Milford Del Support Agency

Updated 1 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors and an 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 care service.

Service and service type

This service provides care and support to people living in ‘supported living’ settings, their own homes and flats, so that they can live as independently as possible. In ‘supported living’ settings, people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period notice of the inspection because some of the people using the service could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 14 March 2023 and ended on 27 March 2023. We visited the location’s office on 14, 15 and 16 March 2023.

What we did before the inspection

Before the inspection we reviewed information, we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We visited 5 people in their homes and had telephone calls or received written feedback from 3 further people who received a service and the relatives of 6 people. We spoke with 16 members of staff, the registered manager, the provider’s nominated individual and a director. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with, or received written feedback, from 2 health and social care professionals.

We looked at records related to the care and support of 7 people. We also reviewed records relating to the management of the service including service improvement plans, staff meeting minutes, rotas, training records, satisfaction surveys and 2 staff files.

Updated 1 June 2023

About the service

Milford Del Support agency provides care and support to people who live in their own homes. The majority of these people are people with learning disabilities and autistic people. It is registered to provide personal care. At the time of the inspection the service was delivering personal care to 17 people. Most people lived in their own home; some people shared their house with up to three other people who received support. Where staff slept in to ensure people were safe overnight, they had a private space to do so in people’s spare rooms. Staff did not have allocated space that people could not access in their homes unless this was agreed as part of their support plan. Staff worked in teams focused on the support of individual people.

In 'supported living' settings people's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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

Right Support:

Not all people were supported to have maximum choice and control of their lives and staff did not always support some people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Restrictions were not always identified or reviewed effectively.

All restraints were recorded but these records were not reviewed adequately to enable safe oversight and to support learning with the aim of reducing restrictive intervention.

Staff enabled people to access appropriate health care and advocated for them. Staff encouraged people to play an active role in maintaining their own health and wellbeing.

Staff supported people to take their medicines safely.

Right care

The service usually had enough staff to meet people’s needs and keep them safe. However, there had been times when this was not the case. Staff had not all received training that reflected the needs of the people they supported.

People could communicate with staff because staff knew them well. Not all staff had undertaken specialist communication training that would support the development of communication and choice.

Staff were respectful when they spoke about people’s needs. Staff knew people well and were committed to working with them as individuals.

Staff had training on how to recognise and report abuse and they knew who they should contact to raise any concerns they had.

People’s support plans usually reflected the risks they faced. Work was ongoing to ensure support plans were up to date before they were being moved onto a new electronic recording system.

Right culture

People’s support plans did not respect their rights as tenants. We have made a recommendation about this.

People were supported by staff who were committed to delivering a quality service to the people they supported.

The management structure had been created to support the organisation’s values and ethos. The service had grown quickly and the leadership team had been impacted by personnel change and absence. This had led to oversight omissions.

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 September 2018)

Why we inspected

We received concerns over a period of time in relation to staffing and staff training. 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 changed from good to 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 Milford Del Support Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing levels and training, restrictive interventions and practices, risk management and governance.

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.