Myrtle Cottage

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were protected from the risk of abuse. Policies and procedures and staff training supported this. Staff understood their safeguarding reporting and investigation responsibilities. We observed sufficient staffing in place throughout the inspection and found staff to be appropriately skilled. During our assessment we identified some areas relating to the recording of staff pre-employment checks and people's 'as required' medicines which required improvements. The registered manager responded positively to these issues and had commenced a programme of improvement activity.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff could describe the provider’s safeguarding procedures and confirmed they had completed safeguarding training. Staff were confident that managers would take action if they raised concerns. Staff gave examples of how they supported people and others to stay safe when experiencing anxiety related behavior. The registered manager was able to confidently discuss safeguarding, the process for reporting and how they learnt from any concerns raised.

There were effective systems, processes and practices to ensure people were safe from the risk of harm and abuse. Safeguarding policies and procedures were in place to protect people from abuse and avoidable harm. We reviewed the safeguarding tracker. We saw evidence of safeguarding concerns being reported to the local authority and CQC.

We observed people and staff interactions to help us understand the experience of people who could not talk with us. People were supported by staff to raise concerns through easy read documentation. Relatives we spoke with felt their loved ones were safe and felt confident they could go to staff with any concerns.

We saw staff were confident when supporting people and understood how to communicate with them through speech and the use of Makaton sign language. Relatives told us they were happy with how people were supported to remain safe.

Staff had a good understanding of people’s risks and how to support people to remain safe. This included supporting people at risk of choking, with anxiety behavior, epilepsy and falls. Staff’s feedback corresponded with information in people’s care plans. Staff told us, people have risk assessments and care plans which they can access via the provider's care and clinical online system. Staff were able to give us examples of how they mitigate risks to people, this included supporting people when they were out. Staff were able to give us examples of positive risk taking. The registered manager told us they ensure staff read the care plans and all risks were identified within them.

There were enough staff to respond to people’s needs safely. During the onsite visit we observed a person at risk of choking supported by staff safely to eat and their food was prepared as stated in their care plan. Staff were skilled in identifying when people’s risks changed and in how to support people to make minor adjustments whilst still remaining as independent as they can.

We reviewed people's behavior support plans which were individualised, detailed and provided a good insight into how people behaved when they were anxious and how staff were to support people to remain safe. Robust contingency plans were in place which informed staff of what to do in emergencies for example, in case of significant staff shortages or bad weather to ensure people continued to receive support.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager did not have effective oversight of the staff recruitment process. The provider's recruitment team had not ensured comprehensive recruitment records were available for each staff member employed. Following the inspection, the manager and the area manager told us they would review all recruitment files and ensure they had oversight of recruitment going forward. Some staff needed to complete some of the provider's required training. The registered manager had identified this training requirement in the last 2 registered manager audits but had not addressed this at the time of the inspection. Staff were supported by supervisions. Supervisions provide an opportunity for managers to meet with staff, feedback on their performance, identify any concerns, offer support, assurances and learning opportunities to help them develop.

During the onsite visit there were enough staff on duty to support people with their needs. People appeared to be in receipt of their 1:1 support and we observed positive interactions between people and staff.

All staff reported they felt there was sufficient staff to support people and the registered manager and deputy manager provided care when needed. One staff member mentioned a lack or drivers but told us they have overcome this by taking people out locally and by using public transport. We were also informed more staff are now able to drive giving people more options for individual activities. Staff were able to describe their induction experience and detailed off-site corporate induction training, then in-house induction training including shadow shifts. Staff who worked nights told us, they had completed both day and nighttime shadow shifts to help them get to know the people well. Staff agreed that the training provided supported them in their role. The registered manager told us that all staff had completed training for people with a learning disability and expressed the importance of the training for the people they support.

During our on site assessment we observed people being supported by staff safely. However, relatives felt there was not always enough staff to support people in the community due to the lack of drivers. One relative said, “There are occasions when they don't have drivers on and they can't go anywhere.” Another relative said, “They don't always have a driver, impacts on me and [person name].” One relative told us, “Not come across the need for more staff.” Relatives were happy with the staff and felt they had the right skills and knowledge to support people safely. One relative said, “Without a doubt, he is very happy, they are very good at reducing anxieties.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff were able to confidently talk us through the medication administration process. Staff told us that medication was recorded on an eMAR and the safety checks this provided. Staff confidently told us the procedures for administering topical creams and what they would do in the case of a medication error. The registered manager told us how they assured themselves they were providing PRN (when needed) medicines safely. They told us, “We monitor PRN, if it is behavior they complete a behavioral form. If it is pain we monitor in case there are any underlying issues. We talk to staff during the competency and explain what it is and why you would administer it.”

People were supported to take their medicines in a way that met their needs. Medicines were observed to be administered at the correct time and given according to their administration records (eMARs) MAR chart as prescribed.

The provider had a medicine policy in place and people's record showed they had received their medicines as prescribed. Some people's 'as required' medicine protocols were not sufficiently comprehensive to ensure staff would always know how and when to administer people's occasional medicines. We identified the registered manager, and the deputy manager were not in date for their medicine competencies. The deputy manager had been giving medicines without an up-to-date competency assessment in place. Both the registered manager and the deputy manager do competency assessments for their staff, however; neither of them had had training to do this. The registered manager was responsive and arranged for herself and the deputy manager to be competency assessed.