Minchinhampton Centre for the Elderly - Horsfall House

Minchinhampton Centre for the Elderly – Horsfall House is a residential care home providing personal and nursing care to up to 44 people. The service provides support to older people and people who live with dementia. At the time of our inspection there were 41 people using the service.

People were accommodated in one adapted building in two separate units. Each unit could support 22 people. One unit provides general nursing care and the other specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

Environmental risks had been assessed but records relating to these did not always provide the information needed to show the provider had taken sufficient action to reduce or mitigate risks.

People’s care records did not always reflect the support staff told us they provided to keep people safe. This meant staff may not always have access to the information they require to reduce or mitigate people’s risks.

Robust staff recruitment processes had not always been followed to ensure safe recruitment of staff took place.

The provider had not ensured effective systems were in place to assess, monitor and improve the service and to ensure compliance with necessary regulations.

The required notification had not been made to us (the Care Quality Commission) when Deprivation of Liberty Safeguards (DoLS) had been authorised. This is required to support the monitoring of legally authorised DoLS. However, where required appropriate application to the local authority for DoLS had been made. Staff worked within the principles of the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff employed to meet people’s care needs and to keep people safe. Successful staff recruitment had led to a reduction in the use of agency staff.

There were arrangements in place to protect people from abuse and discrimination and to identify poor practice and act on this.

We made a recommendation about a practice which could be open to abuse.

People’s medicines were managed safely. There were arrangements for medicines to be reviewed by people’s GPs. People told us they felt safe and well cared for and their relatives were satisfied with the care provided.

The registered manager provided strong leadership and support to the staff team. They were visible and available to people and their relatives for support and advice. Staff worked collectively across the care home to support good outcomes for people.

The service worked closely with commissioners of care and the provider’s day care services to ensure people could access the service as required. There were strong links with local primary healthcare services, community leaders and community groups to improve the quality of the service provided to people.

The provider was motivated to make improvements to the service and provided us with an update on their proposed actions for improvement. These actions related to safeguarding people from abuse, fire safety, Legionella risk, maintenance and safety checks (including relevant records), staff recruitment, submission of notifications to CQC and quality monitoring systems and processes.

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

Rating at last inspection

The last rating for this service was good (published 7 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

We sought some immediate information from the provider following our inspection on what action they will take to mitigate risks.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last rated inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Minchinhampton Centre for the Elderly – Horsfall House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to records pertaining to the management of people’s and environmental risks, staff recruitment, notifications of authorised Deprivation of Liberty Safeguards and the provider’s governance and quality monitoring processes at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The registered manager and provider were proactive in updating policies and processes in line with national and local authority guidance. This included policies relating to infection control and prevention, visiting and staffing. Staff had been trained to cover other staff jobs roles to provide greater flexibility and staffing capacity in response to an outbreak.

¿ Admissions to the service were completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission, to reduce the risk of introducing infection.

¿ Staff followed the risk assessments in place to reduce risk of transmission of infection throughout the service. This covered use of appropriate PPE, barrier nursing and effective cleaning products, enhanced cleaning schedules, and separating the two nursing units through cohorting of people and staff groups, zoning and revised kitchen and laundry processes.

¿ COVID-19 related risks to people and staff had been assessed and measures were in place to reduce these risks. People’s health and wellbeing was monitored. People were observed for symptoms of coronavirus and other potential infections. Nurses referred people to the GP to provide additional clinical care when this was required.

¿ People and staff were tested in line with national guidance for care homes. Testing had helped managers identify when additional infection control measures needed to be implemented and when staff needed to self-isolate. The registered manager and staff had taken immediate action to manage an outbreak. This included working with Public Health England (PHE) and the Local Authority to ensure risks to people and staff were minimised.

¿ People had been supported to self-isolate and socially distance. Creative approaches had been used to assist people who lived with dementia to do this. These included use of ‘Do Not Enter’ signs, which had been effective when people could not recall instructions but could read and follow the familiar red sign.

¿ Visits to the service were suspended in line with national and local guidance and specialist advice. Special arrangements were made for visiting people at the end of their life. When visiting was not possible, people were supported to remain in contact with their family members and friends through calls and virtual means.

¿ People were supported to stay socially engaged and not to become lonely. Staff helped people join in socially distanced group activities, or one to one activities, with a staff member.

¿ An open and transparent approach was maintained throughout the outbreak to keep families, the public and appropriate agencies informed. This included a press release, an information banner on the provider’s website, completion and appropriate sharing of PHE log sheets, tracking and reference materials.

¿ Staff had received training and support on how to implement the provider’s outbreak management plan. They were highly complementary of the support they received from the registered manager and their colleagues.

¿ The provider’s executive team provided support and guidance to the home’s management throughout the pandemic. Reflection and lessons learned will be used to support further learning around the management of COVID-19.

Further information is in the detailed findings below.

Minchinhampton Centre for the Elderly – Horsfall House is better known as Horsfall House and will be referred to as such throughout this report.

Horsfall House is a ‘care home’. People in care homes receive 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. Horsfall House accommodates up to 44 people in one adapted building. There were 43 people at Horsfall House at the time of the inspection.

There was a registered manager in post at 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in February 2017. There were two breaches of regulation at that time in relation to the governance arrangements in the home and the rights of people who could not consent to their care were not always protected. We found the provider had made the needed improvements and met the requirements of the regulations during this inspection.

Medicines were managed safely and people received their medicines as prescribed. Health and safety checks were carried out regularly to ensure the service was safe for people living there.

People and relevant professionals were involved in planning their nutritional needs. People’s health was monitored and healthcare professionals visited when required to provide support to help meet people’s health needs.

Staff had received training appropriate to their role. Staff had received training around safeguarding and were confident to raise any concerns relating to potential abuse or neglect. Staff received regular supervision from the management team. The administration and management of medicines was safe. There were sufficient numbers of staff working at Horsfall House. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, action had been taken to ensure the ongoing safety of the person.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were encouraged to make choices about their day to day lives. People were supported to access health professionals. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team. People’s feedback and the views of relatives and staff were sought to make improvements to their experience of the service.

Horsfall House is registered to provide residential and nursing care for up to 44 older people. The home had two units, one for people with dementia on the ground floor and a general nursing unit. Both units were 22 bedded. All bedrooms were single and had en-suite facilities. The home was purpose built and set within large landscaped gardens. One place was used to provide free respite care for people who needed support on a short term basis. This could be on either unit. At the time of our inspection there were 43 people in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service was partly effective because they were not working within the principles of the Mental Capacity Act 2005 (MCA). For those people who were unable to provide consent to live at Horsfall House, deprivation of liberty safeguards applications had not been made to the local authority. This meant people were being unlawfully detained.

Improvements were required with people’s care records. Core care planning documents were used but the staff added little detail regarding the person’s specific needs. Some plans did not record the intervention required by the staff team. Some daily records were not recorded in date order. These shortfalls had not been highlighted during the services auditing procedures.

The registered manager and staff team understood their role and responsibilities to protect people from harm. No safeguarding concerns have been raised in the last year. Risks to people’s health and welfare were assessed and appropriate management plans were in place to reduce or eliminate the risk. Staffing numbers on each shift were sufficient to ensure people were kept safe.

The management of medicines was safe and there were good infection control and prevention measures in place to safeguard people.

Staff were well trained and able to carry out their roles effectively. New staff to the service had an induction training programme to complete and regular refresher training was arranged for the whole team. People were provided with sufficient food and drink and staff monitored those people who were at risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People were looked after by a staff team who were kind and caring. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Where possible, people were involved in making decisions about how they were looked after. People’s privacy and dignity were maintained at all times. The service aspires to the principles of the Gold Standard Framework for end of life care and has enrolled on this training programme commencing May 2017.

People received care and support that met their individual specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.

Although the registered manager provided strong leadership and was well respected by staff, relatives and the people who lived in Horsfall House, improvements were required in two areas. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Some people in the home had dementia and were unable to tell us about the care they received and the way they were looked after. We completed a short observation framework inspection (SOFI) and spent a period of time observing the interactions of staff with a group of people. On the whole we observed that the staff were attentive to people's needs and were sensitive in the way they spoke to them and each other. There were a few negative interactions that could have been handled better and we discussed these with the registered manager.

People were safe at Horsfall House because staff were trained in safeguarding adults and knew what to do if concerns were raised.

There were sufficient numbers of staff available to meet people's needs. Staffing levels were kept under review and adjusted in accordance with people's needs. Staff received the training and support they needed to undertake the roles for which they were employed.

People can be assured any complaints they may have would be handled appropriately and acted upon where required.

People received the care and support they needed because assessment and care planning arrangements took account of each person's needs, choices and preferences. People were support to take their medicines as they had been prescribed by their GP.

We found that there were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began to work in Horsfall House.

People said 'the nurses and care staff always make sure I am happy with everything', 'I have a say in how I am looked after' and 'the service I receive is top quality but we are still asked if there is anything that could make things better'.