The inspection took place on 30 October 2017. The inspection was unannounced. Middleton Avenue provides care for people with physical and learning disabilities or broad spectrum autism. The service is located in a purpose built bungalow in a residential area of Thornaby. The service is registered to provide support to six people and on the day of our inspection there were five people using the service.
The service had a registered manager in place. 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. On the day of our inspection the registered manager was on annual leave and another manager from a neighbouring Mencap service was made available to assist us with our inspection.
We last inspected the service in August 2015 and rated the service as ‘Good.’ and ‘Outstanding’ in responsive. At this inspection we found the service remained ‘Good’ overall and had sustained ‘Outstanding’ in responsive.
The atmosphere of the home was very homely, warm and welcoming. People who used the service were relaxed in their own home environment.
Without exception people were continually empowered on a daily basis to have choice and control over their own lives from being supported by sustained person centred approaches. Person centred care is when the person is central to their support and their preferences are respected.
The home continued to sustain their ability to be extremely person centred and inclusive and this was by offering intense one to one support where needed, adapting situations to suit people while being creative and this was underpinned by a genuine desire to offer a quality personalised service.
People were continually empowered to forward plan and were also supported to achieve personal goals in their lives that contributed to improving their mental health, wellbeing and general health that lead to an enhanced quality of life.
We spent time observing the person centred support that took place in the service. We saw that people were always respected by staff and treated with upmost kindness. We saw staff being respectful, considerate and communicating exceptionally well with people and supporting people who were distressed.
People’s support plans were exceptionally person centred. They included targets that people wanted to achieve and a ‘one page profile’ that referenced people’s personal histories and described their individual support needs. These were regularly reviewed and people were always at the centre of the process.
People were empowered on a regular basis to shape the service they received to meet their needs and their preferences and responsive changes were made when needed.
People were supported to play an active role within their local community by making regular use of local resources including the local park.
Support plans contained person centred risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm to enable them to do the things they wanted to live their lives fully. The support plans we viewed also showed us that people’s health was monitored and referrals were made to other health support professionals where necessary, for example their GP, community nurse or optician.
Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.
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.
Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the MCA to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.
We saw people were encouraged to eat and drink sufficient amounts to meet their needs. The service was truly reflective of what people liked and people were in control of this and chose what they would like to eat.
People had their rights respected and regular access to advocacy services.
People were supported to maintain their independence on a daily basis.
People were supported to be active in their chosen religion both within the home and in the community.
Support staff told us they felt supported to carry out their role and to develop further and that the registered manager led by example, was person centred focussed, supportive and always approachable.
When we looked at the staff training records, they showed us staff were supported and able to maintain and develop their skills through training, and development opportunities were accessible at this service. People were supported by enough staff to meet their needs and were also supported individually with one to one support.
Medicines were stored, managed and administered safely. We looked at how records were kept and spoke with the registered manager about how senior staff were trained to administer medicines and how this was monitored.
We found an effective quality assurance survey took place regularly and we looked at the results. The service delivered had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views about the support and service they received at events and via surveys.