Archived: Monaveen

Monaveen is an extra care scheme. Staff provided personal care to people living in their own apartments within one large purpose-built building. The service provided support to people with a range of care support needs including physical disabilities, people living with dementia, Parkinson’s disease, Huntington’s Chorea and learning disabilities. At the time of our inspection there were 33 people using 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

Right Support: Systems for managing medicines were not always consistent and some risks to people had not been assessed. People said they felt safe living at Monaveen. Staff understood their responsibilities for safeguarding people from abuse. 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.

Right Care: People were not always receiving a personalised service because there remained a high dependency on agency staff who were not all familiar with people’s individual needs and preferences. The quality of assessments and care plans had improved since the last inspection but not all staff were referring to these documents when providing care to people. This meant people were at risk of not receiving consistent care and support in line with their care plan. One person told us, “There’s no continuity (of staff), what’s in the care plan doesn’t happen.”

Right Culture: Difficulties in recruiting and retraining staff had continued and this had a negative impact on people’s experience of the service. One relative told us, “They often ring me to say there has been a stranger in to do their care.” People, relatives and staff described poor communication and a lack of engagement with the service. A failure to embed quality assurance systems meant improvements seen at the last inspection had not been sustained.

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 requires improvement (published 26 January 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, staffing and the management of the service. 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. The overall rating for the service has remained 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 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. Following the inspection the provider sent an updated improvements plan showing the immediate actions they had taken following the inspection to mitigate risks we identified.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Monaveen is an extra care scheme. Staff provided personal care to people living in their own apartments within one large purpose-built building. The service provided support to people with a range of care support needs including physical disabilities, people living with dementia, Parkinson’s disease, Huntington’s Chorea and learning disabilities. At the time of our inspection there were 34 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support: People told us they felt safe living at Monaveen and described an improving situation. One person said, “On the whole, it’s all good here.” There remained some shortfalls and omissions in the provider’s system for managing risks to people. Records were not always up to date and accurate and this increased risks that people might not receive care and support in the way they preferred or needed.

There were enough staff to care for people safely but there was a high reliance on agency staff which meant that people did not always receive a consistent, timely service from staff who were familiar with them. One person told us, “The main issue here is the lack of regular staff.” There was a plan in place for recruitment to vacant posts. Following the inspection the provider confirmed 2 new staff had started and a further 5 posts were being filled.

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.

Right Care: Staff were not consistent in their understanding and approach to some aspects of infection prevention and control. We have made a recommendation to the provider about infection prevention and control.

Staff demonstrated a clear understanding about how to safeguard people from risks of abuse. People and their relatives spoke highly of the staff and described a kind and caring approach. One person told us, “The staff are kind, caring and very respectful.”

Right Culture: Systems for management oversight had improved but were not yet fully embedded and sustained, there remained some shortfalls in quality assurance. The registered manager described work in progress to make improvements at the service and feedback from people, relatives and professionals indicated the service was continuing to improve. One person said, “They are just getting better and better.” Another person told us their biggest priority was, “To feel safe and remain independent,” they said living at Monaveen helped them to achieve this.

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 requires improvement (published 9 August 2022) and there were breaches of regulations. At this inspection we found some improvements, but the provider remained in breach of one regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We carried out an unannounced comprehensive inspection of this service on 17 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified a continued breach in relation to management of risks to people at this inspection.

Please see the action we have told the provider to take at the end of this 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.

Monaveen is an extra care housing setting where staff provide personal care and support to people living in their own flats within one large purpose-built building. People living here are supported with a range of needs including physical disabilities, dementia, and Parkinson's disease. 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. At the time of our inspection, 40 people who were using the service received a regulated activity.

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

Failings in management of the service had led to people being exposed to avoidable harm and not receiving the standard of service they should expect. When the provider became aware of multiple shortfalls they acted quickly to make changes to the management of the service, to ensure people were safe, and to work with health and social care partners to improve standards of care.

Before the change of management, some people had not received their prescribed medicines when they needed them, and this had contributed to a deterioration in their health. The provider had made improvements to systems for managing medicines and ensuring people could access health care services they needed. Risks to people had not always been identified and assessed and care plans did not always provide clear guidance for staff about how to care for people safely. Care plans and assessments were being reviewed and updated but this work was still in progress.

People, their relatives and staff, told us there had been noticeable improvements in people’s care and support since the new manager was in post. One person said, “There has been a vast improvement here.” People’s needs were being reviewed and people told us they, and where appropriate, their relative, were involved in developing more personalised care plans to accurately reflect their needs.

Staff described improvements in support and training. One staff member told us the organisation of the service was much better and they felt their views were now respected and valued.

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.

The provider’s systems for monitoring quality had failed to identify shortfalls and unsafe practice in a timely way. The new management team had made positive changes over a short space of time and people told us they were much happier with the current standards of care. Many improvements were still in progress and had not yet been fully implemented. This meant improvements were not yet embedded and sustained in practice.

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 23 June 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, management of risks, poor leadership and notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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. The provider had been open and transparent about the issues identified and was already implementing an action plan to ensure improvements were made.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.