Milford Del Support Agency

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.

At the time of the inspection, Milford Dell were providing the regulated activity of personal care to eight people. Our inspection was based on the care and support provided to these eight people, each of whom received a variety of care hours from the agency depending on their level of need. Some people had a learning disability or autism and were living in individual supported living flats; they required support to enable them to retain a level of independence. Other people had spinal injuries and required 24/7 support with personal care; they were cared for by the agency’s ‘spinal team’.

This inspection was conducted between 23 and 27 July 2018 and was announced. We gave the provider two working days’ notice of our inspection as we needed to be sure key staff members would be available.

We last inspected the service in March 2017 when we did not identify any breaches of regulation, but rated the service as ‘Requires improvement’. Following that inspection, the registered manager wrote to us detailing the improvements they planned to make. At this inspection, we found improvements had been made and a new registered manager had been appointed.

There were enough staff available to complete all care and support visits and action was being taken to notify people of any changes to the rotas.

Robust recruitment procedures had been put in place to help ensure that only suitable staff were employed. Individual and environmental risks to people were managed effectively.

Where staff supported people to take their medicines, we found this was usually done in a safe way. Staff followed infection control procedures and used personal protective equipment when needed.

Staff understood their safeguarding responsibilities and knew how to identify, prevent and report abuse. The registered manager reported incidents appropriately to the local safeguarding authority and conducted thorough investigations.

People were complementary about the competence of staff and the quality of care they received. New staff completed an effective induction into their role and experienced staff received regular refresher training in all key subjects. Staff were appropriately supported in their role by managers.

Staff followed legislation to protect people’s rights and sought consent before providing care or support to people.

Managers conducted assessments of people’s needs before agreeing a package of care; where necessary, they put additional resources in place before the person started receiving the service. Care plans were informative, up to date and reviewed regularly.

People received personalised care from staff who understood their individual needs well. Staff were flexible and adaptable when people’s needs or wishes changed.

Where staff were responsible for meeting people’s nutritional needs, they encouraged people to maintain a healthy, balanced diet based on their individual needs and preferences.

Staff monitored people’s health and supported them to access healthcare services where needed.

Staff were caring and compassionate. They built positive relationships with people, encouraged them to be as independent as possible and involved them in decisions about their care.

Staff treated people with dignity and respect and protected their privacy during personal care.

Staff were committed to supporting people to receive compassionate end of life care and were working with a healthcare professional to develop end of life plans for people.

People had confidence in the service and felt it was managed effectively. They knew how to raise a complaint and felt they would be listened to.

There was a clear management structure in place. Managers were communicative and acted as positive role models. Most staff were motivated and happy in their work.

There was an effective quality assurance process in place. The provider sought and acted on feedback from people.

There was an open and transparent culture. The registered manager notified CQC of all significant events and fully complied with the duty of candour requirements.

The inspection was conducted between 1 and 10 March 2017 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

There was a registered manager 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.

People were not always protected from the risks associated with unsuitable staff being employed. Pre-employment checks and references were not always completed before staff started supporting people in their homes. However, the registered manager amended their procedures to address this concern during the course of the inspection.

There were enough staff deployed to meet people’s needs. People receiving care from the agency’s spinal team received care and support from consistent staff. However, this was not always the case for people living in the supported living flats; this caused anxiety to some people, particularly those with a diagnosis of autism.

Staff sought consent from people before providing support. However, at the care planning stage, managers did not follow legislation designed to protect people’s rights. They had made decisions on behalf of people but could not confirm that these were necessary or in the best interests of people.

People received individualised personal care that met their individual needs. However, staff did not always support them in a consistent way that promoted their independence. There was a lack of information in people’s care plans about how staff should help people to develop additional skills.

Not everyone had confidence in the service and staff had mixed views about the way it was run. Some were critical of the way their duties were planned and others did not feel communication was always effective between the staff team working with people in the supported living flats.

The registered manager was addressing staff concerns by introducing a more structured rota and making themselves more available to staff.

A new quality assurance process was being introduced. This led to some improvements; however, it needed further time to become fully effective and embedded in practice.

Staff treated people in a caring and compassionate way. They built positive relationships with people and supported them to maintain relationships that were important to them.

People’s privacy and dignity were protected, particularly when personal care was being delivered. Staff took care to be as discreet and unobtrusive as possible and gave people time alone when they needed it.

People and their relatives told us they felt safe and trusted the staff from Milford Del who supported them in their homes. Staff knew how to identify, prevent and report incidents of abuse.

People were protected from individual risks in a way that supported them and respected their independence. Risk assessments had been completed and measures put in place to reduce the likelihood of harm. Medicines were managed safely and people received their medicines as prescribed.

Staff completed a wide range of training and were suitably supported in their work. Staff supported people to eat a balanced diet and to access healthcare services when needed.

People were involved in planning the care and support they received. People being cared for by the agency’s spinal team received personalised care that met their needs fully. Staff responded promptly when their needs changed.

Most people living in the supported living flats were supported to access activities that met their social needs. These included access to an innovative project that allowed people to interact with animals and socialise with like-minded people living in the community.

The provider sought and acted on feedback from people. There was a complaints procedure in place and the registered manager was planning to develop an easy read version to make it more accessible to people.