Macadamia Support, a supported living service for adults with learning disabilities, autism and mental health needs, was rated Good overall at first inspection but Requires Improvement in well-led due to governance gaps in audits not identifying weaknesses in risk assessments, MARs, recruitment checks and COVID-19 PPE compliance. The provider responded positively and swiftly to feedback, developing action plans and recruiting a quality lead to address identified shortfalls.
Concerns (8)
moderateGovernance: “Audits and checks were being carried out however, these did not fully consider all the areas we (CQC) look at when we inspect registered care services.”
moderateRecord keeping: “we found some of the assessments needed a more thorough review to ensure they better detailed the ways restrictions were minimised or avoided.”
moderateMedication management: “medicines administration records (MARs) that did not contain all the required information to ensure staff could administer the medicines safely.”
moderateMedication management: “there was no PRN protocol to instruct staff on when to administer PRN medicine for pain relief, to one person.”
moderateStaff competency: “we found some gaps regarding required checks which must be undertaken before new staff begin work. This included unexplored gaps in employment history”
moderateInfection control: “by the time of our visits we saw staff were no longer wearing face masks. Current Government COVID-19 guidance states face masks should still be worn by all care staff.”
minorCare planning: “improving the content and quality of some people's care records”
minorStaff training: “Some staff were less confident about how to monitor one person's diabetes. Following our feedback, a referral was swiftly made to a specialist nurse for further support.”
Strengths
· Staff supported people to have maximum possible choice, control and independence over their own lives
· Kind and compassionate care with staff protecting and respecting people's privacy and dignity
· Sufficient appropriately skilled staff to meet people's needs and keep them safe, including one-to-one support
· Strong communication skills using Makaton, pictures, symbols and personalised communication systems
· Staff understood and implemented STOMP principles to avoid over-medication
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving careNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Duty of candour; Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Working in partnership with othersNot rated