The Mallards

The service is registered for up to eleven people with a diagnosis of autism, or a learning difficulty. On the day of the inspection there were eleven people using the service including one person having respite care. The accommodation comprised of the main house and the annex. The service provides both permanent accommodation and temporary, respite care. However, the registered manager said following our visit they were going to cease providing respite care because it is not financially viable.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

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.

At our inspection visit on 21 May 2018, we found people were happy at the service and were being supported to be independent and engage in different activities. The service was mostly well led but we found the registered manager had been off on extended leave and had only recently returned. In their absence, a number of things had not been fully addressed.

The service managed risk well but some areas of refurbishment and repair in the main house were overdue. Audits were not always identifying issues of concern, which could affect the safety and well-being of people using the service.

Staff felt well supported but there was a lack of recording around formal support, personal development, training and growth. Some staff training was overdue.

People were involved and consulted about their needs and preferences. Reviews established if people were unhappy about any part of the service. The service quality assurance system did not firmly establish how they consulted with health care professionals and other stakeholders or how as an organisation they identified common themes or areas of poor compliance across the services.

The registered manager was well respected by staff, people using the service and relatives spoken with. They were sensitive to the needs of people using the service and their staff. People received good care and had fulfilling lives.

Staffing levels were appropriate and people received support from regular staff who knew them well. This was a well-planned service where staff were adequately recruited, supported and trained for their job role.

Medicines were administered as intended and audits were designed to identify and address any shortfalls.

Risks were effectively managed for individuals and for the environment. Shortfalls identified were being rectified. Staff understood what constituted abuse and what actions they should take to report abuse and make people safe.

The Commission is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found people’s rights were being upheld and staff supported people in lawfully and in line with legislation around mental capacity and deprivation of liberties.

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People were supported to eat and drink sufficient to their needs and involved in meal preparation, menu planning and shopping. People had their health needs met and staff monitored long-term health conditions to help ensure symptoms were well managed.

People’s needs were assessed before moving into the service and a clear plan of care put into place. The same process should be followed for people coming in for respite care. People had sufficient occupation, activity and leisure activities.

The service gave people opportunity to comment on the service including having an established complaints procedure and regular reviews of care.

This unannounced inspection was carried out on 18 October 2016. At the time of our inspection a registered manager was 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.

The CQC is required by law to monitor the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider could demonstrate how they supported people to make decisions about their care and where they were unable to do so. One person had an authorised DoLS in place. This meant that people did not have restrictions placed on them without the correct legal procedures being followed.

People’s privacy and dignity was respected by staff. People’s care was provided with kindness and patience and in a way which people preferred.

Staff had been trained in medicines administration and safeguarding people from harm and were knowledgeable about how to ensure people’s safety. Medicines were stored correctly and records showed that people had received their medicines as prescribed.

Although health and support plans were in place for people these did not provide up to date information. This meant that staff did not have full information about how to provide care to people. Risks to people who lived in the home were identified. Although risk assessments were not always in place for all people’s identified risks. Nor had they been formally assessed as prompts for staff to enable people to live as safely and independently as possible.

Staff supported people with their personal care, medicines, activities/hobbies, cooking and domestic tasks in a cheerful and kind way.

Members of staff were trained to provide care which met people’s individual needs and wishes. Staff understood their roles and responsibilities. They were supported by the registered manager to maintain and develop their skills and knowledge through supervision and on going training.

Information on how to make a complaint was available for people and staff knew how to respond to any identified concerns or suggestions.

Arrangements were in place to ensure that the quality of the service provided for people was monitored and action had been taken when necessary.

Staff we spoke with were knowledgeable about safeguarding processes and training records confirmed that all staff had received the appropriate training for safeguarding vulnerable people against abuse.

We were told that a minimum of two support workers worked during the day time to ensure that people's needs were met. Staff rotas we reviewed confirmed this was the case.

We looked at care plans that clearly explained how a person preferred to be supported. We saw information about the choices that people using the service had made, showing people were fully consulted at every stage.

Although people who lived at The Mallards did not choose to answer our questions directly, we observed their manner when they were speaking with members of staff. We saw that people were smiling, talking in a relaxed and confident way with staff and making decisions about their day. This showed us that people living in the home were confident and had no problem with discussing things with staff.

We saw that recruitment files contained appropriate references, background checks plus interview information, showing how new members of staff had been selected. This supported the safety and well being of people using the service.

We saw forms that showed that a quality audit was regularly undertaken by the organisation and that records included the feelings of people using the service. These audits monitored such areas as care plans, the environment, as well as staff training and many other areas, supporting the safety and comfort of people living at The Mallards.