Minster Lodge Care Home

Minster Lodge Care Home is a residential care home providing personal care for up to 25 adults whose primary needs relate to their mental health. At the time of our inspection 20 people lived at the home and 1 person was in hospital.

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

People and relatives spoke positively about the service they received. Staff knew how to keep people safe and protect them from harm. Risks associated with people’s care and the environment were identified and assessed. People received their medicines safely by staff trained in medicine management. Staff were recruited safely.

The registered manager had processes in place to monitor and review the quality of the service provided, for example, audits of care records. The provider had a contingency plan in place, to minimise any risks to the service running safely in the event of, for example, adverse weather conditions. Staff felt valued and supported by the management team.

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.

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 15 February 2018).

Why we inspected

This inspection was prompted due to concerns received in relation to the quality of care provided to people and the culture of the service. As a result, we undertook a focused inspection to review the key questions safe and well led only. 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 remained good.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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

Follow up

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.

Individualised COVID-19 risk assessments and care plans were in place for all residents which provided guidance for staff to follow so they knew how best to support people to reduce the risk of COVID-19 outbreaks.

Staff and people living in the home accessed testing in line with government guidance. Where people refused testing there were risk assessments in place to mitigate the risks of this.

Minster Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Minster Lodge Care Home provides residential support and care for up to 25 people with mental health and physical care needs. At the time of our inspection there were 22 people living at the home.

At the last inspection, in February 2016, the service was overall rated as 'Good.'

Since our last inspection we had been informed that the local safeguarding team was completing an investigation following concerns about care provided to a person when they lived at the home. At the time of writing this report the outcome of the investigation is not known.

At this inspection people remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. There were policies and procedures in place which minimised the risks of abuse to people. The risks to people had been assessed, recorded and plans were in place to manage these risks and keep people safe. People received their medicines safely and as prescribed from trained staff.

Staff undertook training and received regular supervision to help support them to provide effective care.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests.

We saw people had a choice of food and drinks with snacks also available throughout the day. People were treated with dignity and respect. People were asked their preferences about how they wanted to be supported and cared for. These details were recorded in people's care plans including their end of life wishes.

People were supported to see other health and social care professionals when they required additional support.

Staff adopted a kind and compassionate approach to their work. People's involvement in decision-making was encouraged. People's rights to privacy and dignity were understood and promoted by staff. People's choices were respected.

Person centred plans were in place and people and their relatives were involved in planning the care and support they received. Care plans were regularly reviewed.

People, staff and professionals spoke highly about the registered manager and staff. The registered manager and registered provider continually monitored the quality of the service and made improvements in accordance with people's changing needs.

Minster Lodge Care Home provides residential care for up to 27 people, some of whom have mental health needs or physical disabilities. The bedrooms are located on the ground and the first floor. At the time of our inspection there were 24 people who lived in the home.

A registered manager was 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.

People told us their care and support needs were met by staff who were knowledgeable and knew them well. Staff had undertaken training relevant to the specific needs of people who lived at the home and staff told us they were supported within their job roles.

Everyone we spoke with said they thought Minster Lodge was a safe place to live and they were well cared for. Staff had a good understanding of how to report any safeguarding concerns. Staff understood how to keep people safe and were available at the times people needed them. The risks to people’s health and wellbeing were assessed and action taken to minimise any identified risk.

People received their medicines as prescribed, and checks were undertaken to ensure people received them in a safe way.

People were supported in line with the principles of the Mental Capacity Act. The manager understood the importance applying for Deprivation of Liberty Safeguards (DoLs) when necessary. Staff ensured they maintained people’s privacy and dignity and treated people with compassion and respect.

There were enough staff to support people who lived in the home. Recruitment checks were carried out prior to care workers starting work to ensure their suitability to work with people.

People had a choice of meals which met their dietary requirements and preferences. People were supported to maintain their health and attend healthcare appointment when necessary.

People had opportunities to pursue their hobbies and interests and maintain relationships with people important to them.

People and their relatives knew how to raise complaints and were confident actions would be taken in response to these. People had opportunities to put forward their suggestions about the service provided.

There were processes to monitor the quality and safety of the service provided and actions were taken to drive improvement in the service.

When we inspected the service the home had 23 people living there who required personal care. Some people who used the service had limited verbal communication skills. We observed people moving freely around the home, taking part in activities and making choices about how and where they wanted to spend their time.

We spoke with the manager, care staff and seven people who lived at the home.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The staff we spoke with understood their responsibilities in following the policies and procedures of the service to keep people safe. Staff were able to describe the different ways they supported people to keep them safe.

People we spoke with told us they were satisfied with the care and support provided by staff working for the service. One person told us, 'No problems with them at all at this place.'

Staff had received training about the Mental Capacity Act so they were aware of how people could be supported in making decisions if they lacked mental capacity.

We found improvements were needed to the environment so it was clean, safe and well maintained for people. This included accessibility to hot water, clean linen and maintenance of comfortable room temperatures.

Is the service effective?

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively.

Specialist dietary, communication and equipment needs were identified in care plans as appropriate.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate.

It was clear from our observations and from speaking with staff they had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

People told us they were happy with the care and support they received. We observed staff providing support for people. We saw that staff were friendly in their approach towards people and responded to people appropriately.

Is the service responsive?

We saw people were able to access treatment and support from health and social care professionals when necessary.

People were able to participate in a range of activities both in the home and in the local community. We saw one person was escorted to a bus stop and another to the shops on the day of our visit.

We saw there were people in the home who wished to smoke and a dedicated sheltered area had been identified for this in the garden. Staff kept the cigarettes in safe storage but provided people with them upon their request as long as this was in accordance with what had been agreed in their care plan.

Is the service well led?

There were processes and systems in place to monitor the service provided. We saw some of these processes were not fully effective in ensuring people received the quality of care and services they should expect.

Staff understood their roles and received support and training on a regular basis. Some of the training was due to be refreshed and dates had been set to ensure staff were competent to provide the care and support to the required standard.

We found that improvements had been made in the recording and administration of medicines. One person had overall responsibility for medicines and they were able to show us how medicines were dispensed and recorded in a way that did not put people at risk.

We spoke with a staff member and they were able to detail the training they had recently. They were also able to demonstrate how it had a positive impact on their work. The manager showed us details of training undertaken.

We saw that upstairs windows were secured by devices that ensured they could not be opened far enough to pose a risk to people.

We spoke with the manager, a member of staff and one person who lived at the home. We observed interactions between staff and people at the home during our visit. One person who lived there told us “The staff are good, and help me.”

We noted that in some areas staff had not received the necessary training to enable them to be fully competent to to carry out specific tasks.

It was not clear that all staff were carrying out medication administration in line with agreed policies. This was particularly the case in respect of recording the giving and disposal of medicines.

At the time of our visit, the home was undergoing refurbishment to improve the environment. This continued during our visit, mainly in upstairs areas. The completed areas were light and airy and free from any unpleasant odours. People were not disturbed by this work.

The manager told us there were currently twenty people who lived at the home. On the day of our visit, there were in addition to the manager, four permanent care staff, plus two agency staff and three ancillary staff.