Background to this inspection
Updated
16 December 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 10 and 11 October 2016 and was announced. We told the provider we would be coming so they could ensure they would be available to speak with us and arrange for us to speak with care workers. The inspection team consisted of two inspectors and one expert by experience. An expert by experience is a person who has personal experience of using, or caring for someone who uses this type of service.
Prior to this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. Before the inspection, the provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We took the PIR in consideration.
As some people who are supported by MOST were not consistently able to tell us about their experiences, we observed the care and support being provided and talked with relatives and other people involved with people's care provision during and following the inspection. As part of the inspection we visited two of the ten houses and spoke with the registered manager, two care co-ordinators, one community nurse, seven care staff, six people and four people's relatives. We looked at a range of records about people's care and how the service was managed. We looked at four people's care plans, medication administration records, risk assessments, accident and incident records, complaints records, health and safety checks, fire safety documentation and quality audits that had been completed.
We last inspected MOST in September 2012 when it was registered at a different location and no concerns were found.
Updated
16 December 2016
We inspected Milestones Outreach Support Team (MOST) on the 10 and 11 October 2016 and the inspection was announced to ensure that we could access the records we require. MOST support 56 adults, some of whom live in one of the 11 supported living schemes managed by MOST and some of whom live in their own homes with outreach support. However, of these 56 people, only nine people received support with personal care which is an activity requiring registration by CQC. Therefore this inspection focused on the care and support provided to those nine people receiving personal care as outreach in their own home or in one of the supported living schemes.
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.
The registered manager and staff had received training and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, mental capacity assessments were not always completed in line with legal requirements and the MCA Code of practice. Mental capacity assessments were needed for people who may not be able to consent to, for example, bed rails.
Risks to people were not consistently managed, incidents and accidents were not consistently being recorded and action was not always taken to change people’s support plans following incidents or accidents.
People had access to their medicines when they needed them. However, the registered provider had not ensured that all staff had completed the medicines competency check after being trained. We have made a recommendation about this in our report
People received a person centred service that enabled them to live active and people's decisions. However care plans lacked detail about how people like to be supported and did not show that the person was involved in their care plan. You can meaningful lives in the way they wanted. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity.
Complaints were not consistently being recorded. This meant that the registered provider cannot always investigate and learn from complaints. You can see what action we told the provider to take at the back of the full version of the report.
Staff received training in safeguarding and they understood what to do and how to report concerns to keep people safe. However, the most up to date information around safeguarding was not available to all staff. We have made a recommendation about this in our report.
Staff were well trained with the skills and knowledge to provide people with the care and assistance they needed. However, the induction process for new staff was not being consistently carried out across the organisation. This meant that potentially staff may not be trained to the standard identified by the registered provider before they provide care and support to people. We have made a recommendation about this in our report.
People had enough to eat and drink, and received support from staff where a need had been identified. People's special dietary needs were clearly documented and trained staff ensured these needs were met.
Peoples' health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples' care plans.
The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout our inspection, such as staff talking with people as equals. Staff knew the people they cared for well and treated them with kindness and compassion.
People could have visitors from family and friends whenever they wanted. People and their relatives spoke positively about the care and support they received from staff members.
There was an open, transparent culture and good communication within the staff team. Staff spoke well of the registered manager and registered provider. However, not all staff had access to regular supervisions and team meetings to receive support and give their feedback. We have made a recommendation about this in our report.
Quality monitoring systems were not effective and were not being consistently applied. The registered provider had employed a quality manager who had identified shortfalls using a new audit. However, we could not see that changes had occurred or were embedded. We have made a recommendation about this in our report.
The registered manager, who was recently recruited and registered with CQC, provided clear leadership to the staff team and maintained an active presence in the services. They had a clear vision for the service and were aware of challenges and how to overcome them.
We found four breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014.at this inspection. You can see what action we told the provider to take at the back of the full version of the report.