their wishes at the end of their lives if they had wanted to. These wishes needed to be part of each person’s care file as they were currently kept at the children’s hospice.
Staff had received training relevant to their roles and the needs of the people they were supporting. Information and guidelines were available about each person’s medical condition and any equipment they used. Staff competency was checked by the use of workbooks and observation for using any equipment.
The recruitment process was robust and all required checks were in place prior to staff commencing work. Nurse’s registration with the Nursing and Midwifery Council was checked. The registered manager had introduced regular supervisions. Due to the emotional issues of supporting people with life limiting or life threatening conditions staff were also able to attend group counselling sessions on a regular basis. Staff said they felt well supported by the registered manager.
Medicines were administered as prescribed and were safely managed.
People’s health and nutritional needs were met by the service. Detailed care plans were in place and information was available to manage people’s medical conditions. Relevant health professionals were involved in people’s care when required.
The four people currently living at the service had the capacity to make decisions about their care and treatment. The registered manager was knowledgeable about the provisions of the Mental Capacity Act (MCA) and was aware of the procedures to follow if someone who lacked capacity moved to the service in the future.
The home had been completely refurbished to meet the needs of people with a life limiting or life threatening condition. Cleaning schedules were in place. Regular checks of the fire systems and equipment were made. In the event of an emergency that affected the provision of care at 463 people would be able to access the Francis house Children’s Hospice.
Regular residents meetings were held to discuss the care and support at 463, including the food and activities. However these were not minuted. Staff meetings were held every two months which encouraged staff to contribute their ideas and raise any concerns. This meant the registered manager sought the views of people who used the service and the staff team.
A complaints procedure was in place, but one person we spoke with was not aware of it. No formal complaints had been received as the registered manager dealt with any concerns raised verbally with him before the formal system was required.
A system of quality audits was in place, including medicines and the environment.