Menwinnion Country House

Updated 11 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and a pharmacy inspector.

Service and service type

Menwinnion Country House 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced on day one when the pharmacy inspector visited. Day two and day three were unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the registered manager, deputy manager and team leader. During the inspection we spoke with nine people who lived at the service, six staff and a visiting relative. We undertook observations of people receiving care to help us understand their experiences, especially for those people who could not talk with us.

We reviewed a range of records. This included four people’s care records and several medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies, procedures and audits were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at end of life care and activity records.

Updated 11 December 2021

Menwinnion Country House is a residential care home providing personal care for up to 40 people in one adapted building. At the time of the inspection there were 35 people being supported.

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

The service has had a history of non-compliance in regulatory requirements since 2016. We last inspected the service in December 2020. At that time, we had concerns regarding the management and oversight of the service. The well led domain was judged inadequate. The service was judged requires improvement in the management of medicines, assessing people’s capacity, staff training and managing behaviours which may challenge. The service was rated overall requires improvement.

At this inspection we found the provider had taken action to improve all these areas.

Since the inspection in December 2020 the service had a registered manager in post. The provider had reviewed how the service was managed and increased senior roles. This included creating additional roles. For example, deputy manager and leadership roles. This had enabled the management team to focus on developing the service and meeting legal requirements. The operation of the service was overseen by the nominated individual who was responsible for supervising the management of the regulated activity.

The way people’s medicines were managed had improved. Systems and oversight had been developed in order to ensure medicines were managed safely. We made a recommendation at this inspection for further information to be included in records were medicines were required as needed. This would support staff to understand why the medicines were being administered.

At the last inspection we found staff had not received training to support their knowledge and skills in managing behaviours which might challenge, understanding consent and how to safeguard people. At this inspection we found training had been reviewed and a system was now in place which showed all staff received the relevant training. This had helped to develop staff skills and knowledge to support people safely and recognise triggers which might affect people’s behaviour. Our observations on inspection confirmed this.

At the last inspection people’s capacity assessments had not been appropriately assessed under the principles of the Mental Capacity Act 2005 (MCA). At this inspection managers and staff had received training in the MCA and understood how to respond to issues around capacity and consent. At this inspection we found 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.

Previously we found care plans were not written in a way which supported staff to recognise some people’s level of need and risks. They were not person centred. At this inspection we found the registered manager had reviewed all care plans. They were person centred and included information to support staff to recognise and respond to individual needs and risks.

People were supported to eat balanced diet and drink enough to keep hydrated.

Staff had an induction when they started their jobs; and they were supported through regular training and supervision to deliver their roles effectively.

People told us staff were kind and compassionate to them. People were treated with respect and dignity. People received care and support that met their individual needs. People’s end-of-life wishes were documented in their care plans and followed. People were engaged in activities to occupy them.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

The systems in place to monitor the quality of care within the service were effective. The registered manager promoted a positive person-centred culture and fully understood their responsibilities.

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 26 May 2021) and there was a breach of regulation. We issued conditions of registration which included a requirement for the provider to complete a monthly action plan. The provider met that condition which showed action was being taken to meet the regulatory requirements.

Why we inspected

This was a planned inspection based on the previous rating.

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 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.

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

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.