Melton Supported Living Service was rated Good overall at its February 2016 inspection, with Requires Improvement in Effective due to incomplete mental capacity assessments and out-of-date specialist staff training. Governance was partially undermined by quality audits that had lapsed and failed to identify issues such as unreviewed generic risk assessments.
Concerns (5)
critical
Consent / capacity
: “two people who used the service may have lacked the capacity to make some decisions. However, we could not see that mental capacity assessments or best interest decisions had been carried out.”
moderateStaff training: “not all staff had received a yearly update in administering suppositories...Training for staff in this area had expired two months ago.”
moderateGovernance: “audits had not picked up on what we found during our visit...some audits had stopped occurring six months ago.”
moderateRecord keeping: “risk assessments had been undertaken in 2012 and they had not been reviewed.”
minorStaff competency: “medicine competency checks...some of these checks had occurred in the last year whilst others were over three years ago.”
Strengths
· People felt safe and staffing levels were appropriate; robust recruitment processes were in place.
· Staff demonstrated good knowledge of safeguarding responsibilities and reported concerns appropriately.
· Medicines were managed safely with one-page accessible profiles and staff competency checks in place.
· Staff were caring, person-centred, and knowledgeable about individuals' preferences, routines, and communication needs.
· People were actively involved in planning their own care and support, including those with complex communication needs.
Quality-Statement breakdown (17)
safe: People are protected from abuse and improper treatmentGood
safe: Risks to people are assessed and managedGood
safe: Staffing levels are sufficient to keep people safeGood
safe: Medicines are managed safelyGood
effective: Staff have the skills and training to carry out their rolesRequires improvement
effective: Mental Capacity Act 2005 requirements are metRequires improvement
effective: People are supported to maintain good nutrition and healthGood
effective: Staff receive supervision and supportGood
caring: Staff treat people with kindness, dignity and respectGood
caring: People are involved in decisions about their careGood
caring: People's independence is promotedGood
responsive: Care is personalised to meet people's needs and preferencesGood
responsive: People can access activities that matter to themGood
responsive: Complaints are handled appropriatelyGood
well-led: Leadership is open, transparent and drives improvementGood
well-led: Quality assurance and auditing processes are effectiveRequires improvement
well-led: Feedback from people, relatives and staff is sought and acted uponGood
Melton Supported Living Service deteriorated from its previous Good rating to Requires Improvement, with a breach of Regulation 18 for failing to submit safeguarding notifications to CQC and systemic weaknesses in safeguarding investigations, staff training oversight, care plan auditing, and record keeping. Strengths were evident in the caring and responsive domains, with people treated with dignity and respect, good medicines management, adequate staffing, and person-centred care planning.
Concerns (6)
criticalSafeguarding: “safeguarding concerns were not investigated promptly and the registered manager had failed to take prompt action to identify if any improvements or changes to people's care were needed.”
criticalGovernance: “registered manager had failed to submit appropriate safeguarding notifications to the CQC. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.”
moderateIncident learning: “accidents and incidents were not analysed in any depth to identify trends or areas where the service could improve. Each incident was reviewed in isolation.”
moderateStaff training: “insufficient systems in place to ensure that this training was completed promptly, or that staff had understood the training they were required to complete.”
moderateRecord keeping: “Care plan reviews were not always recorded, and people's risk assessments were not always updated when people's needs had changed.”
moderateCare planning: “a wide selection of people's care plans were not reviewed on a regular basis to ensure they were accurate and up to date.”
Strengths
· People were supported to take their medicines as independently as possible with accurate MAR records maintained.
Melton Supported Living Service achieved a Good rating across all five key questions at this inspection, having remediated all breaches identified at the previous Requires Improvement inspection in June 2018. Minor recording gaps were noted in care plan reviews, medication audits and health check dates, but no regulatory breaches were found.
Concerns (4)
minorMedication management: “Weekly checks were regularly carried out by support workers. However, monthly support officer audits were not carried out consistently.”
minorRecord keeping: “Care plans were reviewed. However, records of actions carried out were not always recorded.”
minorRecord keeping: “Care plan records did not contain the dates of previous health checks because the information had been archived.”
minorOther: “A community learning disability nurse told us that the service needs to, 'get better at problem solving for themselves as they can be over reliant on professionals'.”
Strengths
· All ratings improved from Requires Improvement to Good since the previous inspection in June 2018, with all previous breaches remediated.
· People received kind, respectful and person-centred support from consistent, well-trained staff who knew how to meet their individual needs.
· Robust safeguarding systems in place; all staff trained in safeguarding and aware of reporting responsibilities.
· Effective incident and accident review processes with trend analysis, leading to reductions in incidents.
· Care plans were comprehensive, personalised and updated as needs changed, including accessible easy-read formats.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Healthcare needs monitoringGood
effective: Nutritional needs supportGood
effective: Staff supervisionGood
caring: Compassionate and respectful careGood
caring: Privacy and dignityGood
caring: Involvement in decisions and choicesGood
responsive: Person-centred care planning and assessmentGood