MacIntyre Ampthill Support

MacIntyre Ampthill Support is a supported living service providing personal care to people in their own homes. It also operates a shared lives scheme which provides people with long-term placements, short breaks and respite care, within shared lives carers (SLC) own homes.

At the time of the inspection they were providing personal care to 36 people.

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.

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

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not fully able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care was designed to maximise people’s choice, control and independence and the provider had strong systems in place to promote person centred care, dignity and human rights. However, these were not always acted on in some of the MacIntyre Ampthill support settings where people received support.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice but were not consistently used to achieve this. Some people had restrictions placed on them that were not rigorously assessed to be in their best interests.

Documentation relating to obtaining consent to care or assessing mental capacity and making decisions in people’s best interest lacked detail and was inconsistent in some instances.

Some support plans and risk assessments lacked information to guide staff about how to safely meet people’s needs. This was particularly in relation to their specific physical or mental health needs or where people required support to manage behaviours that challenge.

Documentation relating to the management and administration of as required (PRN) medicines was inconsistent and put people at risk of PRN medicines not being administered as intended by the prescribing doctor.

The provider had well documented values that put people at the heart of the service. Policies and systems supported this but were not used effectively in all settings within the service. This meant some people did not consistently receive support which reflected the provider’s values.

Systems to monitor the quality of the service were not always used effectively and did not identify issues found during this inspection.

People were supported by staff who understood how to keep them safe from abuse. Staff received training the provider considered essential to enable them to support people well, although some training in relation to people’s specific support needs had not been provided to all relevant staff.

People were supported by staff who knew them well. Support plans contained clear information about people’s preferences and matters that were important to them.

We have made a recommendation in relation to the administration and recording of PRN medicines.

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 July 2019)

Why we inspected

We received concerns in relation to the management oversight and culture of the service. This included concerns about consent to care, and the oversight of systems to ensure people received safe care. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to management oversight, how people are supported to consent to care and how practices that restrict people’s freedoms are agreed, monitored and reviewed. Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for MacIntyre Ampthill Support 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.

MacIntyre Ampthill Support provides care and support to adults with learning disabilities or autistic spectrum disorder in their own homes. They also had a Shared Lives Service that recruits, trains and supports self-employed Shared Lives Carers (SLCs) who provide placements and respite care for vulnerable adults within their own family homes in the community. The service supports people with learning disabilities and or autism.

Not everyone using the supported living and shared lives service receives a regulated activity. CQC only inspects the service being received by people provided with 'personal care'. This includes help with tasks related to personal hygiene and eating. In these circumstances we also take into account any wider social care provided. At this inspection there were 36 people using the service who received personal care.

People’s experience of using this service

People told us they were very happy with the support they received from staff. They told us they were very happy with their housemates and the staff team allocated to support them.

People told us about what safeguarding meant for them and how staff supported them to learn how to be independent but safe from harm.

Staff were knowledgeable about people`s needs and how to manage any risk involved. Staff were well trained and skilled to support people safely and effectively.

People`s care plans were developed in partnership with them and evidenced their voice in terms of their likes and dislikes and what they wanted to achieve in their lives. People were given information in the format suitable for them to understand and feel involved in the care and support they received.

People lived an active life and were supported by staff to seek employment, attend college, socialise and develop new skills.

There was an effective management system in place with clear roles and responsibilities for managers and staff. This meant that systems and processes were effectively used across all the supported living sites and there were no differences in the quality of the care people received.

The registered managers were closely involved in the monitoring of the quality of the services provided to ensure these were effective and met people`s needs safely. There was effective partnership working with health and social care professionals involved in people`s care to ensure this was seamless and promoted people`s health and well-being.

Rating at last inspection

Good (Report published 24 June 2016

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

MacIntyre Ampthill Support is a domiciliary care and supported living service providing personal care and support to people with learning disabilities, mental health conditions and autism. The service operated within Hertfordshire and Bedfordshire and at the time of this inspection, there were forty-three people using the service.

The service had three registered managers in post. 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.

People were safe using the service as the provider had effective systems in place to protect them from avoidable harm. There was a sufficient amount of staff who had been trained on safeguarding and were aware of their roles and responsibilities in safeguarding people. Medicines were administered safely and people were supported to access other healthcare services and professionals to maintain their health and well-being. Each person had a personalised risk assessment and support plan in place to ensure they were as safe as possible and that the support they received from staff was consistent and appropriate.

People received care and support that was effective and met their needs. Staff had received training in order to carry out their job roles effectively, and they were knowledgeable about people’s support needs. They understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and sought people’s consent before they provided any care or support. People were supported to maintain their independence and encouraged to maintain their hobbies and interests.

The staff were kind, caring and supportive of people. They understood people’s personal history, their likes and dislikes, and they interacted with people appropriately. The staff were respectful of people, their privacy and dignity and they understood the provider’s vision and values.

People were aware of the provider’s complaints system and information about this and other aspects of the service were made available to them. There was also an effective quality assurance system in place.

We gathered evidence against the standards we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found:

Is the service safe?

People's needs had been assessed and risk assessments described how any identified risks to people were minimised. The provider had kept people safe by responding promptly to any allegations of abuse. They also ensured that incidents and accidents were monitored and steps taken to prevent them from reoccurring. However, they did not have sufficient and experienced members of staff to ensure that five people with complex needs were supported safely and consistently.

Is the service effective?

Although we saw that in the short term, people were supported by sufficient staff because agency staff worked regularly to cover any vacancies, we found this did not always provide consistent support for people whose complex needs meant that they required routine and consistency. There was no sufficient evidence in the records we looked at to show that the staff had received regular supervision.

Is the service caring?

When we visited the four people who used the service, we observed that they were supported by kind and attentive staff. From our observations and from speaking with the staff, we noted that they had a good understanding of the needs of the people they supported. We observed that one person who was unable to communicate verbally with us, appeared happy and well looked after. People we spoke with told us that they were happy with the staff that supported them.

Is the service responsive to people's needs?

We saw that the support plans had been updated when people's needs had changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to engage in a variety of activities within their local community.

Is the service well-led?

The provider had two area managers in place, each with responsibilities for managing the support of people living in Bedfordshire or Hertfordshire. We found each area also had an identified manager who had overall responsibility for coordinating people's care, and provided leadership for the staff. This included ensuring that the staff were appropriately trained, had regular supervisions and were supported to provide safe care to people who used the service. However, we found the records held at the office about the staff employed by the provider were not always up to date. This meant that they did not always accurately reflect the training the staff had completed, and whether they had regular supervisions and appraisals.

We observed that people were happy and relaxed in their home environment and noted the atmosphere was calm and homely in each of the two homes that we visited. We spoke with two people receiving support from the service provider and they told us they were happy with their home and the staff supporting them. This was also evident in their gestures and expressions, which showed them to be at ease in the company of staff.

We spoke with three relatives who told us that they were very happy with the level of support that was provided. One person said, "The staff are caring." Another person told us, ".......... gets the care they require."

We reviewed two people's care records and saw that they included comprehensive information to show how people should be supported and cared for. One person told us, "Staff look after me well."

We were told there were currently 11 people using the service who lived in three houses in Bedfordshire and 12 people who lived in three houses in Hertfordshire; they all received care and support through 24 hour supported living accommodation. Whilst the service operated over two counties, during our visit we only reviewed the records for people who lived in Bedfordshire.

At the time of our visit, we were only able to speak with one person as the majority of people were out doing activities or attending the day resource centre. We were also told that most people had limited communication abilities and therefore communication with them after our visit by telephone would not be appropriate.

The person we spoke with also had communication difficulties, but was able to tell us they were happy living at the house and staff supported them well. We observed staff interacting respectfully with the person and we also spoke with three staff members who told us they enjoyed working for the service and being able to support people to maintain their independence as much as possible.

We gathered other evidence of peoples' experiences of the service by reviewing feedback questionnaires and also reviewing the comments and complaints log.