About the service:

¿ MLDP Central provides supported living services for people with a learning disability, autism or mental health needs so they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

¿ The service has nine properties, ranging from small homes for three or four people sharing the kitchen, lounge and bathrooms, to 13 single person flats / bedsits in one building with a communal lounge.

¿ Each property had either a sleep-in room for staff to use at night or staff who were awake all night (waking night staff).

¿ At the time of our inspection the service supported 42 people.

¿ For more details, please see the full report on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

¿ A new registered manager had been appointed in May 2018. They had made improvements to the quality assurance and oversight of the service.

¿ All risk assessments and person centred plans had been reviewed and updated where necessary, including positive behaviour plans where required. People, relatives and staff had been involved in reviewing the care plans.

¿ The health and safety checks system had been reviewed and was being completed in all properties.

¿ Staff enjoyed working at the service and received the training and support to carry out their roles.

¿ The care co-ordinator team was stable and were positive about the changes the registered manager had made at the service.

¿ There were sufficient staff on duty to meet people’s identified needs. Regular agency staff were used to cover gaps in the rota.

¿ People had an activity planner in place. People had agreed goals they wanted to achieve and staff supported them to achieve them.

¿ People and relatives said the staff were kind and caring. The members of staff knew people’s needs well.

¿ People’s communication needs were assessed and communication passports and aids were in place where required.

¿ People were supported to maintain their health and received their medicines as prescribed.

¿ Referrals were made to health care professionals when required.

¿ All incidents, accidents and complaints were investigated and analysed to reduce the likelihood of the same issue happening again.

Rating at last inspection:

Requires Improvement (Report published 24 March 2018). The overall rating has improved at this inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well to at least good.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 23 and 24 January 2018 and was unannounced. MLDP Central was last inspected in October 2016 where we found four breaches of legal requirements with regard to not all risk assessments being assessed, reviewed and managed, a lack of capacity assessments being completed, people’s care plans not being up to date and governance processes were not robust in providing assurances that the quality of people's care and the quality of the service was being monitored. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. At this inspection we found some improvements had been made; however not all legal requirements were being met.

MLDP Central provides support for 47 people living in their own homes. Some people lived in their own flat, with all flats in the property being part of the MLDP Central support network. People received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or flat had a designated staff team. The staff teams were managed by a care co-ordinator. There were six care co-ordinators in total.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a registered manager who had been in place since May 2012. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Risk assessments had been reviewed and were current. A risk screening tool had been introduced in two properties we visited but was not used in two others. We found guidance was not provided for staff with regard to the support two people required to manage risks in relation to epilepsy support and dietary needs following a major operation. Where applicable positive behaviour support plans were in place to guide staff how to manage people’s behaviour.

Person centred care plans had been introduced and were current in three properties we visited. However in one property the person centred care plans were not current and contained information that was out of date. This meant staff in some properties did not have up to date information about the support people required and how to mitigate the identified risks.

Where person centred plans had been completed and were up to date, they gave good details of people’s life history, likes and dislikes, the support they needed and what they were able to complete for themselves. Relatives told us they had been involved in reviewing their relatives’ care plans.

Quality assurance systems were not robust. Trackers were being set up so the registered manager had an overview of the service; however at the time of our inspection information was not easy to find or was not available.

An audit system had been introduced where care co-ordinators from MLDP Central’s sister services in the north and south of Manchester visited MLDP properties. The registered manager did not carry out their own checks within the service.

Health and safety checks were not recorded in all properties. At the flats a fire risk assessment had stated additional fire extinguishers were required for the building. The care co-ordinators had requeste

The inspection took place on 10 and 11 October 2016 and was announced. The service was last inspected in November 2013.

Manchester City Council Supported Accommodation Service Central Network (MDLP) provides support for 51 people living in their own homes with staff support 24 hours per day. Each property had a designated staff team. Staff teams were supported by assistant managers. There were six assistant managers in total who were based in the head office.

Manchester City Council had two other similar services covering the South and North areas of the city. The Care Quality Commission (CQC) inspected MLDP North and MLDP South six months ago and found breaches in regulation. Manchester City Council has since applied to have the MLDP South removed as a location. Following the inspections Manchester City Council formed an improvement team covering three supported accommodation services that were registered with the CQC. During the inspection we discussed the implementation of the improvement plan with the Interim Team Manager for Manchester City Council Supported Accommodation Service .They provided records of meetings and reviews of the improvement plan to demonstrate how the service was moving forward with some of the actions.

The service had a registered manager in place at the time of the inspection. 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. We found risk assessments were not always up to date. Some risk assessments did mitigate risk, others did not provide guidance for staff to follow to keep people safe. We found risk management plans were in place for some people; however these were not always reviewed. This meant that the information and guidance for staff was not always up to date. We found the service did not always assess people’s mental capacity, there was a lack of records to demonstrate best interest meetings had taken place to ensure safe decision making when applications were made to deprive people of their liberty.

The registered manager kept a log of accidents and incidents along with records following instances of behaviours that challenged. Not all accidents and incidents were investigated to monitor for patterns or themes.

Staff told us they received training to enable them to carry out their role. However we found some staff training required refreshing. Training in specific topics necessary to support people who used the service had not been completed.

People, relative and staff knew how to complain. We found the provider had a system to log complaints. However we found these were not always investigated fully with a response given to the complainant.

Audits had not always been completed regularly. There was no evidence to support any managerial oversight or analysis of the audit process to drive improvements in the service. A new audit process had been introduced which the registered manager was implementing.

Some care plans were not personalised and not always up to date. Staff had commenced a reviewing programme to ensure care plans were brought up to date. We found some informative personalised plans had been completed with people.

People we spoke with and their relatives told us they felt the service was safe. We found staff had knowledge and understanding of safeguarding and could explain what action they would take. The service had a new process in place to escalate safeguarding issues and concerns to the most appropriate agencies.

We saw the provider had a thorough and robust recruitment policy and procedure in place. Staff had appropriate checks carried out before commencing employment.

We found the provider had processes and systems in place to ensure medicines were managed safely. Recor

We saw that people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. The people we spoke with who used the service confirmed that they had been involved in making decisions about their support plan.

We met with three people who received support from the team to obtain their views on how well the staff members were providing safe and appropriate care. They told us that they liked living in their houses and that the staff members supporting them were good.

The relationships we saw during the home visits were warm, dignified, respectful and with plenty of smiles and gentle humour.

The support team had a safeguarding policy in place. This included local procedures which staff would follow if they needed to report an alleged incident to the correct authorities. It was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

The staff members we spoke to were very positive about working in the support team. Comments included; “I enjoy what I do” and “I am trained and supported to provide safe care to the people who use the service."

Information about the safety and quality of service provided was gathered on a continuous and on-going basis with feedback from the people who used the service.

Records were in place to ensure that people were protected from the risks of unsafe or inappropriate care and treatment.

At the time of the inspection, Manchester Learning Disability Partnership (MLDP) was providing care and support to approximately 51 people across 16 homes. We visited four homes and spoke with several members of staff. We also visited the office from which the service operated and spoke with the managers of the service.

We spoke with seven people who used the service, including three in a group. They told us that they did not have any complaints. People who used the service told us they were happy with the service they received. Comments included: "It's not bad this place - it's been good" and "I'm happy here". People told us how much they enjoyed the many and varied activities they were doing with staff support, both inside and outside of their homes.

We looked at ten care plans across the four homes where people received care. We saw that, where people could, they were involved in decisions about the planning and carrying out of their care, treatment and support.

We found that the provider was compliant with all of the outcomes we looked at on this visit, with the exception of the outcomes relating to supporting staff and records. We found that whilst staff were, in the main suitably qualified to carry out their role, we saw that appropriate ongoing refresher mandatory training had not being provided to all staff. We also saw that improvements were required in the service user records.