Medihands Clifton

Medihands Clifton is a residential care home providing personal care for up to 14 people who require support to maintain their mental health. At the time of the inspection, there were 11 people living there.

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

The provider had made improvements since the last inspection in how they monitored the safety and quality of care they provided to people. The provider used the systems in place to identify concerns and areas that needed to be improved. Medicines were stored appropriately in a lockable cabinet. Staff managed and administered medicines safely to people as prescribed. Staff were up to date with training that enabled them to provide care effectively.

Staff understood the abuse that could happen to people and knew the action to take to minimise the risk of avoidable harm. Risk assessments and management plans were in place. Staff managed risks to people’s health and well-being in line with their support plans.

New staff underwent checks for their roles before they started providing care. People were supported by sufficient numbers of staff. The provider took action when incidents and accidents happened and learnt lessons to improve the quality of care. Premises were checked for cleanliness and safety to ensure they were safe, clean and suitably adapted to meet people’s needs.

People’s needs were met by staff who followed guidance and support they obtained from health and social care agencies. Staff were trained to carry out their roles and received appropriate support through induction, team meetings and supervisions to discuss their work and performance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care in a person-centred manner. People using the service felt confident to approach the deputy managers and staff to raise any concerns or suggestions they wanted to discuss. The provider worked closely with external agencies to develop the service and make improvements when needed to plan and deliver safe care to people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 July 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Why we inspected

We received concerns in relation to staffing and whether staff had the knowledge and skills they needed to support people using the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Medihands Clifton on our website at www.cqc.org.uk.

Medihands Clifton is a residential care home. At the time of our inspection the service was providing personal care and support to 12 older people with mental health needs. The care home can accommodate up to a maximum of 14 people in one adapted building.

People’s experience of using this service

Most people remained positive about the quality of the care and support they received from this service. A person living there summed up how most people felt about the service in one quote, "This is a good care home and I’m happy living here…The staff treat me well and know what I like and don’t like."

However, we found the service was not always safe, effective or well-led? This was because people were not supported by staff who had ongoing training, the provider did not always follow relevant national guidelines regarding the safe storage of medicines and their governance systems were not sufficiently robust to pick up all the issues we identified during this inspection.

Nonetheless, despite these failings, we found the service remained caring and responsive.

People received their medicines as prescribed and were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient numbers of staff whose suitability to work in adult social care had been checked were available to meet people's needs. The premises were clean and staff followed relevant national guidelines regarding the prevention and control of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were provided with a well-balanced meals that meet their dietary needs and wishes. People were supported to stay physically and emotionally healthy and well.

People continued to be cared for and supported by staff who were kind and compassionate. People were encouraged to make decisions about the care and support they received and have their choices respected. People's privacy was respected and their dignity maintained. People were supported to be as independent as they could and wanted to be.

The service remained responsive. People received personalised care that was tailored to their individual needs and wishes. People had access to a range of activities and entertainment that reflected their social interests. People were aware of the providers complaints policy and how to raise any concerns or complaints they may have. People nearing the end of their life received compassionate palliative care.

The service continued to have the same manager registered with the Care Quality Commission (CQC) who people using the service and staff spoke positively about. The registered manager promoted an open culture within the service and always sought the views of people using the service and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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

Rating at the last inspection

The last rating for this service was good (published 24 December 2016).

Why we inspected

This was a planned inspection based on the previous rating of good.

Enforcement

We have identified two breaches in relation to the unsafe storage of medicines and the ongoing training of staff. This was because we found the cupboard where medicines were kept had been left open in an unlocked office on both days of our inspection. We also found most staff had not refreshed their training for at least three years in relation to most areas the provider identified as relevant to their roles. This included mental health awareness, safeguarding adults, food hygiene, infection control, Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards, equality and diversity, and end of life care.

We have also made a recommendation about staff training on the subject of positive behavioural support to help staff prevent or appropriately manage behaviours considered challenging.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Medihands Clifton provides accommodation and personal care for up to 13 people who have mental health needs, acquired brain injury or who may be living with dementia. The home is owned and managed by a private individual who has two other care homes in the local area. There were 11 people living at the home on the day we visited, one person was in hospital.

The home had a registered manager at the time of the inspection. 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.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. We saw that people could speak to the registered manager or provider at any time.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place. We saw that regular checks of maintenance and service records were conducted to ensure these were up to date.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received appropriate medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff were supported through one to one supervision and through staff meetings.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others.

Detailed records of the care and support people received were kept. People were supported to eat and drink sufficient amounts to meet their needs. People had access to healthcare professionals when they needed them, so their healthcare needs were met.

People were supported by caring staff and we observed people were relaxed with staff who knew them and cared for them. People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to do and to choose the activities or events they wanted to attend.

The registered manager had arrangements in place to respond appropriately to people’s concerns and complaints. From our discussions with the registered manager, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.

Below is a summary of what we found.

Is the service safe?

Care plans had details of people's needs and how these were to be met. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely.

We saw that risk assessments of the environment were regularly carried out and action plans written if required. The temperature of cooked foods was monitored at each meal; this helped to ensure food was correctly cooked.

Staff had received training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and understood how this could impact on the people they cared for.

Is the service effective?

People received effective care from staff that were trained and supported by the manager. We saw that people were happy, well cared for and treated with respect. Care plans were regularly reviewed with the person using the service.

Staff received a range of training. We evidenced that staff were being supported to study for further National Vocational Qualifications (NVQ). Staff received one to one supervision and yearly appraisals.

Is the service caring?

The service was caring. This was confirmed by our observations of staff and people using the service. Staff respected people's privacy, dignity and their right to be involved in decisions and make choices about their care and treatment.

People we spoke with said 'I like the garden', 'this is a good place' and 'I'm near my family here'. People also commented in the annual survey, 'happy to live here' and 'I don't want to go from here'.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. We saw from the daily notes that most people enjoyed the activities on offer and the home catered for their individual preferences. Some people did comment that there 'weren't enough activities'.

On the day of our visit which was unannounced, we saw that a few activities were taking place and people were joining in if they wanted to.

Is the service well-led?

The home employed a manager who knew their staff and people well. The manager told us about the audits that they conducted and showed us the recorded evidence to support them.

People were asked for their views about the service and we reviewed the returned questionnaires.

Staff we spoke with commented "it's good here, you learn a lot and gain experience", 'other staff and the manager are very supportive' and 'best place I've worked'.

At a recent meeting people using the service were asked to comment of the home strengthens and weaknesses. The strengths were cooking, cleanliness and personal care. A weakness was communication.

One person said "I visited and chose to come here" while another person said "my relatives visited and chose the place for me, they made the right choice". "The staff are lovely" and "they're good here" were some of the comments people made about staff. People said "I've got all I need in my room" and "they keep the place nice and clean". "I do what I want", "I go out to the day centre", "I see my family", "I watch television", "I listen to the radio", "I talk with the others" and "not much to do here" were comments people made about what they did.

Staff said they had the training and support they needed to do their job. One member of staff said one of the things they did well was the cleanliness of the home. Another member of staff said they knew the people who use the service well and how to meet their needs.

We saw improvements had been made to the environment. A bathroom on the ground floor had been refurbished, the garden had been developed to provide a covered smoking area with new flower beds and grass and the curtains had been replaced in the lounge. People made positive comments about the new shower and were happy with the improvements to the garden. We saw some good interactions between staff and people who use the service. Staff clearly knew what people liked and how to meet their needs.

During this unannounced visit we saw improvements had been made to the environment and the type of social activities available and provided to people who use the service. We spoke with six people who use the service and two members of staff.

People said they had been watching television, reading the paper, talking amongst themselves and with staff and said they had enough to do during the day. Staff told us they had some jigsaw puzzles and board games that they got out during the day and said that they had time to sit with people who use the service.

"I'm happy living here", "I chose to come", "I'm feeling settled", "I have all I need in my room", "I was able to bring some items of furniture and belongings with me" and "I have the things that are important to me" were some of the comments we received from people about how they experienced living at Medihands Clifton. We saw some bedrooms had been personalised with individuals belongings and photographs, while other rooms were quite bare.

People told us they liked the food saying "I enjoyed lunch", "the food is usually good", "I had enough to eat", "they asked me if I wanted shepherds pie for lunch" and "we have porridge, toast and a cup of tea for breakfast".

"I watch television", "I go out to the day centre" and "we don't do much" were comments people made about what they did each day. Daily records indicated many people spent much of their time in the lounge watching television. We saw people sat in the lounge watching television, two people made a cake with staff and one person had a visitor.

People told us staff provided the care and support they needed saying "they listen", "they give me the help I need", "some are better than others", "they call me by my name" and "they respect my privacy". We saw some good interactions between staff and people who use the service with staff demonstrating good knowledge of people's needs and how to meet them.