Mainwaring Terrace

We found the following examples of good practice.

Staff knew people at the service well. Staff were aware of the importance of supporting people’s wellbeing during the pandemic.

Staff encouraged people to participate in activities which they enjoyed.

An enhanced cleaning schedule of high touch areas was in place. The home appeared clean throughout.

All visitors to the service were required to complete a lateral flow test, questionnaire and risk assessment. The service completed risk assessments to support people to spend time with their relatives.

People also had the option of using a log cabin at the service for visiting. This enabled people to visit the service without entering the home.

Mainwaring Terrace is a residential care home providing personal and nursing care to 10 people with learning disabilities or autistic spectrum disorder at the time of the inspection.

Although the service was registered as a large home, people lived in four individual properties on the same road. Three of the properties were next to each other with a fourth over the road. Up to three or four people lived together in each property. It was registered for the support of up to 14 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were safely supported. Improvements had been made to the management of medicines and premises safety. Risks to people were assessed and monitored. Staff were recruited safely and understood the principles of safeguarding vulnerable adults. Our observations were people were safe in the environment.

People were supported in line with the mental capacity act and were supported to make decisions in their best interests. The staff team worked with health and social care professionals to ensure people remained fit and well. People were given choices and support to eat a healthy and nutritious diet. The properties were suitable for people’s needs and people had their own bedrooms where they could furnish with personal belongings. Staff received training to support their job role.

Staff were caring and kind to the people living at Mainwaring Terrace. It was clear bonds had been formed and people told us the staff were good and listened to them. A relative spoke highly of the good work the staff team had done to ensure their relative remained well cared for and safe. People were given choices and encouraged to reach personal goals. Staff could describe how to support people and were aware of people’s routines.

Care plans were detailed and regularly reviewed. Care plans were developed with people, their relatives and staff and contained people’s likes, dislikes, preferences and aspirations. People were supported to attend many activities in and away from the home. People knew how to make a complaint and there was easy read information available to enable people to understand the process. Plans were being formulated to support people’s wishes should they be at the end of their life.

A new registered manager was in post and staff told us morale had been boosted and they felt well supported. The registered manager had oversight of the home and completed regular audits and walk around to monitor and improve the service. The management team worked in partnership with other professionals and multi-disciplinary working led to best outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service did not use any restrictive interventions at the time of inspection.

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 1 November 2018) 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

This was a planned inspection based on the previous rating.

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.

The inspection was brought forward in part due to concerns raised about theft of people’s personal property.

Our last inspection of this service was on the 19 October 2016 and we found the service to be overall good. At this inspection, we found a number of concerns relating to the premises safety of the service and medicines management. Further information pertaining to this can be found in the body of the report.

Mainwaring Terrace is a “care home” providing care for up to 14 people in the Northern Moor area of Greater Manchester. People in care homes received accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 10 people living at Mainwaring Terrace on the day of inspection.

Mainwaring Terrace consists of four separate properties on a suburban road in Sale Moor, Manchester. Three properties are located next to each other and have their own entrances and the fourth property is on the other side of the road. Mainwaring Terrace supports people who have autism.

There was a registered manager in post. 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 registered manager has been absent from the home for a number of months and the inspection was facilitated by the quality assurance manager and two deputy managers from the home.

Medicines were not always safely managed. A number of prescribed medicines had not been signed for after administration. Medicines were not consistently audited so we could not be assured they had been given as prescribed.

Staff members had been recruited appropriately and had in place the satisfactory employment checks before commencing their role.

Premises safety in relation to fire system checks and gas and electrical safety were not always up to date. There was a lack of oversight about who was responsible for the premises safety checks.

Investigations had taken place in relation to the theft of a person’s personal items. However, there was no evidence that the theft had occurred and the service had not ensured people’s personal items were recorded when they first move in to the service to provide an audit trail.

People were supported to eat a heathy and nutritious diet and we observed staff supporting people to cook their own meals. There were a range of snacks available for people to access at their leisure.

People were able to access health care support from primacy medical services and we saw people did see their GP, dentist and other professionals when required. We have made a recommendation that the service needed to improve their procedure for monitoring people who became unwell.

The service was working in line with the Mental Capacity Act. People received appropriate capacity assessments and where people lacked capacity, they were referred to the local authority under Depravations of Liberty Safeguards (DoLS). Where required, people, their families and professionals were involved in best interest’s meetings.

Staff received training to enable them to carry out their role. Staff felt the training was good and informative.

Staff did not receive regular supervision in line with the policy of the organisation.

We observed kind and caring interactions between people living at the home and staff members. Staff members were aware of how to support people with anxiety and implemented techniques to reduce levels of agitation.

People said they felt staff cared for them and our observations were that staff offered privacy and dignity to people.

Care plans were reflective of people’s needs and gave strategies for supporting people with challenging behaviour and promoting independence. However, care plans were intermittently reviewed which meant we could not be assured they were always current.

Activities were varied and people were supported to access community based activities with a focus on exercise.

Staff were able to communicate to people in a variety of methods. We observed people using Makaton (sign language), pictorial images and short sentences. People had information in their care files to alert staff to how they may be feeling when a person acted in a particular way.

Complaints were responded to in a timely manner and outcomes shared. The service has received a number of compliments thanking them for their care and support.

There was a lack of over sight of the service in relation to medicines and premises safety and audits to monitor and improve the service were not fully competed. Our observations were that the service needed a long-term solution to successfully oversee the management of the home

Staff were able to attend regular staff meetings to discuss people, raise concerns and share ideas.

During our inspection there were 10 people living in the homes.

The service was last inspected in January 2014 and was compliant with the standards we inspected. This inspection was unannounced and took place on 19 and 20 October 2016.

There was a registered manager responsible for the service. 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.

There were sufficient staff available to enable people to take part in a range of activities according to their interests and preferences. Some people required a minimum of one to one staffing to help keep them safe. Staff duties were clearly allocated so people received the support they needed.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service however improvement was needed to ensure staff files were in good order. We made a recommendation the service follows good practice guidance in relation to staff files and recruitment.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help keep them safe.

People received their medicines when they needed them. Staff had received training in the management and administration of medicines and their competency in this area had been regularly reviewed to ensure their practice remained safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed.

Where restrictions were placed on people, these were regularly reviewed to ensure they were the least restrictive option. People’s privacy was considered and people were asked for their consent before staff assisted them with any tasks.

People were supported by a caring staff team who knew them well. Staff morale was good and there was a happy and relaxed atmosphere in the home. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

Routines in the home were flexible and were based around the needs and preferences of the people who lived there. People were able to plan their day with staff and they were supported to access social and leisure activities in the home and local community. There was an emphasis on enabling people to be as independent as they could be and to live a happy and fulfilling life.

There were effective systems in place to monitor and improve the quality of the service provided.

We carried out observation, gathered evidence from care records and relevant discussions

The people who used the service were being supported and enabled to make informed choices about their care and treatment. We saw staff caring for the needs of people in a professional manner. They ensured that the people they cared for were supported in taking part in activities in the local community.

We found an open and welcoming atmosphere where people were encouraged to express themselves.

People who used the service told us they had given consent to their care and treatment.

The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met. Information about people who used the service was obtained and shared appropriately.

A robust staff recruitment process was in place, which helped to ensure that people were

supported by staff members who were suitable for their required roles. From the staff records we looked at we were able to see that the staff currently working for the service had been appointed correctly.

People's records, staff records and other records relevant to the management of the services were up to date, accurate and fit for purpose.