This was an announced inspection which took place on10 March 2017. We had previously carried out an inspection in December 2015 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; these related to the unsafe handling of medicines, a lack of staff training and a lack of robust quality assurance processes in the service.

During this inspection we found the required improvements had been made and the provider was now meeting these regulations.

MacIntyre Care is a national organisation providing personal care and support to adults with learning disabilities and mental health needs. At the time of our inspection the MacIntyre Bury and Rochdale Supported Living service was supporting one person who had been assessed as requiring assistance with personal care.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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.

The person who used the service told us they felt safe with the staff who supported them; their relative confirmed they had no concerns about the safety of the service provided. The person was supported by a staff team who had been safely recruited. Sufficient numbers of suitably trained staff were always available to meet the person’s assessed needs. All staff were required to complete training in ‘Positive Interventions’ before they supported the person who used the service in order to ensure they were able to deal appropriately with any behaviour which might challenge others.

Staff had received training in safeguarding adults. They were able to tell us of the correct action to take in order to protect people who used the service from the risk of abuse. They told us they considered they would be fully supported by the registered manager should they report any concerns. Policies and procedures were also available for staff to refer to should they need to report any concerns. An annual assessment was completed to check the understanding of staff regarding safeguarding procedures.

Systems were in place to help ensure the safe administration of medicines. Staff had received training in the safe handling of medicines. Arrangements were in place to regularly assess the competence of staff to handle medicines safely.

Care records included risk assessments and risk management plans. These provided information and guidance about how to ensure the person who used the service and staff were protected from identified risks.

Regular checks were completed to ensure the safety of the property occupied by the person who used the service.

Staff received the induction, training and supervision they required to help ensure they were able to deliver effective care. A training matrix was in place and regularly updated by the provider; this recorded when staff needed to complete refresher training in order to ensure their skills and knowledge were up to date.

Staff understood the principles of the Mental Capacity Act 2005 and appropriate action had been taken to safeguard the rights of the person who used the service in view of the restrictions in place. Staff told us they would support the person who used the service to make their own choices and decisions wherever possible.

The person who used the service received the support they needed to attend health appointments. Staff encouraged the person to make healthy nutritional choices as much as possible.

Staff were seen to be kind, caring and respectful towards the person they supported. They had a good knowledge of the person’s needs and preferences and how best to communicate and engage with them.

Staff suppor

During our inspection we spoke with one person supported by the service, three support staff, the administrator and the location manager.

People spoke positively about the care and support provided by the service. One person told us; “I’m happy, everything is going well”.

A comprehensive assessment and care planning process was in place. Records were reviewed and updated on a regular basis ensuring information was accurate and up to date. Records reflected the individual needs of people and how they wished to be supported. Due to the complex needs of people additional support was provided from a variety of specialist health and social care professionals.

Suitable arrangements were in place with regards to safeguarding and protection ensuring people's rights were upheld.

Relevant recruitment checks had been carried out prior to people commencing work ensuring their suitability for the position. On-going training and development was offered to staff. New training had been introduced covering specific areas of support offered by the service enabling staff to develop their knowledge and skills about the complex needs of people.

Systems to monitor and review the quality of service provided were in place to check that people received a quality service.

During our visit we had the opportunity to speak with three people who use the service. Two people did not wish to answer specific questions about their care and support but were observed interacting with staff. We found that people had a good rapport with staff and interactions were relaxed and friendly. One person spoken with told us, “I’m very happy, they [the staff] help me do what I need” and “we work well together”.

There was evidence that people were involved and consulted with about their care and support. People were able to express their needs and wishes and these were taken into consideration when planning their support.

We were shown information about new training which had been developed for staff and was to be provided in the New Year. This course focused on the specific and complex needs of people supported by the service and the legal framework which supports it.

Some of the people supported by the service had particular restrictions or agreements in place and required very specific care and support to meet their complex mental health needs. This was done in partnership with specialist health care professionals who assisted the team in maintaining people’s health and well being.

From our observations we found that people enjoyed a good rapport with staff. Interactions were relaxed and friendly. People were fully informed and involved in planning their support. They had copies of their own plans which were in both written and picture form. These provide personal information in a sensitive way and informed staff about the person’s needs and wishes.

Feedback from staff was very positive about working for the service. They told us that they felt supported by management, that they felt valued as team members and that they received on-going training and development, which enabled them to provide the support people needed.

Staff were also very positive about their experience of working for the organisation. Staff spoken with us told us “I love my job”, “I would speak with my manager if I had any issues”, “We have a lot of training” and “We have good communication within the team and help each other”. One staff member also said “They have supported me to do my NVQ at level 3.”

The local authority told us about their findings following a recent review of the service. They said, “In each house visited there were good examples of improving people’s quality of life with examples of staff working proactively to maintain independence and choice in how people wish to be supported.”

They also said that; “Macintyre have demonstrated that they have complied with Interagency Adult Safeguarding policies and procedures. All investigations have been appropriately addressed.”

This was an announced inspection that took place on the 15th and 18th December 2015.

MacIntyre Care is a national organisation providing personal care and support to adults with learning disabilities and mental health needs. At the time of our inspection the MacIntyre Bury and Rochdale service was supporting one person who had been assessed as requiring personal care.

Support provided includes assisting people to maintain their own tenancy, assistance with domestic tasks, food preparation, personal care and daily activities.

The service had 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.

At the time of our inspection the registered manager was off work for an extended period expected to be for up to four months. The Care Quality Commission had been notified of this absence as required. The MacIntyre area manager was managing the service during this period. They visited the service two days per week and were available at all other times via telephone.

During this inspection we found a breach of Regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely. Some medicines could not be accounted for. The Medicines Administration Record contained hand written entries that did not include the prescribed directions. Staff training in the administration of medicines was not up to date.

We found a breach of Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not received the essential training required to help ensure people were supported safely and effectively.

We found a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because behavioural support plans, behavioural risk assessment and ‘as required’ medicine guidance had not been signed and dated as being current to ensure staff took the correct action when supporting the person with their behaviours. Records of best interest meetings were not available and policies and procedures held in the property were not current.

You can see what action we told the provider to take at the back of the full version of the report.

A relative of a person who used the service told us that they thought their relative was safe. There were sufficient staff on duty throughout the day. Staff were able to tell us the correct action they would take if they witnessed or suspected abuse.

There was a robust system of recruitment in place to help ensure people were protected from the risks of unsuitable staff being employed.

Detailed risk assessments and care plans were in place. These provided guidance for staff on how to support people. Staff knew the people they supported well, including their likes and dislikes.

Activities were arranged on a weekly basis. Records were kept of activities completed and any reasons if they had not been able to take place.

A system was in place to deal with any complaints about the service. The relative we spoke with and staff told us that the manager acted upon any complaints received.

A number of quality audits were in place. Summaries of these were sent to the area manager, with an action plan to address any issues found.

We saw that an annual survey was completed by people who used the service or their relatives. A summary report was written with any actions that would be taken following the survey results.