The Minims (12 & 31)

The Minims (12 & 31) is a residential care home providing personal care to 10 people who have a learning disability and some who have a mental health diagnosis. The home can accommodate up to 12 people.

The home comprises of two separate bungalows within the same street, numbers 12 and 31. Each bungalow can accommodate six people. There were four people living at number 12 and six people living at number 31 at the time of this inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People told us they liked living at the home and felt safe. Relatives told us they never had concerns about people’s safety. Risks to people’s health and welfare were assessed and staff knew the measures in place to keep people safe. Staff were knowledgeable about safeguarding procedures and how to report their concerns internally and externally. Staff administered people’s medicines safely.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff were knowledgeable about people’s dietary needs and they were supported by health professionals if needed to ensure people ate and drank well.

Staff told us they had training to help them understand their roles. They felt supported by their managers.

People received joint up care from staff working at the home as well as health and social care professionals. There were regular reviews of people’s care to ensure the support they received fully met their needs.

People and relatives told us staff were kind and caring and they trusted staff. Staff involved people as much as possible, relatives where appropriate or independent advocates in people’s care to ensure the care people received was in their best interest.

People were supported to attend day centres and plan the activities they liked to do regularly like shopping, going to cinema and gardening. Regular outings were organised so that people could visit places. Complaints were recorded, and actions taken to address all the issues raised by the complainant.

Audits completed by the registered manager and the provider were effective in identifying areas in need of improvement and actions were taken to improve the quality of the service provided

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 (published 09 January 2019).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 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 positive and caring relationships with the people in their care.

Staff received the appropriate training to meet people’s needs. Staff received inductions and they were supported with their supervisions.

People were supported to eat and drink enough to maintain a balanced diet. Staff supported and involved people with choices about the food they ate.

People were supported to maintain their health and had access to health care professionals when required.

Care was provided in a way that promoted people’s dignity and respected their privacy. Staff developed positive relationships with people who lived at The Minims.

People received personalised care and support that took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Staff understood the importance of confidentiality and information held about was kept secure.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

Accidents and incidents were documented and reviewed to identify trends and patterns and to ensure people were kept safe.

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 positive and caring relationships with the people in their care.

Staff received the appropriate training to meet people’s needs. Staff received inductions and they were supported with their supervisions.

People were supported to eat and drink enough to maintain a balanced diet. Staff supported and involved people with choices about the food they ate.

People were supported to maintain their health and had access to health care professionals when required.

Care was provided in a way that promoted people’s dignity and respected their privacy. Staff developed positive relationships with people who lived at The Minims.

People received personalised care and support that took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Staff understood the importance of confidentiality and information held about was kept secure.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

Accidents and incidents were documented and reviewed to identify trends and patterns and to ensure people were kept safe.

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.

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.

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.

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.