Myrtle Cottage

This inspection took place on the 28 July 2018 and was unannounced

Myrtle Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered for up to six people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were four people living in the home.

The home was a two storey detached property which had an open plan lounge and dining area, a sensory room, a kitchen, one bedroom and a shared bathroom on the ground floor. On the first floor there were five further spacious bedrooms.

The care service had been developed and designed in line with the values that underpinned the Registering the Right Support and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

The service had not had a registered manager in post since August 2017. 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. A new manager had started at the home and had undertaken a telephone interview with our registration team five days prior to our visit.

People were not able to tell us about their experiences of life at the home so we therefore used our observations of care and our discussions with staff and other stakeholders to help form our judgements.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide the assessed care hours to people and recruitment checks had ensured staff were suitable to work with vulnerable adults. When people were at risk of seizures or behaviours which may challenge the service staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People had been involved in assessments of their care needs where possible and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs and preferences understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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.

Families and professionals described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. Equality Diversity and Human Rights (EDHR) were promoted and understood by staff. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People were not supported with end of life care.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations.. Leadership was visible and promoted good teamwork. Staff spoke positively about the new management changes and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Myrtle Cottage is a care home that provides support for six people, with a learning disability and behaviours which challenge. Myrtle Cottage is in Emsworth with access to the local community. On the day of our inspection there were five people living at the home.

There was no registered manager in post. 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 provider had not informed us that they had moved the registered manager to another location. The provider had employed a new manager who started working at the service on 10 July 2017. The new manager had been managing the home for the one day prior to the inspection and they are referred to as the manager throughout the report. They told us they would make an application to be registered once their probation period had ended.

At the last inspection in May 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the required action had been taken and there were no longer any breaches of regulation.

Staff knew how to keep people safe and had a good understanding of how to report safeguarding concerns. Safeguarding concerns had not been raised since the last inspection. People’s finances were managed safely.

People told us they felt safe and happy living at the home. Risks to people's health conditions were assessed to minimise them; staff were aware of people's individual risks People were supported by adequate numbers of staff.

People received their medicines safely and they had their nutritional and health needs met.

People's consent was sought before staff provided care.

Staff were undertaking a variety of training to meet people's needs. People were relaxed and comfortable around staff and had their dignity and privacy respected. People were supported to be as independent as possible. Where possible people had been involved in developing their care plans and were supported to follow their interests and hobbies.

There was an opportunity for people and their families to become involved in developing the service and they were encouraged to provide feedback on the service both informally and formally.

Systems were in place to monitor and assess the quality of the service and records had improved.

This inspection took place on 3 May 2016 and was unannounced. The home was previously inspected in October 2014, where no breaches or legal requirements were identified.

Myrtle Cottage is a care home that does not provide nursing. It provides support for six people, with a learning disability and behaviours which challenge. Myrtle Cottage is in Emsworth with access to the local community. On the day of our inspection there were five people living at the home.

The home had not had regular management input for about a year. There was a longstanding staff group who knew people well. One of the staff was the deputy manager.

A registered manager was in place however they had a new role as area manager for the provider which meant they had not visited the care home regularly. A new manager had been appointed and they told us they would be applying to register as manager with the Commission. We refer to this person as manager throughout the report. 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.

People who use this service were protected against the risk of abuse because staff recognised the signs of abuse or neglect and what to look out for. They understood their role and responsibilities to report any concerns and were confident in doing so.

However, people were not protected in all aspects of their life at the home. Appropriate systems were in place for the management and administration of medicines. However, there were not systems in place to ensure all of the medicines were stored safely.

Action had not been taken to ensure all cooked foods were safe for people.

Action had not been taken to ensure all portable appliances were safe for people to use.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people's needs. There were risk assessments related to people's day to day care and details of how these risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of suitable staff to meet people's needs and promote their independence and safety. The new manager had ensured staff would be provided with relevant training and regular supervision was to be arranged. Staff were aware of their roles and responsibilities and the lines of accountability within the home.

Due to a lack of consistent management we saw that staff had only received supervision twice in the last 18 months. However the staff told us they felt they supported each other well.

The provider promoted safe recruitment practices, which ensured staff were suitable for their job role. Staff described the new manager as very approachable. Staff talked positively about their jobs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and staff we spoke with understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

People had good access to health and social care professionals when required.

Staff motivated, encouraged and supported people to be actively engaged in activities inside and outside of the home. For example, people went out to their local community most days of the week for activities, including visiting their local club for activities and the cinema.

People and their families knew how to make a complaint and a copy of the 'how to complain' information was available in the home. Five complaints had been made since the last inspection. Systems were in place to gather people’s views and assess and monitor the quality of the service.

There had been a lack of regular manager input in the last 12 months which had impacted areas such as audits, staff supervision and recording.

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.

The inspection was carried out by a single inspector. We spoke with three of the people who lived at the home. Due to the nature of people's learning disability we were not always able to ask direct questions to people. We did however chat with them and were able to obtain their views as much as possible. We also spoke with a relative of one person, the registered manager and three members of staff.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People we spoke with told us they felt safe while being supported. They told us the care staff were good. None of the people we spoke with had any concerns about the support they received. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. During the inspection we looked at two plans of care. Both of the care plans had risk assessments in place to help minimise any risk that had been identified.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what the person could do themselves and what support they needed from staff.

During our visit we saw staff consulted people as much as possible when they supported them. Staff spoke to people clearly and explained to people what they were doing. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We looked at how staff recorded what support had been provided each day. We saw that recording took place throughout the day. This provided good information about the care and support given as well as providing evidence of care delivery.

Is the service caring?

We observed staff speaking to people appropriately and they used people's preferred form of address. We saw people and staff got on well together. There was a good rapport between staff and people who used the service and we observed staff and people enjoying each other's company.

We observed that people were happy with the support they received and a relative of one person we spoke with was very happy with the care and support their relative received. They told us the staff were caring and provided the help, care and support their relative needed.

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw review notes which showed alterations had been made to people's plans of care as people's needs had changed.

We saw that people were able to participate in a range of activities both in the home and in the local community. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives and staff were asked for their views about how the home was meeting people's needs and any concerns or ways to improve the service were acted on.

Is the service well led?

Myrtle Cottage had a policy and procedure for quality assurance and the provider organisation also employed a quality manager who ensured that six monthly checks on the quality of the service provided were carried out. The provider also employed an area manager who carried out these audits.

A relative we spoke with told us that they had regular contact with the home and said that they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

Staff meetings took place every three months and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

Meetings with people who used the service also took place weekly and these were used to discuss any issues in the home and also to plan activities and menus for the following week.

The manager told us that all staff received supervision every six to eight weeks where staff performance issues were discussed and additional staff training was identified as necessary. The manager also told us that staff received annual appraisals. Staff we spoke with confirmed this.

We spoke with four of the six people who lived at Myrtle Cottage. Due to the nature of people's learning disability we were not always able to ask direct questions to people. We did however chat with them and were able to obtain their views as much as possible. We also used a range of methods to help us understand people's experiences. These included; observing how staff supported people, talking to staff, talking to people who used the service and looking at records.

We spoke with two relatives of people and they told us that they were very happy with the care and support their relatives received. They said that the staff were always cheerful and that they all got on well with their relatives. However one person told us that improvements could be made in how staff carried out observations of people. The other relative told us that communication could be improved.

Relatives also told us that they knew how to make a complaint if they needed to and said they were confident that any complaints would be dealt with appropriately.