Mewsbrook House

Mewsbrook House is a 'care home'. It is registered to provide care and accommodation, including nursing care, for up to 50 people and there were 46 people living at the home when we inspected. The service was providing care for a wide range of care needs including older persons, dementia, mental health, substance misuse and physical disabilities.

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

The required improvements had been made since the last inspection in respect to the environment of the service and acting on the outcomes of quality audits.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and the provider learned from any mistakes. Our own observations and the feedback we received supported this.

The environment of the service had been improved and was pleasant and enabled people to mobilise and orientate themselves around the service. Staff had received appropriate training and people received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were enough staff to care for them. Our own observations supported this, and we saw friendly relationships had developed between people and staff. People enjoyed the food and the provider acted on their feedback in relation to how the service was run.

People received medicines safely. The service was clean, hygienic and a pleasant environment to spend time in. People’s care plans were up to date and accurately reflected their needs. People were able to receive visits from their relatives and there was a programme of activities to support their well-being.

Staff worked collaboratively with outside agencies such as the local authority and healthcare professionals. People were protected from harm and abuse, as staff knew how to safeguard people and what procedures they should follow. Complaints were responded to appropriately and people’s wishes at the end of their life were respected. People were able to express their views and had their dignity, independence and privacy promoted.

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 and update

The last rating for this service was requires improvement (published 31 December 2019) 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 we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service, and to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from requires improvement to good based on the findings of 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

Throughout our inspection we saw the service was not always clean, unpleasant odours were present in some areas of the service. We saw that the service was not well maintained, there were areas in need of repair and redecoration. Failure to ensure the premises are properly maintained is a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were quality assurance systems in place and audits had identify most of the areas in need of attention. However, these audits did not have any actions or timescales to resolve the issues identified. This is an area in need of improvement.

We spent time with people during our visit and received positive feedback from people living in the service. Staff demonstrated empathy and cared for people they supported. People said they were happy with their care. People were cared for by kind staff who ensured that people received the care they needed and wanted. People told us that the staff were, “A bit of fun. We can have a bit of banter and we can make a joke”.

The management and staff created a caring environment and we observed good relationships between people and all grades of staff. Staff at all levels were approachable and keen to talk about their work. People appeared at ease with staff and staff told us they enjoyed working at the service. Staff told us they felt well supported by the registered manager and each other. The service was safe, with systems and processes which ensured that any concerns were reported to appropriate authorities without delay.

Rating at last inspection:

At our last comprehensive inspection in February 2017 (Report published on 22 March 2017) we rated the service good. We carried out a focused inspection in August 2018 (Report published on 18 December 2018) following information of concern. The focused inspection inspected the service against two of the five key questions we ask about services; is the service safe and well-led. We rated the service requires improvement.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Before the inspection we had information that the registered manager had failed to always notify the Care Quality Commission (CQC) of incidents in relation to allegations of abuse. A provider must inform the CQC of any incidents in relation to abuse or allegations of abuse. A notification is information about important events which the provider is required to tell us about by law. This was discussed with the registered manager during the inspection.

Mewsbrook House is registered to provide care and accommodation, including nursing care, for up to 50 people and there were 48 people living at the home when we inspected. The service was providing care for a wide range of care needs including older persons, dementia, mental health, substance misuse and physical disabilities.

All bedrooms were single. Communal areas consisted of several lounge and dining areas, which had all been merged to create one large communal area. There was a garden, which people used.

The home had a registered manager. 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.

Recruitment practices did not always ensure the suitability of staff. Risks to people were not always assessed when recruitment decisions were made. Risks to people were not always assessed and recorded. Where risk assessments were not available the registered manager resolved this during the inspection. People were protected against avoidable harm and abuse however risks were not always assessed and safeguarding processes were not always followed.

Infection control processes kept people safe from infection however offensive odours were present in some areas of the home on both days we visited. There were systems for monitoring the quality of care and support including auditing systems but not all issues were identified or acted on.

Staff worked closely with community health professionals and therapists to maximise people's well-being and worked well in partnership with other agencies.

Good systems were in place for reporting accidents and incidents internally and the service was responsive to people's individual needs. Medicines were managed and stored safely by staff.

People had positive and caring relationships with the staff who supported them. Some people and their relatives were provided opportunities to give their views about the care they received. People and relatives said they knew what to do if they were not satisfied with the service. The registered manager demonstrated a 'hands-on' approach and knew people well. Complaints were logged and records showed that complaints were responded to. Sufficient numbers of nursing and care staff were deployed to meet people’s needs.

The last inspection was carried out in February 2017. The overall rating given was good.

We found breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Mewsbrook House is registered to provide care and accommodation, including nursing care, for up to 50 people and there were 49 people living at the home when we inspected. The service was providing care for a wide range of care needs including older persons, dementia, mental health, substance misuse and physical disabilities.

All bedrooms were single. Five bedrooms did not have an en-suite facility, 17 had an en-suite bathroom and 28 an en-suite toilet. Communal areas consisted of several lounge and dining areas, which had all been merged to create one large communal area. There was a garden, which people used.

The home had a registered manager. 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.

At the last inspection on 26, 30 November and 14 December 2015, we identified three breaches of Regulations associated with the management of medicines, the premises and environment were not adequately maintained or decorated. Standards of hygiene were not sufficiently maintained and the care records were not securely stored when not in use. We also recommended the provider introduce a system so people and visitors could identify staff working in the home. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider has now met all the legal requirements.

At the last inspection, we identified that medicines were not safely managed. This was a continued breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely. Therefore, this regulation was now met.

At the last inspection, we observed the premises were not always clean or properly maintained. This was in breach of Regulation 15 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found noticeable improvements had been made to the home environment which had been service user led. The home was clean and tidy throughout, routinely maintained and monitored by the registered manager; therefore, this regulation was now met.

At the last inspection, we noted care records were not securely stored when not in use in order to ensure people’s personal information was kept confidential. The provider had not ensured care records were securely stored, which meant people’s confidential records cold be accessed by other people and visitors. This was in breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we observed that cupboards containing confidential information were lockable. We also observed signs on each cupboard reminding staff to keep the cupboards locked when not in use. Therefore, this regulation was now met.

At the last inspection, we found improvements were needed in regards to some of the care plans and risk assessments, which required reviewing to include people’s needs and preferences. At this inspection, we found care plans represented people's needs and preferences to enable staff to fully understand people's needs and wishes.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Staff worked closely with community health professionals and therapists to maximise people's well-being. People felt safe and had positive and caring relationships with the staff who supported them. People were protected against avoidable harm and abuse. Good systems were in place for reporting accidents and incidents and the service was responsive to people's individual needs.

The registered manager used a needs dependency tool to assess the required staffing levels to meet people’s needs. Relatives considered there were enough staff to meet people’s needs. Sufficient numbers of nursing and care staff were deployed to meet people’s needs. We saw that staff recruited had the right values, and skills to work with people who used the service.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training, which equipped them to deliver their roles effectively. Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the training, which the provider had assessed as mandatory was up to date. People and their relatives felt the staff had the skills and knowledge to support people well.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The members of the management team and nurses we spoke with had a full and up to date understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that appropriate DoLS applications had been made, and staff were acting in accordance with DoLS authorisations.

The service placed a strong emphasis on meeting people's emotional well-being through the provision of meaningful social activities and opportunities. People were offered a wide range of both group and individual activities, which met their needs and preferences. Visiting was unrestricted and people's relatives felt included in the care of their loved ones.

People were provided with a variety of meals and the menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was fully respected.

People's privacy and dignity was respected. Staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

People were involved as much as possible in planning their care. The registered manager and staff were flexible and responsive to people's individual preferences and ensured people were supported in accordance with their needs and abilities. People were encouraged to maintain their independence and to participate in activities that interested them. People who lived at the service were allocated key workers and we observed trusting friendships between people and staff members. A key worker is a named member of staff responsible for ensuring people's care needs were met

The complaints procedure was displayed and people said they knew what to do if they were not satisfied with the service. Complaints were logged and records showed the provider looked into complaints and responded to complainants.

People and their relatives were provided opportunities to give their views about the care they received from the service. Staff understood their role and responsibilities.

The service had robust systems in place for monitoring the quality of care and support. The auditing systems showed that the manager was responsive to the needs of people who lived at the service. The registered manager demonstrated a 'hands-on' approach and knew people well.

As a result of improvements made to the quality and safety of Mewsbrook House, the overall rating of the service had improved from ‘requires improvement’ to ‘good.’

At the time of our inspection 42 people lived at the home. We spoke with four relatives and four people to seek their views of the home. It was not always possible to establish some people's views due to the nature of their conditions. To help us understand the experience of people who could not talk with us we spent time observing interactions between staff and people who lived in the home. We reviewed the care records of four people. We also spoke with four staff, the registered manager and the provider.

The inspection team was made up of a single inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a Summary of what we found.

Is the service safe?

People were treated kindly and with dignity and respect by staff. Staff were clear they would report concerns to the manager and these would be acted on. There was a system in place for recording of incidents and accidents and staff could describe to us how this information was used to improve the service for people.

Care plans had been developed for people based on an assessment of needs, however these did not always reflect the person's current needs and there was not always evidence of forward planning for people to ensure their individual needs were met.

Records held for people at the time of our visit were not always up to date and did not reflect their current needs. Some records could not be found at the time of our inspection visit and therefore staff could not locate these promptly. Daily records were inconsistent in their completion and did not always reflect the action staff had taken to meet people's needs. The lack of up to date care plans and inconsistencies in recording of daily records meant people may be at risk of receiving care and support that was unsafe or inappropriate to their needs. We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to care planning and delivery and records.

CQC monitors the operation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) which applies to care homes. Management we spoke with had a good understanding of DoLS and their responsibility in this.

Some areas of the home were not clean at the time of our inspection and we observed some practices which would increase the risk of spread of infection. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control.

Is the service effective?

Before people received care they were asked for their consent. Staff supported people to make day to day decisions. Staff were observed to respect the decisions people made. Where people lacked capacity to make decisions the provider was not able to demonstrate they had applied the Mental Capacity Act 2005 in full. Capacity assessments were not undertaken for specific decisions that needed to be made. No evidence of best interests' decisions could be found. We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to consent to care and treatment.

Is the service caring?

The staff we spoke with knew people well. Our observations demonstrated staff had a good understanding of people's needs and the support they required. We saw staff were kind in their approaches when supporting people. All of the relatives we spoke with expressed their satisfaction with the service provided. All four told us they felt their relative was safe and well looked after. They told us the staff were kind, caring and knowledgeable of people's needs.

Is the service responsive?

People's health and care needs were assessed and care plans were developed to enable staff to support people in the way they not only chose but also needed. Where there were risks associated with people's care and treatment, these had been assessed and actions to reduce these risks had been identified. This meant people received care which was planned and delivered in a way that was intended to ensure people's safety and welfare. Care plans were reviewed monthly and basic information about the persons current support needs was documented, however this did not always trigger a review of the content of the planned care.

Is the service well led?

The service had a number of systems in place to monitor and assess the quality of service. All of the staff and people who used the service said they felt supported and listened to. Staff told us they were confident issues of concern would be acted upon.

We saw there were systems in place to monitor and assess the quality of the service including questionnaires, meetings with people who lived at the home and regular staff meetings. We saw learning from accidents and incidents took place and staff were able to tell us how leaning from these was shared. The manager showed us the system they would be introducing in the month following our visit to audit care plans to ensure these were accurate and up to date.

One person spoken with told us "All the staff treat me with dignity." A relative told us that "It was good on the whole" and that their family member was always well groomed. Another relative told us "I am very pleased with all they have done. The staff are very friendly and they know [family member] very well. "

A relative told us that they had received information about the care and support on offer in the home prior to admission. However another person and their relative told us that they had not received any information as the move had been an unexpected one from another home. They were however satisfied with the care in the home, saying that there had been an improvement in life in general at the home in recent weeks since there had been a change in the management.

We found that there were appropriate arrangements in place to ensure that people were safeguarded from abuse. The social work professional spoken with told us that the home worked with them to ensure safeguarding concerns were fully investigated.

We found that there were not correct measures in place for the prevention and control of infection. There was not an infection control and prevention lead.

We saw that medicines were handled safely in the home.

We saw that staff were appropriately trained and supported.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

One person spoken with told us "Staff call me by my Christian name as this is my preference and this I think is a mark of respect'

A relative told us 'The family received information about the care and support that their family member would be given before using the service and the home has fulfilled this promise'

We saw that there was a nutritious meal on offer which people told us they enjoyed.

We found that there were appropriate arrangements in place to ensure that people were safeguarded from abuse.

We found some deficiencies in the management of medication and the training programme was not up to date.