MidCo Care

People lived in self-contained flats and bungalows designed to promote independence, choice and control. Some people lived in shared supported living environments, whilst others lived in individual accommodation. Several people had access to private outdoor spaces and gardens. Support was tailored to people's individual needs, with some people receiving one-to-one support and others receiving shared support arrangements.

The service supports older people and younger adults with a range of care and support needs, including people living with mental health needs, learning disabilities, autism and physical disabilities. The assessment focused on the regulated activity of Personal Care only.The assessment was completed by an Inspector and an Expert by Experience. Assessment activity included off-site and on-site visits, including out-of-hours assessment activity.

People were supported by staff who had the skills, knowledge and experience to meet their individual needs safely and effectively. Staff demonstrated a good understanding of the people they supported and were attentive to changes in people's needs and wellbeing. Staff spoke positively about the support available to them and described a culture of continuous learning and development.

There was a positive learning culture within the service. Incidents, accidents and safeguarding concerns were reviewed, and learning was used to improve outcomes for people. The provider demonstrated a commitment to continuous improvement and ensuring lessons learned were shared across the service.

Risks were assessed and managed in ways that promoted people's safety whilst supporting independence, choice and control. People and those important to them were involved in care planning and reviews. Staff supported people to achieve positive outcomes whilst ensuring identified risks were managed safely and proportionately.

People experienced good quality of life outcomes and were supported to pursue their interests, hobbies and goals. People maintained links with their local communities, accessed activities important to them and were supported to take holidays away from home when this was important to them. Staff worked creatively and consistently to help people develop new skills, increase independence and achieve outcomes that mattered to them.

The provider demonstrated a commitment to supporting people through change using planned and person-centred approaches. We saw examples where people were successfully supported to accept positive changes within their homes and daily lives through consistent encouragement, positive reinforcement and understanding of their individual communication and support needs.

People were supported to live with others who shared similar interests, lifestyles and support needs where appropriate. This helped to promote positive relationships, compatibility and good experiences for people using the service.

Medicines were managed safely and there were effective systems in place to oversee medicines administration, auditing and review. We found examples where medicines used to manage behaviours of distress had reduced over time of because of effective person-centred support, positive behaviour support approaches and staff understanding people's individual needs.

Leaders had developed effective governance arrangements to oversee quality and safety. Care records, risk assessments and support plans were regularly reviewed and updated. Systems were in place to monitor incidents, medicines, staff performance and service quality. Leaders used audits, reviews and feedback to identify areas for improvement and drive positive change.

Leaders explained they had undertaken coaching, management development and support through external professionals and Skills for Care, which had strengthened leadership and helped improve outcomes for people.

We assessed the service against 'Right support, right care, right culture' guidance to make judgements about whether the provider guaranteed autistic people and people with a learning disability respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA) and how restrictions on people's liberty were managed. Staff and management worked within the principles of the MCA. Deprivation of Liberty Safeguards (DoLS) authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions and had choice, control and freedom over their lives.

The provider had engaged appropriately with local authorities to ensure the necessary legal authorisations were sought where people were subject to continuous supervision, monitoring or significant restrictions. Records included decision-specific mental capacity assessments and best interest decision-making processes. We saw positive examples of restrictions being reviewed to ensure the least restrictive options were being considered and applied. For example, where covert medicines administration was in place, records demonstrated involvement from healthcare professionals and pharmacy teams, alongside regular review of whether covert administration remained necessary and whether less restrictive alternatives could be supported in the future.