Archived: Minster Grange Care Home

Minster Grange Care Home is a residential and nursing home which provides accommodation for up to 83 people. The service supports disabled adults and older people, including people who have nursing needs or may be living with dementia.

The service is located in York, north of the city centre. Accommodation is provided across three floors each containing two units. On the ground floor, Ash provides nursing care and Aspen provides nursing care for younger adults. On the first floor, Beech and Briar provide 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.

All the bedrooms are en-suite and the service also has communal lounges, dining rooms and bathrooms on each floor. There is a safe garden and outside balconies on the upper floors for people to use. A car park is available for visitors.

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. The registered manager will be referred to as ‘manager’ throughout the report.

At the last inspection in November 2016 the provider was rated as required improvement. This was because they were in breach of five Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulation 10 Dignity and respect, Regulation 12 Safe care and treatment, Regulation 15 Premises and equipment, Regulation 18 Staffing and Regulation 17 Good governance.

We asked the provider to submit an action plan regarding the breaches identified and during this inspection the actions were met. No further breaches were identified during this inspection.

Systems and processes were in place that helped keep people safe from harm and abuse. Staff had completed safeguarding training and knew the signs of abuse to look out for and how to raise any concerns.

The provider ensured there were sufficient skilled and qualified staff to meet people's individual needs and preferences.

People received their care and support from regular staff that ensured continuity and consistency.

The provider had a robust recruitment process. Checks were completed that helped the provider to make safer recruiting decisions and minimise the risk of unsuitable people working with vulnerable adults.

Where people had been assessed as requiring assistance with medicines support, these were administered safely in line with their prescription. Systems and processes were in place to record the administration of medicines. Audits were in place to maintain standards and to identify any errors or omissions where actions would be taken.

The provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

There were enough staff to meet people's needs. People received support from staff who showed kindness and compassion. People’s dignity and privacy was protected. Staff understood people's individual needs in relation to their care. Support plans were centred on the person and reflected individual's preferences.

People received care and support from staff that had the skills and knowledge to understand their role. Staff received regular documented supervision to ensure they were supported in their role and development. The provider completed competency checks and were implementing further checks to ensure staff remained competent to carry out their roles.

People were supported to pursue interests and activities of their choosing. They were supported by a dedicated team of activities co-ordinators and staff fully supported people with the programmes on offer.

We checked and found the service was working within the principles of the Mental Capacity Act 2005. Staff confirmed people were assumed to have capacity unless assessed as otherwise and were supported to make decisions. The manager and staff had an understanding of Deprivation of Liberty Safeguards. They had made appropriate referrals to the relevant authorities to ensure people's rights were protected.

People were supported to eat and drink healthily. Any specific dietary needs were recorded in their care plan and staff confirmed they requested support from other health professionals where it was required.

The provider had ways of involving people and their relatives and obtaining their suggestions for how the service could be improved. People who used the service had been involved in planning and reviewing the care provided.

There was an effective complaints procedure for people to raise their concerns.

There were systems of audit in place to check, monitor and improve the quality of the service. Associated outcomes and actions were recorded with timely outcomes and these were reviewed for their effectiveness. The provider worked effectively with external agencies and health and social care professionals to provide consistent care.

The provider, manager and staff were committed and enthusiastic about providing a person centred service for people.

Everybody spoke positively about the way the service was managed. Staff understood their levels of responsibility and knew when to escalate any concerns. The manager had a clear understanding of their role and responsibilities and requirements in regards to their registration with CQC.

The service is located in York north of the city centre. Accommodation is provided across three floors each containing two units. On the ground floor, Ash provides nursing care and Aspen provides nursing care for younger adults. On the first floor, Beech and Briar provide 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. All the bedrooms are en-suite and the service also has communal lounges, dining rooms and bathrooms on each floor. There is a safe garden for people to use and a car park is available for visitors.

We inspected the service on 2, 10 and 16 November 2016. The inspection was unannounced. This meant the registered provider and staff did not know we would be visiting.

This inspection was in response to concerns we had about the care and support provided at Minster Grange Care Home. Information shared with the CQC raised concerns about moving and handling practices, infection prevention and control issues, staff training, the management of risk and the appropriateness of staff’s response to accidents and incidents. This inspection examined the wider risks to people who used the service associated with these concerns.

At the last inspection, in April 2016, the service was rated ‘Good’. However, we found a breach of the legal requirements in relation to the governance of the service. During this inspection, we found a continued breach of regulation relating to the governance of the service. We found that the registered provider did not have robust quality assurance systems to identify and address areas of practice where the quality and safety of the care and support provided had been compromised. Issues and concerns identified during the course of our inspection demonstrated ineffective quality assurance systems. Whilst the registered provider was responsive to our feedback and implemented action plans to address areas of concern, this demonstrated reactive rather than proactive management.

Although we saw examples of kind and caring interactions between staff and people who used the service, we also observed inconsistencies, where the care and support provided was not effective or dignified. We identified gaps in staff’s training, concerns relating to the induction and supervision process and found that robust competency assessments were not consistently completed to monitor and support staff’s continual professional development.

We found that the support provided to people who used the service did not consistently maintain their privacy and dignity. Accident and incident reports did not always contain sufficient information about how staff had responded following a fall, how the person was supported to get up, or how staff had followed-up any injuries or concerns. This meant we could not be certain that staff had taken appropriate action which kept people who used the service safe.

During the inspection, we observed areas of the service which were unclean and showed evidence of ingrained dirt. The systems in place to monitor infection prevention and control practices had not been effective in identifying and addressing our concerns.

We concluded that there were breaches of regulation in relation to dignity and respect, staffing, safe care and treatment, premises and equipment and the registered provider’s governance of the service. You can see what action we told the registered provider to take at the back of the report.

People who used the service told us they felt safe with the care and support provided. Staff we spoke with demonstrated that they understood how to respond to safeguarding concerns. We identified minor recording issues on medication administration records and have made a recommendation about the management of medicines.

We observed that staff were not always effectively deployed across the service, which impacted on the timeliness of the care and support provided. We have made a recommendation about monitoring staff deployment in the body of our report.

Staff asked for people’s consent to provide care and support. Care files evidenced that consent to care was appropriately sought in line with legislation and guidance on best practice. Appropriate authorisations were in place where people were deprived of their liberty.

We received mixed feedback about the quality of the food provided, but observed that there were systems in place to ensure people ate and drank enough. People were supported to access healthcare services where needed.

People who used the service told us staff were generally kind and caring. We observed that people were supported to make decisions and have choice and control over their care and support.

Care files evidenced that people’s needs were assessed and individualised plans put in place to guide staff on how to meet those needs.

The registered provider employed activities coordinators and we observed that a range of activities were on offer for people who used the service. However, we received mixed feedback from people about the activities on offer at Minster Grange Care Home and observed that there was limited stimulation for people who were nursed in bed.

The registered provider had a policy and procedure in place outlining how they managed and responded to complaints. However, this information was not displayed in an accessible way for people who used the service to access if needed.

The registered provider is required to have a registered manager in post. At the time of our inspection, there was a manager who had been the service’s registered manager since May 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Life Style Care plc operates Minster Grange Care Home and this was the first inspection since the provider registered in May 2015. The home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to a maximum of 83 people. There were 72 people living at the home at the time of this inspection.

The home is situated in York and there are six units currently open within the home. Care can be provided for young disabled adults and older people and those with nursing and dementia care needs. The ground floor has two units, Ash and Aspen, and provides nursing care and care for young people. The middle floor has two units, Beech and Briar, and provides care for people living with a dementia related condition. The top floor has two units, Copper and Chestnut, and is for people living with dementia and people requiring residential care. There is a safe garden for people to use and a car park is available for visitors.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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.

We identified some concerns about the way that peoples consent to care and treatment was obtained and recorded. It was not always clearly recorded how the registered provider ensured that individuals had been consulted with about their care needs, and that people had agreed and consented to the care and support being provided for them. We found the registered provider had audits in place to check that the systems at the home were being followed. However, we found these had failed to detect omissions in recording and there was a lack of documentation in relation to obtaining peoples consent in their care plans. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed. We found staff had a basic awareness around the principles of the Mental Capacity Act (MCA) (2005).

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff deployed to meet people’s needs. Staff had been employed following safe recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately at the home.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses deemed by the registered provider as both essential and service specific. Staff told us they completed essential training such as fire safety, basic food hygiene, first aid, infection control, health and safety, safeguarding and moving and handling. Records showed staff participated in additional training including topics such as Deprivation of Liberty Safeguards, Mental Capacity Act 2005 and equality and diversity.

People's nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. However some aspects of the dinging experience could be improved and the registered manager was taking action to address this.

People spoken with said staff were caring and they were happy with the care they received. They had access to a wide range of activities provided in the home.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. People who lived at the home received additional care and treatment from health professionals based in the community.

We saw people’s complaints had been responded to appropriately using the registered provider’s complaints policy and there were systems in place to seek feedback from people and their relatives about the service provided. We received mixed responses about how effectively the registered provider responded to people’s concerns. We discussed these comments with the registered manager at the end of the inspection who agreed that further work was needed to respond to concerns and provide more thorough feedback to people.

You can see what action we told the provider to take at the back of the full version of the report.