M Power Limited - 22a Bromley Road

About the service

Mpower - 22A Bromley Road is a residential care home providing personal care for up to ten people with a learning disability and/or autistic people . At the time of the inspection ten people were living there.

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

Right Support

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. The provider was making further improvements to the environment of the home.

The size of the service was not in line with best practice guidance for services for people with learning disabilities and/or autistic people, but we did not find evidence that the size of the service was negatively impacting on the quality of care people received. The service had improved the range of activities on offer. People were encouraged and supported to identify and take part in activities and pursue interests that were tailored to them. Where appropriate, staff encouraged and enabled people to take positive risks. Staff communicated with people in ways that met their needs.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs and promoted equality and diversity in their support for people. People’s religious and cultural needs were well supported.

People told us or communicated with us they were happy living at Mpower - 22A Bromley Road. Relatives told us their family members were happy, safe and comfortable at the service. We observed positive interactions between people and staff.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. There was enough appropriately skilled staff to meet people’s needs and keep them safe.

Right culture

People received good quality care and support because trained staff could meet their needs and wishes. People led active lives because of the ethos, values, attitudes and behaviours of the management and staff.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

Despite this we found the service could do more to help people identify long term goals and aspirations and learn new skills. The provider was also not doing all they could to ensure people’s next of kin or representative was able to contribute to the formation and review of their care and support plans. We have made recommendations about supporting people to acquire and maintain skills and ensuring people and their representatives can contribute to care and support plans.

The registered manager and provider had implemented effective checks and audits on the quality and safety of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 May 2019) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to see if improvements had been made to person-centred care and assess that the service is applying the principles of right support right care right culture. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The provider had adapted the visitors’ protocol as government guidelines changed. Visiting relatives were asked to complete a COVID-19 test, wear appropriate [personal protective equipment] PPE and follow hand hygiene procedures before entering the service.

The provider supported people to adhere to self-isolation guidelines when they had a positive COVID-19 test result. The provider had plans in place to ensure people could continue to access their local community safely during the pandemic.

New admissions to the service were managed safely. New residents were given a COVID-19 test before being living at the service.

The provider ensured there was an adequate supply of PPE and staff received ongoing infection control and prevention training. The registered made regular checks to ensure staff used continued to use PPE appropriately.

The service was taking part in regular COVID-19 testing for people and staff in line with current government guidance.

The service was kept clean and hygienic. There were regular checks and audits of the service to ensure high standards of hygiene were maintained.

The registered manager was supported in their role by senior managers within the organisation.

We found the following examples of good practice.

The provider had implemented a Covid-19 action plan to ensure all risks were considered and plans made to mitigate these. The provider had put in place and adapted the visitors’ protocol when risk factors and government guidance changed. There was a clear process in place to ensure all visits to the service were managed safely. People were supported to keep in touch with family and friends using alternative methods such as video calls when visits to the service were suspended.

There were sufficient staff on duty to support people to meet people’s needs and support them to adhere to self-isolation guidelines.

The provider had systems in place to ensure stocks of personal protective equipment (PPE) were maintained. As well as gloves and masks all staff and visitors were supplied with surgical gowns to wear over their clothes to reduce the risk of cross contamination. All staff were trained in infection control and the correct use of PPE.

Staff understood signs and symptoms that might indicate acute ill health that required immediate medical attention. The registered manager conducted infection control audits and observations of how PPE was used to ensure high standards were maintained.

The service was taking part in ‘whole service’ testing in line with current government guidance to protect all residents and staff.

At the previous inspection on 3 January 2018 we found that the service did not meet the standards we inspected. People did not always have effective risk assessments and management plans in place to mitigate potential risks. People were not supported to consent to care and the premises were not well maintained. In addition, staff did not follow infection control processes which increased the potential risk of infection.

There was a registered manager. This registered manager was new to the service and was employed in October 2018. 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 this inspection we found that the registered manager had taken some action to improve the service.

Risk assessments and management plans were updated to provide staff with detailed information to manage risks associated with people’s needs.

Staff had access to and used personal protective equipment including the use of gloves and aprons to reduce the risk of infection. There was a programme of redecoration and maintenance of the premises. However, we found new concerns related to activities for people, the quality of some care records and people were not always supported to practice their religious beliefs.

There was an individual activity programme in place. People who were independent in the community accessed services and social events that interested them. There were no activities arranged in the home for everyone to take part in if they wished to do so.

Care records were not always accurate and did not always accurately reflect people’s needs. There were systems in place for monitoring the quality of care. Staff completed regular audits of the service and developed a business plan to address any concerns in the management of the service. However, the audits had failed to identify the shortfalls we found during this inspection.

There was a system in place to identify people at risk of harm and abuse. Staff followed this guidance to protect people from abuse and to report safeguarding allegations promptly.

The recruitment procedures in place ensured that suitably experienced staff were employed to work with people. Pre-employment checks were completed and returned as part of the recruitment process before staff were employed. Enough staff were employed to care for people safely. The staff rotas showed the deployment of staff was at an appropriate level to effectively support people.

Accidents and incidents that occurred at the service were monitored. The registered manager shared concerns with staff to learn from them and to manage the occurrence.

Each member of staff was supported with an induction, training, supervision and an appraisal.

People had enough to eat and drink. People and staff developed a menu. Staff and people were involved in the preparation and cooking of meals for all people living at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to give their consent to receive care and support. They also made decisions about how they wanted their care carried out. Staff understood how to support people who were unable to make decisions for themselves.

People said staff were supportive and kind to them. Staff and people engaged well and were respectful of each other. Staff supported people with their care and support while protecting their privacy and dignity.

People understood how to make a complaint about the quality of care if they were unhappy about an aspect of the service.

The registered manager understood their responsibilities to inform the Care Quality Commission of significant events that occurred at the service.

There was partnership working between the registered manager and health and social care professionals and voluntary organisations that could support people at the service.

M Power Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

M Power Limited is registered to provide care and accommodation to up to 11 people. At the time of our inspection seven people were using the service, some of whom had mental health conditions or a learning disability.

The service has recently undergone refurbishment. Bedrooms were single occupancy rooms and located over two floors. The building was not adapted to meet people’s needs and parts of the accommodation are not accessible by wheelchair. The service has a garden. The provider was in the process of making new admissions to the home

There was 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.

People’s care was not always responsive to their individual needs. Staff did not provide appropriate support to one person who had behaviours that challenged the service and others. This put the safety of the person and that of others at risk. People were not always protected from the risk of isolation and were not always able to access all parts of the accommodation. Staff did not always follow good hygiene practices. The environment and accommodation were clean with the exception of the staff room.

Staff knew how to identify and report abuse. Staff followed the provider’s safeguarding procedures to ensure they protected people from potential abuse. There were sufficient staff deployed to meet people’s needs. Staff underwent appropriate recruitment procedures before they started to provide care.

Risk assessments and management plans were in place. Staff had information about people’s needs and the support they required. Staff obtained consent from people before they delivered care and support. People had access to healthcare services when needed.

The registered manager monitored accidents and incidents to identify any patterns and to minimise recurrences.

Staff received the support they required to undertake their roles through an induction, training and supervision of their practice.

People told us they received sufficient amounts to eat and drink. People told us the food provided did not always meet their cultural preferences. We observed people during their lunchtime meal. The food served was not appetising and the menu lacked imagination. Although there was a menu planner, staff prepared a meal that was not planned for that day. Staff monitored people's nutritional needs and made referrals to healthcare professionals for guidance when needed.

People’s care was provided in a dignified and compassionate manner. Staff respected people’s privacy and dignity. Interactions between staff and people were positive. Staff supported people to have equal access to information and opportunities as full citizens.

Staff supported people to undertake activities of their choosing. People enjoyed links with the local community.

People using the service and their relatives knew how to make a complaint if they were unhappy with care delivery. People’s views about the service were welcomed and their feedback was used to develop the service.

People using the service, their relatives and staff said the registered manager was visible at the service. They raised concerns about the management and staffing changes at the service. Staff were supported in their roles and worked well as a team.

Audits and checks were carried out on the quality of care. Improvements were done when needed. The provider planned to carry out quality monitoring questionnaires to obtain staff and people’s views about the service. However, they had failed to identify the shortfalls found during this inspection.

People benefitted from the close working partnership between the registered manager and other health and social care professionals and external agencies.

We found three breaches of regulation in relation to person centred care, need for consent, and premises and equipment. You can see what action we have told the provider to take at the back of the full version of this report.

We spoke with three people who used the service. We spoke with staff on duty on the day of our visit. We left our phone number so that people could contact us if they wished. Four staff called us to speak with us.

Is the service safe?

The home was safe. Staffing levels were adequate. The home was covered 24 hours per day and there were on-call arrangements in case additional support was required in an emergency. Staff understood the home's emergency evacuation procedure.

Is the service well-led?

There was a manager in post who started in July 2014. They were in the process of completing their registration with the Care Quality Commission. Staff were trained to do their jobs effectively. The manager showed us a plan to conduct staff supervision six weekly. All staff had received one-to-one supervision from the manager in August and September. Team meetings were held monthly. This ensured staff had support to meet the needs of people they supported.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained in their roles to support people safely. There was a safeguarding policy in place and staff understood the types of abuse and how to report it. Risks were assessed for people and actions were taken to address any risk promptly. Staffing levels were adequate and the home was covered 24 hours a day by staff. There was emergency plan in place to manage unforeseen events. Incidents and accidents were recorded and reviewed and lessons learned were discussed with staff. Specialist equipment was provided for people who had mobility problems and staff had received training in using these. The home was clean and in good state of repair.

Is the service effective?

People's care was planned and delivered in a person centred way. People were involved in their care planning and care plans were written in an easy to read format, thereby making it easy for people to understand their care plan. The provider involved other healthcare professionals in the planning and coordination of people's care and treatment. We saw evidence of the involvement of a speech and language therapist (SALT) in supporting one person with swallowing difficulties and recommendations were implemented by staff. People were supported to access community and health services as required. People participated in a range of activities within and outside the home.

Is the service caring?

Staff understood the needs of people they supported. People using the service told us that they were treated with dignity and respect. One person said, 'Staff are nice and listen to us.' Staff interacted and responded to people in an open and positive manner. The atmosphere was relaxed and staff engaged people in discussions. People's care plans and daily activities reflected their preferences, interests, and choices.

Is the service responsive?

People were supported to participate in activities within and outside the home. There was an effective joint working between the home and other professionals to ensure the service responded to people's needs. People were supported to attend educational centres to develop new skills. People told us they knew how to make a complaint if they were unhappy. People's care plans were reviewed and updated to reflect changes in their needs and circumstances.

Is the service well-led?

The provider worked well with other agencies in meeting the needs of people using the service. Staff were trained in their roles. There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records that actions were taken to address identified shortfalls or recommendations from audits.

Staff were not regularly provided with the support and supervision they needed to do their jobs effectively. There was no record to show that induction was carried out for new staff. One-to-one supervision for staff was not regular in line with the organisation's policy and procedure. Daily handover took place; however, a structured team meeting was last held in September 2013.

Staff ensured people gave their consent to the support offered and people we spoke with confirmed that staff included them in decisions about their daily lives. One person's relative told us that the service consulted them regularly about the care and support provided and any changes to this.

Up to date, individual care and support plans were in place for people using the service which addressed their care and support needs and protected them from risks.

The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met.

Staff received appropriate induction, professional development, supervision and appraisal.

There was a process for in place for dealing with complaints and this was in an accessible format for people using the service.

We spoke with the local authority commissioners who reported that they had no significant concerns about the service from their own monitoring.

Although people told us they were satisfied with the support they received, we found other evidence that people may not always protected against the risks of receiving inappropriate or unsafe care and support because it was not clear how their needs were analysed and the risks assessed as the basis for deciding staffing levels.