Medihands Healthcare

Medihands Healthcare provides accommodation and personal care for up to 17 adults with mental health needs. At the time of the inspection there were 17 people using the service, only 2 people who used the service received help with personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

people using the service were happy and told us they felt safe living there.

The provider had acted upon the breaches we found at the last inspection in relation to managing risk, premises and equipment, staffing and good governance.

The service employed enough staff to support people and there were robust recruitment checks in place. Medicines were administered safely by staff who had received the appropriate training to do so. Staff followed infection control guidance and the home environment was clean.

Risks to people, including those in relation to smoking and emergency evacuation plans had been updated recently.

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.

Staff received regular training and supervision which allowed them to support people effectively.

The home had undergone extensive refurbishment since the last inspection, these included new fire compliant doors, a new lounge with improved seating and lighting and accessible flooring and bathroom facilities.

People received appropriate support in relation to their diet and nutrition, including religious needs. Their healthcare needs continued to be met by the provider.

Feedback from people was that the service was well-led. There was warm atmosphere in the home and we noted some pleasant interaction between people and staff. The provider undertook a number of checks which helped to assure themselves that the quality of service was good.

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 03 November 2021) and there were breaches of regulation in relation to safe care and treatment, premises and equipment, staffing and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made in relation to the breaches and the provider was no longer in breach of these regulations.

Why we inspected

This inspection was carried out to look at improvements against the breaches found at the previous inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 to good based on the findings of this inspection.

Follow up

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

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

Medihands Healthcare provides accommodation and personal care for up to 17 adults with mental health needs. At the time of the inspection there were 16 people using the service.

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

People were positive and happy with care they received and said they felt safe living at the service. We found that their care needs were met by the provider through good care planning and support.

Despite the positive feedback, we found some areas of concern. We found the décor of the home needed updating and there were some areas within the home that could compromise the safety of people. Some of the risks in relation to fire safety for individual people had not been fully completed and their evacuation plans had not been reviewed in over a year.

Although there were governance procedures in place, these did not always identify the areas of concern we found at the inspection.

The provider assessed risk in relations to people care needs, including their mental health. There were appropriate recruitment checks in place and there were enough staff employed to keep people safe. People were supported to take their medicines and the provider had effective infection control procedures in place, including those in relation to COVID-19.

Staff received an induction to the service and completed mandatory training, however staff supervision had not been completed on a regular basis.

People were supported by staff in relation to their healthcare and their dietary and nutrition needs.

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.

People told us they were treated with respect and dignity. Staff demonstrated a caring attitude towards people.

Care plans were reviewed on a regular basis and people were supported to access the community to avoid social isolation. People told us they knew who to speak with if they were unhappy.

Some aspects of the service were well managed. The registered manager was approachable and worked with local partners to ensure peoples received the appropriate support.

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 Good (published 3 May 2018).

Why we inspected

The inspection was part of a thematic review looking at a sample of services rated Good.

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 have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, the premises and good governance at this inspection. We have also made two recommendations to the provider to carry out competency checks to assure themselves that staff have the appropriate skills to carry out their duties and to gather feedback from relatives and healthcare professional son a more formal basis. Please see the action we have told the provider to take at the end of this report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home was based in two adjoining houses, linked by internal corridors. Bedrooms are all single occupancy with shared bathrooms on each floor. There are two main sitting rooms and one smaller room. Dining areas are in the sitting rooms and the conservatory. There was a kitchen and a training kitchen, where people could practice home skills.

At our last inspection in February 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Support plans continued to show staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person's daily life. Where risks were identified, management plans were in place. Records showed that incidents or accidents were thoroughly investigated and actions put in place to help avoid further occurrences.

We observed that there were sufficient numbers of qualified staff to support people and to meet their needs. The provider's staff recruitment process continued to help ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff continued to have the skills, experiences and a good understanding of how to meet people's needs. The provider had developed new ways for staff to learn and implement their training in practical ways.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Detailed records of the support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff, in a relaxed and friendly atmosphere. Staff respected people’s privacy and dignity. People's needs were assessed and information from these assessments had been used to plan the support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people's concerns and complaints. The home continued to be well managed by the provider, registered and deputy managers. The provider had developed new ways to help staff understand the homes policies and procedures.

The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.

Further information is in the detailed findings below

Medihands Healthcare provides accommodation and personal care for up to 17 adults with mental health needs. The care home is owned and managed by a private individual who has two other care homes in the local area. There were 17 people living at the home on the day we visited.

The home had a registered manager at the time of the inspection. The registered manager was also the provider/owner of Medihands Healthcare. We have referred to them in this report as the provider. 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.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people could speak to the provider or deputy at any time.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place. Records showed that incidents or accidents were thoroughly investigated and actions put in place to help avoid further occurrences. We saw that regular checks of maintenance and service records were conducted.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people’s rooms.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People told us they felt happy to speak up when necessary. From our discussions with the provider and deputy, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe and they received individualised care. Assessments carried out by the staff ensured that people's needs were identified and met. Risks were assessed and reviewed regularly to ensure people's individual needs were being met safely. People were involved in making decisions about their care and how they wanted to be cared for. The premises were maintained and clean. Staff had undertaken training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and understood how this could impact on the people they cared for. People were supported to take their medicines in a safe way.

Is the service effective?

People received effective care from staff who were trained and supported by the manager. People told us that staff were "nice and sometimes strict". People we spoke with told us that they were provided with clear information which helped them understand the care and treatment choices available to them. People were involved in assessments of their health and care needs and in writing their plan of care.

Is the service caring?

The service was good and caring. This was confirmed by all the people we spoke with. Staff respected peoples' privacy, dignity and their right to be involved in decisions and make choices about their care and treatment. Care plans we viewed detailed people's individual preferences, so that staff knew people's individual wishes. People told us that staff 'want the best for me', 'it's ok here', 'I can go out when I want to' and 'they understand me'.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. We saw that visiting professionals gave people time to express themselves. The provider organised some activities in the evening and weekends and people commented that these were good. The provider responded to appropriately to peoples complaints.

Is the service well-led?

Medihands Healthcare was privately owned and the provider had two other care home in the local area. The owners were very hands on and we saw that they knew the people who used the service well. People using the service and staff we spoke with said the leadership of the service was excellent and it was a good place to work. Staff felt well supported to raise any concerns and said they were always acted on.

People said "I am happy living here", I'm settled here", "I looked around and chose to come here" and "I have all I need in my room". Comments about the food included "the food is good", "if I don't like what is provided, they will do me something different", "I like the food" and "sometimes I cook for myself". People told us they did things they wanted during the day, saying "I go to the day centre", "I go shopping", "I play cards", "I don't do much", "I see my family" and "I see my friends". People told us that they felt safe and said they would speak with staff if they had any worries or concerns.

Staff told us they had the required checks before they started work and said their induction training gave them all the information they needed. Staff said that they were happy working at Medihands and had regular meetings, supervision and support.