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The Minims (12 & 31) Requires improvement

We are carrying out a review of quality at The Minims (12 & 31). We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 13 December 2018

During a routine inspection

This inspection took place on the 13 and 17 December 2018 and was unannounced. At the last inspection in March 2018 the service was rated as overall requires improvement. The provider was in breach of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not ensure proper and safe management of medicines. In addition, the provider had not ensured equipment was tested to ensure peoples safety and not all staff understood what action was required in the event of a fire to keep people safe. The provider had failed to complete their own action plan for the required improvements needed to be made at the service. Systems to monitor and identify areas of concern were not effective.

We received an improvement action plan following the last inspection, which the provider had updated so we could monitor the progress. The action plan told us how they would make the required improvements. At this inspection, we found the provider had made the required improvements. However, we found other areas that needed further improvement.

12 and 31 The Minims is a residential care home for 12 people who have a learning disability and some who have a mental health diagnosis. 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 home comprises of two separate bungalows within the same street, numbers 12 and 31. Each bungalow can accommodate six people. There were five people living at number 12 and six people living at number 31 at the time of this inspection.

People had their own personalised bedroom and en-suite facilities. There were shared communal areas such as the lounge, dining area, kitchen and laundry facilities. The registered manager’s office is located at number 31.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was not a registered manager in post. 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. The service has a new manager starting on the 24 December who will be registering with CQQ before the end of January 2019.

Staffing levels did not always ensure people needs were met at a time they wanted.

Suitable systems to monitor the cleanliness of the home were not in place.

Safe medication practices were followed by staff when administering people`s medicines. There was guidance for medication given when required (PRN).

Staff were familiar with people’s personal evacuation plans in the event of an emergency.

The provider ensured Deprivation of Liberty Safeguards (DoLS) applications were renewed when required. Staff understood the Mental Capacity Act (MCA) and the importance of promoting people’s choice.

Staff supported people to access the community and follow their interests. A key worker role had been introduced to promote personal development for people who lived at The Minims.

People were supported to have a voice and complaints were dealt with appropriately.

Audits were effective and contained action plans where areas of concern were identified.

Fire alarm tests were routinely completed as required to ensure people were safe.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced.

People felt safe, happy and well looked

Inspection carried out on 20 March 2018

During a routine inspection

The inspection took place on the 20, 21 and 26 March 2018 and was unannounced. At the last inspection in June 2017 the service was rated as overall requires improvement. The provider was in breach of two regulations 13 and 18 of the HSCA 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that staff understood their individual responsibilities to prevent, identify and report abuse while providing care and treatment. The provider had not notified CQC of all incidents that affect the health, safety and welfare of people who use the service.

We received an improvement action plan following the last inspection, which the provider had updated so we could monitor the progress. The action plan told us how they would make the required improvements. At this inspection, we found the provider had made some improvements. However, they had not met all the actions set out in their action plan. For example, the management team had not successfully implemented the key worker role or the regular monthly mattress audit checks.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found that the right support and best practice was not always been promoted.

12 and 31 The Minims is a residential care home for 12 people who have a learning disability and some who have a mental health diagnosis. The home comprises of two separate bungalows within the same street, numbers 12 and 31. Each Bungalow can accommodate six people. There were six people living at number 12 and five people living at number 31 at the time of this inspection.

People had their own personalised bedroom and en-suite facilities. There were shared communal areas such as the lounge, dining area, kitchen and laundry facilities. The registered manager’s office is located at number 31.

There was a registered manager in post. 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.

Safe medication practices were not always followed by staff when administering people`s medicines. The guidance for medication given when required (PRN) was not present for one person we looked at.

Not all staff we spoke with were familiar with people’s personal evacuation plans in the event of an emergency. When asked they did not know all actions required in the event of a fire.

Deprivation of Liberty Safeguards (DoLS) applications were not always applied for when required. Staff understood the Mental Capacity Act (MCA) and the importance of promoting people’s choice.

Staff supported people to access the community and follow their interests. However, the provider had not successfully developed the key worker role and this area needed to be improved.

Complaints that were recorded were not always documented in the correct files.

Audits did not always have action plans and some audits had not identified areas of concern we found at the inspection.

Staff had not always completed the shift duties documentation. Fire alarm tests were not always completed as required to ensure people were safe.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced.

People felt safe, happy and well looked after at the home. Staff received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Staff obtained people’s consent before providing personal care and support; they developed

Inspection carried out on 5 June 2017

During a routine inspection

The inspection took place on 6 June 2017 and was unannounced. At our last inspection on 16 June 2016, the service was found to be not meeting the required standards in the areas we looked at. They were rated requires improvement. Medicine practices were not safe. At this inspection we found that the provider had made the improvements required in respect of the medicines. However, there were other areas that required further improvement.

The Minims provides care and support for up to twelve people with a learning disability. Accommodation is provided in two self-contained bungalows at 12 & 31 The Minims.

There was a registered manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Staff had received training in how to safeguard people from abuse and report concerns, both internally and externally. However we found that staff had not consistently reported areas of concern that required reporting.

People were supported to take part in meaningful activities relevant to their needs, both at the home and in the wider community. However we found that not everyone was supported to pursue their interests.

Notifications were not always sent when required for reportable incidents. There were not adequate systems in place to identify and report concerns.

Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance. However not all staff understood their roles and responsibilities.

Trained staff helped people to take their medicines safely and at the right time. However further improvements were required.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

People and relatives were positive about the skills, experience and abilities of staff who worked at the homes.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the homes.

Complaints were recorded and responded to in line with the service policy.

Inspection carried out on 16 June 2016

During a routine inspection

The inspection took place on 16 and 20 June 2016 and was unannounced. At our last inspection on 24 April 2014, the service was found to be meeting the required standards in the areas we looked at. The Minims provide care and support for up to twelve people with a learning disability. Accommodation is provided in two self-contained bungalows at 12 & 31 The Minims. At the time of the inspection there were 12 people who used the service.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. At the time of our inspection the registered manager was not in work, there was an interim manager at the home.

Where people had been supported with medication the interim manager was unable to demonstrate that audits had been completed to help ensure safe practice.

People were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance. However we found that some refresher training was overdue and there was not always sufficient staff to meet people’s needs.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to help keep people safe.

People were supported to maintain good health and had access to health and social care professionals when necessary. People enjoyed a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their families’ access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

We found breaches 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 this report.

Inspection carried out on 24 April 2014

During a routine inspection

This inspection was carried out by an inspector. During the inspection, the inspector set out to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, relatives and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People who used this service told us they felt safe. Relatives of people who used this service also told us they felt their relatives were kept safe from all forms of potential abuse. Staff who worked at this service were able to identify the different forms which abuse can take and told us how they would respond if they suspected that abuse may be taking place.

We saw that staff interacted respectfully with people who used this service at all times. We also checked that staff had been trained in the safeguarding of vulnerable adults and found this to be the case.

We looked at records and saw that where a person's liberty needed to be deprived, the provider had taken all necessary steps to report this need and had gained the necessary authority for such practice to temporarily occur.

Is the service effective?

People who used this service told us that they were well supported, and this view was backed up by both relatives of these people and staff who supported them.

Staff had received all the necessary training to enable them to provide effective support for all of the people who used this service.

One person who used this service told us, "Staff help me a lot." Another person said, "I like living here." And, "I would like to stay here."

Is the service caring?

All interactions observed between people who used this service and staff were positive.

The registered manager was able to tell us about how some people's needs had changed and how the service worked hard to either meet these changing needs or help the person to move on to an environment which could better meet their needs.

Relatives of people who used this service told us, "I would know if my relative was not happy." They went on to say, "They are very happy there." Another relative said, "When my relative has been home to stay with me, I have no worries about taking them back to their home." They also told us, "I have never had any concerns."

Is the service responsive?

Relatives told us that they felt they were listened to by senior staff if they wanted to discuss any issues or concerns. They told us that health checks were always carried out for their relatives and that they were given feedback on the outcomes of these.

We checked that the service learned from complaints and incidents and accidents by analysing what had happened and why such events had taken place. We found that this was the case.

We saw that where a person who used this service wished to make a complaint, they were supported to do so by staff.

Is the service well-led?

We were told by a relative that the registered manager and senior staff were all, "Very good."

The staff we spoke with were very clear about their role and responsibilities to provide safe and effective support at all times.

People who used this service told us that they felt they were listened to and that they had control over what happened in their home.

Inspection carried out on 12 September 2013

During a routine inspection

During our inspection visit to The Minims we spoke to the eleven people using the service at the time. As not all of the people were able to express their views verbally we also spent time observing and listening to interactions between staff and people who used the service. We spoke with three members of staff, the manager and the service improvement manager.

People living in the home expressed satisfaction with the care and service that they received. They told us that the staff looked after them well and took them on holidays and trips out. One person told us "Staff are very good, they go for walks with me, help me with my washing and whatever I need”. Another person was looking forward to being able to do more outdoor activities which we found were in the process of being arranged.

People told us that they liked the food and staff told us that the menu was discussed and agreed at a weekly residents meeting. We saw that some people were involved in food preparation and cooking. One person told us that they liked to make their own lunch and we saw others choosing their meals for staff to prepare.

We saw that all people who used the service were relaxed in the presence of staff. Two people told us that if they had any concerns they would speak to the staff and they would listen to them and act on what they said.

Inspection carried out on 13 August 2012

During a routine inspection

During our visit to the service, on 14 August 2012, we met and spent time with seven of the people who live at The Minims. People had been doing a variety of things during the day and were returning home when we met them. The activities reflected people’s level of independence to go out on their own or with support. Two people had been out for a pub lunch and indicated they had enjoyed this. People told us about a barbeque involving friends and family that had recently taken place. As we met with people, in lounges and their rooms, we noted that people supported various football teams and had recently been to an Olympic football match. We observed that people appeared to be relaxed and interacted positively with the staff and moved freely and confidently about their home.

A regular visitor to House 31, from Mencap, told us they had been in contact with the service for five years and had not found any problems.