The inspection took place on the 5 and 6 September 2018 and was announced. We gave the service 24 hours’ notice that we were due to inspect to prepare people living at the service for our arrival.

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 s

Mainwaring Terrace comprises four houses each providing accommodation and support for up to thirteen people who have autism and complex support needs.

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.

The service supported 13 people with learning disabilities to live as independently as possible.

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.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plan. We spoke with two of the twelve people using the service. They told us that their care and support needs were being properly met. They also said that their care and support was provided in a way that met their individual needs and wishes.

Comments made included;

“It’s good here, I have a nice room and they (staff) are nice to me.”

“I like it here and go out a lot with the staff."

“I do lots of different things every day and am being looked after.”

“They (staff) are nice to me.”

“They (staff) knock on my door when they are looking for me”.