Archived: The Mendips Residential Care Home

The Mendips Care Home is registered to provide personal care and accommodation for up to seven people. The service supports people with complex mental health needs. We met the three people currently living in the home on the day of our visit.

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

At our last inspection in September 2018 we found that audits were not being used to check the quality of the service. We found that some actions had been taken to implement audits, however, these were very basic. This could put people at risk of receiving unsafe care. This was because the systems used did not show clearly if the service was being formally and regularly checked and monitored. The provider lived on the premises and they told us they had a constant and daily contact with the service and the people at the home. This in turn meant they were constantly informally reviewing and checking the services people received.We have made a recommendation around how the service could improve in this area.

People were safely supported with their medicines and these were managed safely by competent staff. To support staff there were medicines policies available.

Emergency procedures and contingency plans were in place. Staff had access to and understood the importance of personal protective equipment (PPE). An infection control policy and procedure were in place and staff had completed training in this area.

People said they were very well supported and their full range of needs had been assessed.

Care plans and risk assessments were in place to support staff so people's individual needs could be met and risks minimised.

People told us positive things about life at the home. One comment was “The staff team are all very, very good they keep the place clean and tidy, they are always keen to help, if you want to do anything. You can have a laugh with them. "

Safe recruitment procedures were in place and staff were supported in their role with appropriate training and supervision. The staff and management team worked closely with health and social care professionals.

People knew about their care plans and told us they were included in regularly reviewing and updating them with the staff.

A small staff team had built up positive relationships with people and their relatives. They had a good understand of how to meet each person's individual needs and really understood their routines and preferences.

People's privacy and dignity was respected. People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests

People's dietary needs were assessed and met. People spoke positively about the choice of meals on the menu.

People took part in variety of activities and spoke positively about these. People were encouraged to maintain contact with relatives and friends.

People were supported to have maximum choice and control of their lives and staff supported support 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 Requires Improvement (report published September 2018)

Why we inspected: This was a planned inspection based on the previous rating.

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

The inspection took place on 18 September 2018 and was unannounced and was carried out by two inspectors.

The Mendips is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 is registered for up to nine people. There were five people living at the home on the day of our visit.

There was a registered manager for the service. They were also the provider, and have been referred to as the provider throughout our report. 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 our last inspection in March 2016 we had found that staffing levels failed to ensure known risks to people from another person at the home were minimised. The staffing numbers had not been risk assessed to ensure the home was fully safe for people who could be aggressive towards each other.

At this inspection we found that actions had been taken to ensure that a safe number of staff were on duty at any time.

Formal quality checking audits were not up to date. This could put people at risk of receiving unsafe care if it was not being formally regularly checked and monitored. The provider acknowledged that quality checks were not up to date. However, they lived on the premises and they told us they had a constant and daily contact with the service and the people at the home. This in turn meant they were constantly informally reviewing and checking the services people received.

People told us they felt safe with the staff. People were very comfortable to approach the staff member and the provider thought our visit. This conveyed that they felt relaxed with them. People looked very relaxed and comfortable in the home environment. People told us they liked it being a small care home as it was like home to them.

Risks to the safety of people were identified and the staff had been on safeguarding adults training. This meant they knew how to identify the different types of abuse. Staff also understood the procedure for reporting concerns. Written risk assessments were in place that identified the areas where the safety of people could be at risk.

People received care and support that met their mental health and range of other needs. People were supported whenever possible to make their own choices and decisions in all aspects of their daily life. If people did not have full capacity to make decisions for themselves staff understood what to do to ensure that decisions made on behalf of the person were in their best interests. This showed that the home was meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. It also showed that the home was acting in ways that protected the legal rights of the people concerned.

The staff understood how to support people effectively. The staff team were caring and attentive in manner towards each person who lived at the home. People felt that staff and the provider were kind and caring toward them. The staff and the people we met told us they felt supported by the provider.

People were provided with the food and drink they enjoyed and they could make a choice. People were given discreet assistance if they needed support to eat their meals.

People were supported with their physical health needs. There were arrangements in place for people to see their GP and other healthcare professionals when they needed to do so for their health.

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

The Mendips Residential Home is registered to provide personal care and accommodation to up to nine people with mental health needs.

At this inspection we found that one person’s behaviours had changed over the last four months. This had lead to a number of potential and actual safeguarding incidents. These involved the person and other people at the home and sometimes staff. Due to the potential increased risks to people’s safety and that of staff the numbers of staff deployed should be reviewed as a matter of priority.

There was a registered manager for the service who was also one of the providers. 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 that all of the staff who assisted them were always kind and caring in manner. People interacted in a positive and warm way with the staff who provided them with personal care and other support.

People were assisted with their needs by staff who were monitored and supervised in their work. People also benefited because they were supported by staff who were trained to understand their needs.

People spoke highly about the care and support they received from the staff. Everyone we asked said that staff treated them properly and were kind to them.

Care records were informative and clearly showed what to do to effectively assist people with their personal care needs.

People were well supported to make complaints about the service that was provided if they were unhappy about any aspect of the service .

The staff knew what the provider’s values were for the service. The staff followed their values in their work. These included providing personalised care to ensure people were treated as unique individuals.

There was a system in place to ensure that checks on the quality of care and service were carried out. The concerns we found at the inspection in relation to staffing had been identified by the registered manager as part of their checks of the service .

Overall, we found that there was a more organised and planned approach in these areas. People's rights were being better protected, for example because of improved procedures for obtaining consent and for the reporting of incidents between people.

A new care plan format had been introduced; this showed a more 'person centred' way of supporting people who used the service. A staff member commented that the people's care records were now 'clearer and more structured'. We found that the records provided better information about people's strengths and needs and the support that they wanted from staff.

People who used the service said that they felt settled in the home. One person told us 'the best thing is the meals' and they said that vegetarians were well catered for. Meetings were being held when people could pass on their views about the home and their daily routines. A new system of monthly audits had been set up and this provided a means of monitoring the quality of service that people received.

The areas of non-compliance included the arrangements being made for planning people's care and for staff training. Standards in relation to consent and safeguarding were also not being met. Significantly, the provider did not have an effective system in place for monitoring their own performance on a regular basis.

One person who used the service told us that they were able to do some things independently. They said that they enjoyed visiting local cafes. We saw that other people were more dependent on staff to ensure that their health and care needs were met. We found that people's care records were not being well kept. Overall, care and support was not being planned in a person centred way which reflected the needs of the people who used the service.

We had not planned to look at records as a separate standard however this was included because of the shortcomings we found during our visit.