86 Meade Hill Road

86 Meade Hill Road 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 Outreach Community group who have other care homes and outreach services in and around the Bury area of Greater Manchester. At the time of the inspection five people were living at the service.

The home is a large, adapted, detached house within its own grounds. People living there have their own bedrooms, and the home also has communal living areas, including a living room, dining room and kitchen.

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.

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

People's needs were not always met because of the staffing levels within the service. A member of staff had recently returned to work, however another one was leaving shortly after the inspection. The service had access to a pool of bank staff, and one was on duty on the first day of inspection.

The service had basic paper-based care records. There were some assessments of risk, but these needed to be reviewed and updated to reflect people’s increasing dependencies. We have made a recommendation in relation to this. Care plans required reviewing and updating so that they provided staff with a true picture of people’s current needs and wishes.

There were quality and assurance systems in place to monitor the safety and quality of care provided. However, further work and more regular audits were required both at manager and provider level, so that the service improved for people living in the home.

We found the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care and right culture.

Right support: The service did not support people to have maximum choice, control and independence. This meant people were not able to work towards identified goals. Staffing levels impacted on people's opportunities to go on trips out and take part in pastimes and activities both in and away from the home. When they were able to go out, people were supported by staff to take part in activities in their local area. People had exclusive use of their own bedrooms and living spaces and were able to personalise these accordingly.

Right care: People were able to express their views, but routines existed in the service based on the availability of staff. People did not always have opportunities to do things spontaneously. Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. For example, people were supported to have access to food and prayer relevant to their faith. Where appropriate, staff encouraged and enabled people to take positive risks. Safeguarding concerns were investigated. Staff knew how to recognise and report abuse. The staff team knew people well and had a good understanding of their needs, despite basic care planning documentation.

Right culture: Actions to improve people's experiences were not taken in a timely manner. Routines were established within the home that did not promote person-centred care. Staff communicated with families and other professionals. People had access to independent advocates to help represent their wishes, but best interest decisions were not always formally documented. People's dignity was respected.

People were not consistently 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 did not support this practice.

People were negatively impacted, although people told us they enjoyed living at the home. A risk assessment regarding a person’s change in need was completed during the inspection. Staff recruitment was in progress.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Since the last inspection the provider’s registration has changed as they had moved premises. The last rating for the service under the provider’s previous registration was Good, (published on 29 March 2019).

Why we inspected This inspection was prompted by a review of the information we held about this service.

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.

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, 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.

Action was taken by the provider during the inspection with regards to documenting new risks and making access to the rear garden safer. We were assured this aspect would be addressed by the landlord and that the risk of potential injury to people would be reduced.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 86 Meade Hill Road on our website at www.cqc.org.uk.

Enforcement and Recommendations We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care and good governance. We have made a recommendation in relation to updating risk assessments. 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.