Archived: Minstead Trust

Minstead Trust is a residential care home providing personal care to up to 10 people. The service provides support to adults with learning disabilities, autism and other multiple needs. The home is part of a large manor house in a remote location with grounds providing day services and a small holding. At the time of our inspection there were 9 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/ or who are autistic.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support: More needed to be done to ensure that people were consistently supported to be kept safe. Improvements were needed to ensure medicines and risks were managed in a way that ensured the best possible outcomes. The provider was working with people to promote consistent person-centred care. People lead confident, inclusive and empowered lives where they were in control and could focus on areas of importance to them. Staff supported people to take part in activities and pursue their interests in their local area.

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.

Right Care: People received kind and compassionate care and staff understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. Staff understood people’s different communication support needs. We saw people being supported using their preferred communication methods and staff demonstrated an awareness and understanding of people's needs. These reflected a good understanding of people’s needs with the relevant assessments in place. Support focused on people’s quality of life outcomes and met best practice.

Right Culture: Whilst the provider demonstrated a commitment to create a culture of improvement that provided good quality care to people, the success of this approach had been affected by records not always being effective and actions not always followed up and the premises was in need of refurbishment. People received good quality care, support and treatment which focused on people making choices and being able to lead confident, inclusive and empowered lives. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. People and relatives were positive about the registered manager and the service provided. The registered manager responded immediately during and after the inspection.

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 good (published 19 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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 changed from good to requires improvement 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.

Enforcement and Recommendations

We have identified one breach of regulation in relation to poor record keeping and lack of management oversight and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service:

At our last inspection in November 2016 we rated the well led domain as ‘Outstanding’. Our inspection findings, and the feedback received, at this inspection now supported a rating of ‘Good’.

People felt safe living at Minstead Trust and they were very much at the heart of the service. We received consistent positive feedback from people, their relatives and health professionals. People received excellent care, based around their individual needs that ensured care was personalised and responsive.

Staff understood the needs of people using the service and supported them in an exceptionally personalised way. Staff knew people well and we saw that care was provided respectfully and sensitively, taking into account people’s different needs. The impact this had on people was outstanding and had resulted in people living an active life with choice evident throughout.

Staff developed exceptionally positive and caring relationships with people and their families. Staff were highly motivated and demonstrated a commitment to providing the best quality care to people in an individualised and compassionate way. People’s privacy and dignity was always maintained.

Each person had a plan of social, leisure and educational activities that had been tailor made for them. Their plans considered how they wanted to live their lives as well as their emotional and health needs. People and staff had regular and comprehensive discussions to review each person's support plans to make sure they always considered their holistic needs.

People were cared for by a motivated and well-trained staff team, who always put people first. Staff had the specialist knowledge and skills required to meet people’s needs.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

The culture of the service was open, transparent and progressive. All the staff were committed to continuous improvement of the service, individual care and looking at the provider. People using the service, their relatives and the staff felt valued. The service developed and promoted community involvement within the home.

Rating at last inspection: At the last inspection the service was rated as Outstanding. (Report published 03 December 2016).

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

Follow up: We will follow up on this inspection as per our re-inspection programme, and through ongoing monitoring of information received about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service 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.

Staff provided new opportunities and experiences for people and supported them to constantly reflect on what they had achieved and look at what they would like to do in the future. For example, some people were being supported to start the process of applying for work or college placements. Other people were learning skills to be more independent.

People lived in a safe and comfortable environment. They were able to take risks and were supported to make decisions which reflected their preferences and individual needs. The staff worked in an extremely person centred way, by responding to the person's individual communication needs to make sure the care and support they were provided was right for each person. This included the way in which they responded to risks, making sure people felt safe and had the support they needed in any given situation. This meant that each person had a bespoke service which was developed with them and changed to reflect the changes taking place in their lives, confidence and abilities. This was confirmed by the relatives and professionals who we spoke with, who felt the person centred approach was a particularly positive feature of the service.

Each person had a plan of social, leisure and educational activities which were tailor made for them and considered how they wanted to live their lives as well as their emotional and health needs. The staff worked very closely with a team of healthcare consultants to make sure support was planned in an appropriate and individualised way. This meant that all the decisions about people's care and support were well thought out and included the perspectives of different professionals. They had regular and comprehensive discussions to review each person's support plans to make sure they always considered their holistic needs. They monitored how people reacted and felt about each situation they were exposed to so that care could be adjusted to ensure it met the person's need. People were involved in planning their own care and making decisions. For people who could not express how they felt verbally, the staff made sure they had opportunities to express themselves in the way they could and that this was understood and acted upon.

Staff were provided with opportunities to develop their skills and career. Individual staff abilities and interests were valued and incorporated into the way the service worked. All of the staff were able to contribute their ideas at all levels of the organisation from planning individual people's care to being part of developing new ways of working and procedures. The staff gave extremely positive feedback about working for the provider and the opportunities they felt they had been given.

The systems for monitoring and improving the service were an intrinsic part of the way the service worked. The staff continually monitored individual care, feedback from people using the service and information about them was used to reflect on and improve practice. Records were well thought out, clear and organised. The way in which records were used was seen by all the staff as an important part of quality assurance. Whilst the records were extremely detailed, time spent creating and updating these did not detract from the care provided to each person.

The culture of the service was open, transparent and progressive. All the staff were committed to continuous improvement of the service, individual care and looking at the provider as a whole. People using the service, their representatives and the staff felt valued and important representatives of the organisation. The staff felt ownership of and followed the aims and objectives of the organisation. People using the service and their representatives gave very positive feedback about their experiences. The staff regularly consulted relatives and external professionals to ask for their opinions. Relatives and professionals told us how they felt the service was outstanding.

There were effective recruitment and selection processes in place. The manager explained to us that care staff were interviewed and were subject to a Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA) check.

People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on. One relative said "They do ask us what we think and they always act on it". We looked at questionnaires that were completed by relatives. One person said "We can't fault Minstead, information is always accurate and we are involved".

People's needs were assessed and care was planned and delivered in line with their individual care plan. All three care records reflected an appropriate range of assessment of health and well being needs and personal interests. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person said "I feel safe here" People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Care staff we spoke with attended an appropriate range of training courses relevant to people's needs. Training covered Mental Capacity Act 2005, Deprivation of Liberty Safeguards, moving and handling and safe food handling. We were also told that one member of staff requested to complete a counselling course which was approved. People were given support by the provider to make a comment or complaint where they needed assistance. Staff told us that several people had independent advocates. One person said "I'd get my family to help me if I had to complain"