This inspection took place on 23 and 24 January 2018 and was unannounced. MLDP Central was last inspected in October 2016 where we found four breaches of legal requirements with regard to not all risk assessments being assessed, reviewed and managed, a lack of capacity assessments being completed, people’s care plans not being up to date and governance processes were not robust in providing assurances that the quality of people's care and the quality of the service was being monitored. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. At this inspection we found some improvements had been made; however not all legal requirements were being met.MLDP Central provides support for 47 people living in their own homes. Some people lived in their own flat, with all flats in the property being part of the MLDP Central support network. People received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or flat had a designated staff team. The staff teams were managed by a care co-ordinator. There were six care co-ordinators in total.
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.
The service had a registered manager who had been in place since May 2012. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
Risk assessments had been reviewed and were current. A risk screening tool had been introduced in two properties we visited but was not used in two others. We found guidance was not provided for staff with regard to the support two people required to manage risks in relation to epilepsy support and dietary needs following a major operation. Where applicable positive behaviour support plans were in place to guide staff how to manage people’s behaviour.
Person centred care plans had been introduced and were current in three properties we visited. However in one property the person centred care plans were not current and contained information that was out of date. This meant staff in some properties did not have up to date information about the support people required and how to mitigate the identified risks.
Where person centred plans had been completed and were up to date, they gave good details of people’s life history, likes and dislikes, the support they needed and what they were able to complete for themselves. Relatives told us they had been involved in reviewing their relatives’ care plans.
Quality assurance systems were not robust. Trackers were being set up so the registered manager had an overview of the service; however at the time of our inspection information was not easy to find or was not available.
An audit system had been introduced where care co-ordinators from MLDP Central’s sister services in the north and south of Manchester visited MLDP properties. The registered manager did not carry out their own checks within the service.
Health and safety checks were not recorded in all properties. At the flats a fire risk assessment had stated additional fire extinguishers were required for the building. The care co-ordinators had requested these from the central ‘works’ department but they were still not in place three months after the fire risk assessment recommendation had been made.
People and their relatives told us they felt safe when supported by MLDP Central staff. Staff had completed training in safeguarding vulnerable adults and were able to explain the action they would take if they suspected any abuse had taken place.
We saw sufficient staff were on duty to meet people’s needs, although a high proportion were agency staff – staff told us this was around 50% in one property. Regular contracted agency staff were used to cover vacancies, which meant they got to know the needs of the people they were supporting. However we were told other agency staff were used as well, with one relative saying they were concerned that the agency staff did not know the needs of their relative.
People were supported to engage in various activities. One relative said people were now able to go out more than previously.
People and their relatives were very complimentary about the regular staff supporting them. Staff were able to describe people’s assessed support needs and knew people well.
An exercise had been completed to record the exact support each person required. This was because people’s needs had not always been re-assessed by the relevant social services department. The service increased people’s support above the social services assessed need if their needs had changed.
A safe system of staff recruitment was in place at the service. Staff training had increased. The service was now able to specify what training their staff required and this would be sourced for them. Staff said they felt well supported by the care co-ordinators and had staff meetings every two to six months. Staff had job consultation sessions (supervisions) with their care co-ordinators. Care co-ordinators were due to visit their properties each week; however at one property we were told they visited each fortnight.
We found a safe system for administering medicines was in place. Staff had received training in the administration of medicines. People we spoke with told us that they received the medicines as prescribed.
We found that people were supported to maintain their health. Health action plans were in place but required updating in one property. We saw records of medical appointments attended and referrals were made to specialists as required. Systems were in place to monitor people's nutritional intake where required.
People’s communication needs had been assessed. A communication passport had been used to assist hospital staff to communicate with one person when they had to be admitted to hospital.
People’s capacity to make decisions had been assessed and referrals made to the local authority for formal capacity assessments and best interest decisions to be made on their behalf. Any restrictions in place were recorded. Historical restrictions in place at the flats we visited were being questioned. If they were no longer required they were being removed. Staff were now more aware of the Deprivation of Liberty Safeguards and why any restrictions were in place. The service was working within the principles of the Mental Capacity Act (2005).
Accidents, incidents and safeguarding were monitored by the care co-ordinators and registered manager. We saw investigations had been completed where required.
At this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.