This inspection took place on 9 and 10 January 2018 and was unannounced. MLDP North was last inspected in November 2016 where we found a breach of legal requirements with regard to risk assessments not being robust. 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 question of safe to at least good. At this inspection we found improvements had been made and all legal requirements were being met.

MLDP North provides support for 48 people living in their own homes. Some people lived in their own bungalow in a complex of several bungalows together and received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or group of bungalows had a designated staff team. The staff teams were managed by a care co-ordinator. There were seven 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 2016. 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.

At this inspection we found that the improvements seen at our last inspection in November 2016 had been sustained and built on.

Risks had been identified for each person and risk assessments were in place to mitigate these risks. All risk assessments we saw were current. Risk assessments detailed why any restrictions were in place, although one required further clarity which was evidenced as being completed straight after our inspection. Staff were aware of the reasons any restrictions were in place.

Behavioural support plans were in place and current for those people who may display behaviours that challenge staff. Person centred care plans were in place, had been reviewed and were up to date.

Quality assurance systems were in place. Trackers were used to monitor that care plans, risk assessments, staff training, staff supervisions and service audits were being completed. Incidents and accidents were reviewed by the care co-ordinators and any action taken recorded. These were logged onto a tracker so an overview of all incidents across the service could be reviewed for trends or patterns.

The registered manager had completed audits for each of the properties. A schedule of audits of MLDP North were to be undertaken by care co-ordinators form MLDP North’s sister services in the south and central areas of the city was in place. However, due to reasons outside of the registered manager’s control these audits had not been completed as planned in 2017. Action plans were produced following the audits and were signed off as the actions were completed.

The number of incidents had reduced across the service, linked to having more stable staff teams and a reduction in unfamiliar agency supporting people. People’s needs had been re-assessed by social services as part of the procedures of applying to the court of protection under the Mental Capacity Act (2005) when people had constant staff supervision or had restrictions in place. This had led to an increase in support hours for several people which had enabled people to participate in additional activities.

A system was in place to recruit staff

We undertook this inspection of MLDP North on 22 and 23 November 2016. The inspection was unannounced which meant the provider did not know we were coming.

MLDP North provides support for 55 people living in their own homes. Some people lived in their own bungalow in a complex of several bungalows together. People received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or group of bungalows had a designated staff team. The staff teams were managed by a care co-ordinator, who managed two teams. There were seven care co-ordinators in total.

The service had a registered manager who had been in place since May 2016. 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 previous inspection took place in March 2016 where five breaches of the Health and Social Care Act 2008 were identified. The provider was placed into special measures by CQC. We took enforcement action and issued three warning notices to the provider. The provider appointed a new experienced Nominated Individual (the service manager for the independent living services) to oversee the service. A Nominated Individual is a person employed as a director, manager or secretary of an organisation with responsibility for supervising the management of the regulated activity.

An interim improvement manager was also appointed and an improvement plan developed. Manchester City Council has two similar services in the South and Central areas of the city. The development plan covered all three services. Since the last inspection the Nominated Individual and interim improvement manager have met regularly with CQC to update us on the improvement plan and the progress they were making.

This inspection was carried out to check what improvements had been implemented since our last inspection. We found that improvements had been made throughout the service and these were sufficient for CQC to be able to take the service out of special measures.

People and their relatives told us they felt safe supported by MLDP North staff. Staff had undertaken training in safeguarding vulnerable adults and were able to describe the different types of abuse and how they would report any concerns. The registered manager monitored all safeguarding referrals. An escalation policy had been introduced so any referrals to other professionals about a safeguarding concern were followed up. We saw multi-disciplinary meetings had been held where appropriate.

Care plans, risk assessments, moving and handling guidelines and behaviour management plans had been reviewed and updated. These gave guidance for staff about the support people required. However we found some staff teams continued to be risk averse and restricted people, for example from going into the kitchen. The risk assessments did not support this and the reasons for the restriction were not evident.

A new positive risk assessment tool was being introduced which would assess what a person wanted to do and looking at how this could be achieved safely.

People’s personal care files had been standardised across the service and old information removed. This meant staff were able to access the information in the files more easily. The care co-ordinators used a standard method for saving electronic files. This meant other care co-ordinators in the service were able to access the information if required.

The staff teams were now stable and the use of agency staff had greatly reduced. New staff had been recruited. This meant people were supported by staff that new them well. The number of incidents occurring had reduced due to people being supported by familiar staff. However we saw that people were n

This was an unannounced inspection which took place on the 22 and 23 March 2016. We had previously inspected this service in July 2014 when we identified four breaches of the regulations we reviewed; these related to assessing and monitoring people’s nutritional needs, administration of medicines, acting in accordance with the Mental Capacity Act (2005) (MCA) and having effective quality audit systems in place for the service.

Following the inspection in October 2014 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. Part of this inspection was undertaken to check whether the required improvements had been made. We found that people’s nutritional needs were assessed and monitored and medicines were safely administered. However we found that the service was not acting in accordance with the MCA and did not have robust quality monitoring systems in place.

MLDP North provides support for 55 people living in their own homes. Some people lived in their own bungalow in a complex of several bungalows together. People received a range of support each day. Other people lived in shared houses with staff support 24 hours per day. Each house or group of bungalows had a designated staff team. The staff teams were managed by a care co-ordinator, who managed two teams. There were seven care co-ordinators in total.

The service had a registered manager in place. 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 was not working at the time of our inspection and so the service was being managed by the Nominated Individual (NI). A Nominated Individual is a person employed as a director, manager or secretary of an organisation with responsibility for supervising the management of the regulated activity.

People we spoke with, and their relatives, said that they felt safe being supported by MLDP North. Staff told us that they had completed safeguarding training and could describe the action they would take if they witnessed or suspected abuse. We saw that referrals were made to other professionals by the care co-ordinators if relevant when concerns were raised. However these had not been followed up to ensure a prompt response from the other agencies. We were told that a new policy had been introduced to make sure any new referrals were followed up in a timely manner.

We found some risk assessments were in place to identify and mitigate risks people may face. However not all risks had been identified and they were not always up to date. Behavioural support plans were in place for people with complex needs. These gave guidance for staff to manage people’s behaviour; however they did not identify what the actual risks were.

We found agency staff were employed on temporary contracts to provide consistent support for people. However we saw that the number of incident reports increased when agency staff were used. Staff told us that some of the people they supported could not access their usual activities with agency staff due to the risk of an incident occurring when people were supported by unfamiliar staff. We were told agency staff did not always complete the necessary incident forms, meaning that a complete record of the incidents which had occurred was not kept.

We were shown the information provided to two new agency staff to support people with complex needs. The information was not sufficient to enable the agency staff to safely support the people who used the service.

We found a safe system for administering medicines was in place. Staff had received training in the administration of medicines. People we spoke with told us that they received the medicines as prescrib

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

We announced this inspection by giving the provider two working days notice of when we planned to visit. The service has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

MLDP North Network is a supported living scheme providing personal care to 42 adults with a learning disability, living in 13 properties in the north of Manchester. Three of these properties provide individual flats accommodating 12 people. Each person accommodated has their own tenancy with a housing association. Network managers oversee the 24-hour care provided to people by teams of support workers at each location.

At our last inspection of this service in November 2013 we found two breaches under Regulations 11 (1) (a) and 23 (1) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following this inspection the provider sent us an action plan telling us what improvements they were going to make. During this inspection we found that the provider was on target to have all support staff trained in safeguarding adults from abuse, moving and handling and fire safety by the end of December 2014. However, we found further concerns during this inspection relating to staff and management not receiving training in infection control and preventing malnutrition. This compromised the health and safety of people who were using this service.

The staff we spoke with knew how to report allegations or suspicions of abuse and we saw two written examples of this taking place in January 2014. This was followed up by the registered manager taking appropriate action to deal with both disclosures in the best interests of the people concerned.

People who used this service told us they felt safe and four relatives confirmed the service was provided safely.

People’s moving and handling and behavioural support needs had been appropriately risk assessed and written guidance on safe practice had been provided for staff to follow. The provider had reviewed each person using this service to determine what restrictions were being applied to their liberty. They told us they were taking advice to ensure they were acting within the law and protecting the human rights of people who used the service.

Effective arrangements were in place to manage the behaviours of people, which challenged the safety of themselves and others. Appropriate best interest decisions had been carried out and records of restraint showed that these physical interventions had only been used as a last resort. However, staff had not consistently followed Mental Capacity Act guidance on best interest decision-making for people who were confined to their beds during the night.

Medicines were stored securely and records demonstrated that people were receiving the support they needed to take their medicine according to their GP’s instructions. However, the exact times of administration had not been recorded, so we could not confirm if medicines were being administered at the recommended intervals.

People’s care records detailed life histories, significant events and what was important to the person, including their preferences, likes and dislikes. Risks associated with mobility, epilepsy and incontinence had been assessed and guidance was provided for staff to keep people safe. However, nutritional risks had not been assessed and no action had been taken to investigate two people’s weight loss.

People had access to the full range of community health services and care records showed that people had received dentistry, chiropody, physiotherapy and regular sight tests. People had also been referred for specialist health care as required.

Four people told us they liked the food provided and they had enough to eat and drink. Records confirmed that people were eating healthy diets.

The people we spoke with told us that staff listened to them and respected their privacy and dignity.

People told us about the activities they engaged in during the day. Records provided evidence that two people with more complex needs had befrienders to assist them in engaging with their community.

We saw evidence that staff received supervision and appraisals and attended team meetings. Minutes showed that staff were able to raise concerns and make suggestions about meeting the needs of the people they supported.

The quality assurance systems in place for this service were not sufficiently robust in identifying areas for improvement. The provider’s quality assurance had not identified the issues and causes for concern which we found with training in infection control and malnutrition, gaps in care records, medication recording issues and gaining the consent of people to restrictive measures.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.