Archived: Minster Grange Care Home

Minster Grange Care Home is a residential care home providing personal and nursing care for up to 62 people. The service provides support to people with physical disabilities and older people, some of whom are living with dementia. At the time of our inspection there were 40 people using the service. People are supported across 3 floors. Each floor has its own communal areas.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Risks to people were not appropriately assessed, monitored, and managed. People’s care plans did not always reflect their current needs. Lessons had not been learnt following previous CQC inspections. There were not enough staff to provide safe and person-centred care. Staffing levels were increased for the second day of our inspection. Medicines were not always managed safely.

The mealtime experience for people was poor. People had to wait long periods of time for meals and there was limited choice. Due to staffing levels, people did not always receive personal care in a timely manner.

People were generally supported to have maximum choice and control of their lives although staffing levels impacted this. Staff tried to support people in the least restrictive way possible and in their best interests, although again staffing levels impacted these practices.

The provider failed to make and sustain necessary improvements. There was a lack of clear and positive leadership. The service had a poor regulatory history and failed to improve despite professional input and assurances from the senior management team. There was no registered manager. Staff spoke of a poor culture and some staff felt they were not treated equitably.

The building was well maintained, and regular health and safety checks were completed. The service was clean and tidy. Staff were kind and caring, and worked hard to support people in line with their choices and preferences. However, this was restricted by staffing levels. Staff had received appropriate training for their roles and were knowledgeable about people’s needs. The operations director and nominated individual were responsive to our feedback.

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 14 June 2023) and there were multiple 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the quality of care delivered. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective, and well-led.

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

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

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

Enforcement

We have identified breaches in relation to staffing, dignity and respect, safe care and treatment, and good governance.

Whilst enforcement action was proposed and being processed, the provider submitted a voluntary application to de-register this location and therefore enforcement action did not proceed.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. The provider has submitted a voluntary application to de-register this location.

Minster Grange is a residential care home providing personal and nursing care for up to 62 people. The service provides support to people with physical disabilities and older people, some of whom are living with dementia. At the time of our inspection there were 41 people using the service. The service is divided into 5 areas across 3 floors. Each floor has its own communal areas.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Risks to people were not always appropriately managed. Guidance for staff was not always clear and accurate. There were not always enough staff to ensure people received safe and person-centred care. PPE was not always stored and disposed of in line with best practice guidance.

The provider had failed to improve the quality of the care provided. Some improvements had been made but the provider remained in breach of regulations. Some improvements made previously had not been maintained. Staff morale was not always positive, and staff did not always feel fully engaged with the service. There was no registered manager at the time of the inspection.

The dining experience for people was not always positive although most people told us they liked the food. People’s needs were assessed although guidance for staff was not always clear. Staffing levels impacted people receiving care in line with their assessed needs.

People were generally supported to have maximum choice and control of their lives although staffing levels sometimes impacted this. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were recruited safely. Medicines were generally managed safely, and people received their medicines as prescribed. Some medicine records needed to be more robust. The environment was well maintained. Health and safety checks were up to date and staff took part in fire drills. The service was clean and tidy.

Staff had the right skills and experience. Inductions for agency staff members were not always in place. This had been identified by the acting manager who was in the process of rectifying this. Staff made appropriate referrals to other professionals. The design of the service met people’s needs.

People and relatives, where appropriate, were involved in the development of the care plans. Care plans contained information about people’s likes and dislikes. People were supported to discuss end of life wishes and these were recorded. People were supported to take part in a range of activities, although staffing levels impacted care workers’ ability to spend quality time with people. People’s communication needs were met. There was a complaints procedure in place and complaints were investigated appropriately.

Most people and relatives were happy with the care provided and spoke positively about the care workers and nurses. The management team held a relatives’ meeting to provide an update and assurances. The management team complied with the duty of candour and relatives confirmed they were kept up to date.

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 10 January 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider seek advice from a reputable source to ensure robust medicine practices. At this inspection we found some improvements had been made but some areas of medicine management needed further improvement.

This service has now been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 August 2020 and breaches of legal requirements were found. We carried out a focused inspection on 15 April 2021 where the provider remained in breach of legal requirements. A further focused inspection was carried out on 7 December 2021. Some improvements had been made but the provider remained in breach of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well-led.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained requires improvement and the provider has remained in breach of regulation.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.

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

Follow up

We have already requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Minster Grange is a residential care home providing personal and nursing care to 48 people at the time of the inspection. The service is registered to support up to 62 people. The service provides accommodation across three floors and five units.

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

Governance systems that had been implemented needed further time to be embedded and sustained to ensure areas for improvement were identified and addressed. Not all areas of improvement had been sufficiently made, for example we found some continued concerns with the security of the building, the management of risk and record keeping.

Risks to people were not always identified and mitigated. Hazards that could put people at risk of harm had not been identified, such as falls and fire risks. These were addressed by the manager during the inspection.

Infection control systems had been put in place to support people to isolate. Although, improvements were noted further areas still needed addressing such as ensuring equipment was fully cleaned and Personal Protective Equipment (PPE) was stored and disposed of safely.

Medication records were not always robust. We have made a recommendation regarding medicines practice.

Improvements had been made to the culture of the service. Staff felt supported and the new manager was approachable. Relatives told us they had noticed improvements in the service and that communication had improved.

People were now supported with a varied choice of meals, the manager had implemented a variety of alternative menus for people to choose from, which met people’s beliefs and wishes.

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

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 of this service was Inadequate (published 12 October 2021) and there were multiple 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 enough improvement had not been made/sustained in all areas and the provider was still in breach of some regulations.

This service has been in Special Measures since 12 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 carried out an unannounced focused inspection of this service on 15 and 19 April 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. 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 Minster Grange Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management and governance 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 for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Minster Grange is a residential care home providing personal and nursing care to 58 people at the time of the inspection. The service is registered to support up to 83 older people. We identified only 62 beds were available at the time of inspection. We are dealing with this outside the inspection process. The service is across three floors and five units.

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

People were not safeguarded from the risk of harm. The building was not adequately secure. Incidents were not always recorded appropriately, the management team had not ensured action was taken to prevent future incidents occurring and that the appropriate people were informed.

Procedures were not in place to safely support people in isolation in relation to the COVID-19 pandemic. This put people, staff, relatives and others at risk of the spread of infection.

There was insufficient staff to meet people’s needs. This meant people had to wait for personal cares and meals and did not receive person centred care.

People were not fully supported with choices of meals. There were no menus in place and staff did not always know what was available for lunch to inform people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Records of consent, capacity assessments and best interest decisions were not always in place when people had to move rooms and units within the building.

Systems in place had failed to improve the quality and safety of the service. The provider had failed to make sufficient improvement following our last inspection and further deterioration was identified at this inspection.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 22 October 2020) and there were 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing, mental capacity act, person centred care and leadership of 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.

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.

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

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 Minster Grange Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, safeguarding, risk management, person centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection we recognised that the provider had failed to notify the commission of safeguarding incidents and serious injuries. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Minster Grange is a residential care home providing personal and nursing care to 53 people. The service can support up to 83 people. The service has five separate units across three floors. On the ground floor, Ash provides nursing care and Aspen provides nursing care for younger adults. On the first floor, Beech provides nursing care for people who may also be living with dementia. On the second floor, Copper provides residential care for people who may be living with dementia and Chestnut provides residential care for older people.

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

This service had a new provider who registered with the Care Quality Commission (CQC) on 14 January 2020. The new provider’s governance systems to monitor the quality of care provided had not been fully embedded into the service. This meant the provider had not identified and addressed the shortfalls found at this inspection. Records of the care people received were not consistently completed.

One unit did not have sufficient staff to meet people’s needs. The provider increased staffing levels during the inspection. Lessons had not been fully learnt from previous incidents to protect people’s safety.

People’s nutritional needs were met, although further work was required to promote choice at meal times. The building was appropriate for people’s needs and their bedrooms were fully personalised. People were supported to access health care services.

Within the context of Covid-19 infection risk, procedures were in place to ensure infection control was managed. Staff understood their responsibilities to reduce the risk of spread 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.

Staff were kind and caring and had developed positive relationships with people living at the service. We received positive feedback from relatives about the staff and the care they provided 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

The last rating for the service under the previous provider was good, published on 12 July 2017.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, end of life care, nutrition and personal hygiene. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to staffing and governance 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 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.