Minstead House

About the service

Minstead House is a residential care home providing personal care for up to 8 people. The service provides support to people with learning disabilities and autism. At the time of the inspection there were 6 people living in the home.

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

Right Support: The risks to people were identified; however, these risks and the plans for keeping people safe were not always reviewed. Staff knew how to look after people. People and their relatives told us their needs were being met in the home.

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.

Right Care: Improvements were needed in relation to the management of people’s medicines. Staff training needs had not been consistently monitored and addressed. The provider protected people from poor care and abuse. The provider ensured people were treated with respect and dignity whilst receiving care and treatment. Staff knew people well and cared for them in the way they wished.

Right Culture: The provider had failed to implement effective systems to assess, monitor and improve the quality and safety of people’s care. People’s care records were not always accurate, up-to-date and complete. People and their relatives told us the provider was communicative. Staff felt supported by the provider and able to do their job.

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 14 March 2018)

Why we inspected

We received concerns in relation to the safety of people and the culture of the home. As a result, we undertook a comprehensive inspection. We found no evidence during this inspection that people were at risk of harm from this concern.

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, Effective, Responsive and Well-led sections of this full report.

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

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

Enforcement

We have identified a breach in relation to the provider’s governance and quality assurance 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.

• Although visitors were not allowed into the service, the provider had ensured that gym sessions could continue for people and a local trainer visited the home weekly and held gym sessions through the window.

• Personal Protective Equipment such as masks, gloves and aprons were available to visiting professionals on entry to the building.

• People were supported to maintain contact with people important to them via telephone and video calls. The service completed weekly calls to families to provide updates on people’s well-being.

• Where additional staffing support had been required, this was sourced from a sister service of the providers and staff remained at this service to reduce the risk of cross infection.

• Where people or staff had received a positive Covid19 test, the provider followed national guidance relating to self-isolation.

Further information is in the detailed findings below.

We found the following examples of good practice.

¿ People were supported to maintain social contact with their relatives and friends by using SKYPE calls and closed window visits.

¿ People were supported to utilise technology to continue to participate in social activities, for example, WhatsApp was used for gym training sessions and on-line yoga.

¿The management team told us risk assessments had been undertaken to enable people to leave and return to their home safely and to limit the use of public transport.

¿ People's laundry was washed separately to prevent risk of cross contamination.

¿ Signage displayed in formats people understood described how to use Personal Protective Equipment (PPE) and how to wash hands effectively.

Further information is in the detailed findings below.

The home is registered to provide accommodation and personal care, for a maximum of eight people with learning disabilities and there were eight people living at the home on the day of the inspection. A registered manager was in place. A 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.

We last inspected this service on 28 September and 4 October 2016 and rated it ‘Requires improvement’. We found people's rights were not always protected because key processes had not been followed or implemented to ensure that people's rights were upheld. We also found audit systems had not always been effective at identifying where improvements were needed. This inspection found there had been improvements across the service.

People were supported by staff to take their medicines and records were completed by staff to record when medicines had been administered.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

Staff were available to meet people’s individual needs promptly and demonstrated good knowledge about people living at the home. Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

People enjoyed a good choice of meals and were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP and any changes to their care needs were recorded and implemented.

People were relaxed around the staff supporting them. We heard and saw positive communication throughout our inspection and saw people smiling and responding positively to staff. Relatives we spoke with told us people enjoyed good relationships with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

Relatives said they were involved in reviews of people’s care and said staff listened to them. Relatives and staff felt confident they could raise any issues should the need arise and that action would be taken as a result.

The provider had systems in place to check and improve the quality of the service provided. People, relatives and staff were positive about the service and the way it was managed for the people that lived there. The registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

Minstead House is registered to provide accommodation and support for up to eight people who have a learning disability. At the time of our inspection four people were living at the service.

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. 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.’

Systems in place to monitor and improve the service had not always been effective in identifying where improvements to the service needed to be made.

People received care and support with their consent where possible, and the staff ensured that people were supported in the least restrictive way.

People were protected from the risk of abuse because the provider ensured that staff had received the training they needed so that they could recognise and respond to the risk of abuse.

People were supported by staff that were kind and caring and who took the time to get to know them. People were cared for by staff that protected their privacy and dignity and respected them as individuals.

People were supported by enough staff. Staff had been safely recruited and had received adequate training so that they had the skills and knowledge to support people effectively.

People were supported to have their medicines when they required them, from staff that had the relevant knowledge and skills they required to promote safe medication management.

People were supported to stay healthy and had access to health care professionals as required.

People could choose how to spend their day and they took part in activities in the home and the community. People were supported to maintain positive relationships with their relatives.

There were some processes in place for responding to complaints.