This assessment took place between 15 May to 28 May 2024. Morton Gardens LTD is a domiciliary care agency providing personal care to people living in a supported living setting. At the time of our assessment there were 3 people using the service. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. Right support: People had independence, choice and control over their own lives and an active role in maintaining their health and wellbeing. People accessed support for their healthcare needs when needed. Staff supported people to make decisions following best practice in decision-making. Right care: Staff promoted equality and diversity. They knew how to protect people from abuse. Staff understood and met people’s communication needs. People’s care focused on their quality of life and based on current practice. People took part in activities and helped to maintain relationships with friends and family. Staff were trained to meet people’s needs and keep them safe. We found an issue with recruitment practices. The provider took action to improve this. Right culture: People were involved in planning their care. Staff met their needs and wishes. People’s support was reviewed to make sure this was effective. The service valued and acted on people’s views. People’s quality of life was enhanced by the culture of improvement and inclusivity. Risks of a closed culture were minimised. People received support based on transparency, respect and inclusivity. Improvements were made to governance systems after our visit to ensure there were regular checks of recruitment practices.
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Morton Gardens Ltd received an overall rating of Requires Improvement at its first comprehensive inspection, with a regulatory breach identified under Regulation 11 due to failure to conduct Mental Capacity Act capacity assessments and best interests meetings for key decisions. Strengths included safe medicines management, consistent and caring long-serving staff, person-centred care plans, and an open leadership culture, but governance systems failed to detect the MCA compliance gaps.
Concerns (3)
criticalConsent / capacity: “staff did not always conduct capacity assessments where it was believed people lacked capacity to make some specific decisions. These decisions included those relating to medicines and day to day finances.”
criticalConsent / capacity: “The provider had not followed best interest processes in line with the MCA and arranged best interests meetings in relation to these decisions.”
moderateGovernance: “these audits had not identified that the requirements of the Mental Capacity Act 2005 was not followed at all times which meant they did not know they needed to improve in this area.”
Strengths
· People's medicines were managed safely with robust GP-approved guidance, annual competency assessments and accurate stock records.
· Sufficient staffing with long-serving staff providing consistency of care; robust recruitment checks in place.
· Staff treated people with dignity and respect; relatives reported staff were kind, caring and understood people well.
· Person-centred care plans detailed individual needs, preferences, health backgrounds and communication needs.
· Staff supported people to access healthcare professionals and monitored nutrition and health needs proactively.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to live healthier lives and access healthcare services; supporting people to eat and drink enoughGood
effective: Staff support: induction, training, skills and experienceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Meeting people's communication needsGood
responsive: End of life care and supportGood
well-led: Continuous learning and improving care; managers and staff being clear about their roles and regulatory requirementsRequires improvement
well-led: Promoting a positive culture; engaging people, staff and partners; working in partnership with othersGood