We carried out an announced inspection of MacIntyre Telfords Quay on the 3rd and 6th October 2016.

MacIntyre Telfords Quay supports people with a learning disability who live in communal accommodation with separate tenancy arrangements and require 24 hour care and support. They also support individuals who live independently in the community.

The service had two registered managers in post; one responsible for the Cheshire West and the other for the Wirral area.

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.

Our last visit to the service was on the 23rd of January 2013. The registered provider was compliant with the regulations that we used at that time.

People felt safe with the staff team and observations showed that people felt comfortable with the staff team at all times. Staff demonstrated a good understanding of the types of abuse and how these were reported and investigated. Staff also had good understanding of what external agencies they could contact if they had concerns about care practices used by the registered provider.

The registered provider looked at the risks faced by people in their support and took these into account. These assessments were up to date and agreed by the people who used the service.

Recruitment practices used by the registered provider were robust and ensured that people were protected. People were involved in the recruitment process by commenting on the qualities of prospective new members of staff through interactions.

Staff considered they received relevant and regular training in order to assist them to carry out their role. Staff told us that they received regular supervision and appraisals.

Staff had a good understanding of the Mental Capacity Act and associated safeguards. The registered provider included consideration of the capacity of individuals as part of the assessment and care planning process.

The nutritional needs of people were taken into account. Where support in preparing meals was provided, people told us that staff supported them in all aspects of eating and drinking. People felt involved in all aspects of menu planning including shopping and budgeting.

People told us that they felt staff cared about them and supported them in a dignified and respectful manner. People were provided with the information they needed in respect of what they could expect from the service they received. People’s privacy was protected by the measures the registered provider had taken to ensure confidentiality.

Care plans were person centred and reflected the health and social needs of people. These were presented in a way which took the communication needs of people into account. Care plans were up to date and if changes were required; these had been identified. Where changes to people’s health had been identified, care plans were reviewed and additional resources to assist the person were brought in.

People knew how to make a complaint and when concerns were raised, these were investigated in a timely and thorough manner.

People told us they thought the service they received was well led. They said that the registered manager maintained a presence within the service, and they knew who they were and that they were helpful, nice and approachable.

The registered provider had auditing systems in place to ensure that the registered manager and the management team were accountable. Staff told us that they felt supported by the registered manager and that the registered manager was open to suggestions that they had. The registered provider was aware of their responsibilities as a registered service.

We spoke to seven people who used the service either by telephone or through a face to face discussion with them with their permission. Their comments included:

"They are alright"

"I feel safe with the staff"

"They ask me what I think of them"

"They listen to me"

"I would tell them if I was not happy"

"They always ask me and I like them"

“Staff are very kind”

“Staff help me to look through my care plan”

During our visits to meet with people, we noted that for those with limited verbal communication, staff acted on behalf of these individuals with their best interests at the centre of their practice. .

We spoke to seven members of staff. Staff felt that the service had enabled them to received training relevant to their role and had that the management team was approachable and would listen to their views.

This visit found the welfare of people being promoted through the practice of the agency and their willingness to involve people who used the service in their daily support needs. We found that the agency adopted practices and provided training which protected people from harm. People were further protected through the service's robust recruitment process. We found that the service responded to the views of people and ensured that any comments raised were taken seriously. The service continually monitored the quality of the support it provided to people. People were aware of how to raise concerns and were confident that the service would respond to these.

Prior to an offer of a service being made an assessment of people’s care and support needs was carried out. Care records also showed the service had provided people who were considering using their service with detailed information about the care and support to be offered including the cost. Four of the five people who used the service spoken with confirmed this information and made the following comments:

"I like living here and the staff are very good to me.”

“I decide what I need and when I need it the staff are very good and support me very well.”

Care records showed people were given a contract that detailed the responsibilities of the provider and the client. When a person lacked the capacity to consent to the care to be provided the service ensured consent was sought from appropriate stakeholders including a relative, lasting power of attorneys or independent advocates.

Following an assessment of people's care and support needs this information was then included in the plan of care drawn up by the person the service and other professionals involved in their care.

People who used the service told us the staff who supported them were caring and treated them with respect.

Staff files looked at showed there were effective recruitment and selection processes in place.

Records and a discussion with a member of the management team showed that where complaints had been made they had been recorded and action had been taken.

People using the service who were spoken with confirmed that they were treated with respect and their dignity was maintained. People also told us that they were generally satisfied with the standard of care provided and were of the opinion that staff understood their needs.

Comments received included: “The people who support me are nice and make me happy” and “I like my home. I am supported to do my shopping and to do the things I enjoy like bowling, going to the pub and cinema.”

People spoken with confirmed that they felt safe and had no concerns regarding the care provided. No concerns, complaints or allegations were received from the people using the service during the visit.