Archived: Minster Rest Home

Minster Rest Home provides personal care and accommodation for up to 19 older people. Some people had mental health conditions. There were 17 people living at the home when we carried out our inspection on 14 and 15 April and 18 people on 9 May 2016.

A requirement of the service’s registration is that they have 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. A registered manager, who was also one of the providers, was in post.

People we spoke with had mixed views about whether they felt safe at the home. We found risks associated with people’s care, as well as health and safety risks related to the premises, were not always identified and assessed to make sure people were protected from the risk of harm. We spoke with the local authority about concerns we had identified. A visit by the local authority and other health professionals resulted in one person being relocated to alternative accommodation.

There were insufficient numbers of staff to meet people's needs safely and effectively. Care staff were required to complete additional duties such as cleaning and cooking which prevented them from focusing on meeting people’s needs. People told us they felt some of their needs were met but said staff were always rushed and had little time to spend with them. People had limited opportunities to engage with staff and build relationships with them so they felt valued as a person.

Some pre recruitment checks were completed on new staff , but it was not always clear the provider had checked their suitability to work with people in the home. Staff training was not up-to-date and we observed staff did not always support people in a safe way.

People received their medicines but records were not sufficiently detailed to confirm these were always given as prescribed.

People were not routinely provided with a choice of meals and people told us they wanted more choices to be offered. Meals, snacks and drinks were provided at set times during the day as opposed to as and when people wanted them. Where required, people were supported to eat although this was not always a positive experience for them. People had access to healthcare support when needed.

The principles of the Mental Capacity Act were not understood or routinely followed by staff. There were people in the home who were subject to restrictions related to their care. It was not clear whether these people had capacity to make their own decisions or whether decisions about restrictions applied to their care had been agreed with them or were made in their best interests.

The provider had not ensured the rooms people occupied were safe and comfortable. We found many of the rooms had broken items of furniture and some of the taps did not work effectively. Some people had portable heaters in their rooms either due to heating problems or because they felt cold. The heaters had not been risk assessed to ensure they were safe to use.

The home was not consistently responsive to people's needs. People's choices and preferences were not regularly sought and people felt they were not listened to. People had limited stimulation and opportunities for their social needs to be met. A lack of background information about people’s interests and preferences meant there were people who did not experience person centred care.

There was a complaints procedure and a system to record complaints. Relatives told us they felt confident to raise any complaints with the registered manager if needed. However, we could not be confident that complaints received were always recorded to demonstrate the provider had taken them seriously and had addressed them.

The provider did not have sufficient systems and processes in place to assure themselves that people living at the home received a good quality service that met their needs. People were not given opportunities to provide their opinions of the service and to be regularly involved in decisions related to their care. There was a lack of audit processes to ensure improvements to the service were identified and acted upon in a timely manner, for the benefit of people who lived there.

We found a number of 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 the report.

The overall rating for this service is ‘Inadequate’ and the service will therefore be placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the time of our visit there were 12 people living in the home. We spoke with five people who lived at the home, and three members of staff. We also spoke with the registered manager and the provider. We looked at the care records of four people who lived at Minster Rest Home.

At our visit in June 2014 we found care plans were available for most of the identified needs of people. However, there were some instances where care plans were not detailed enough to ensure people were always appropriately supported. In addition, people's backgrounds, preferences and interests had not always been recorded in their care plans. This information is important so staff can deliver care that meets people's individual needs and in a way they prefer.

At this inspection we looked at four people's care records to see whether improvements had been made. We saw care plans were detailed and were tailored to each person's individual health and support needs. Records were up to date, and regular reviews had taken place. All the records we looked at had up to date mobility plans which contained detailed information on the number of staff needed to assist people, and what type of equipment people needed to transfer safely. This meant care plans were available for the identified needs of each person and supplied staff with the information required to make sure the person's needs were met.

At our last inspection we found care records contained very little detail about people's preferred daily living routines or information about their background, interests, hobbies, likes and dislikes. At this visit we reviewed information on people's care records, and looked at new admissions to the home. We saw that people were now involved in completing information about their preferences on their care files.

People received help and support from other health professionals when required, such as doctors, dentists and chiropodists.

At the time of our visit there were ten people living in the home. We spoke with three people and a visiting relative. Managerial duties at the home were split between the registered manager and the manager. The registered manager was mainly responsible for the care of people living at the home and the daily management of care staff. The manager was mainly responsible for the administrative duties at the home including premises maintenance and records management. We spent time talking with both managers and two care staff.

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

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

Is the service safe?

The home was clean and tidy with no unpleasant odours. There had been repairs and improvements made to people's bedrooms and communal areas. Improvements to the kitchen and bathrooms ensured they were easier to clean to reduce the risk of infection. One person we spoke with confirmed they were happy with the improvements in the bathroom facilities. They said, 'The bathroom is a lot cleaner. It was a bit of a mess before.'

We found equipment used within the home was maintained and regularly serviced.

We saw employment records that showed the provider had an effective system in place that made sure people received care from staff who were suitably qualified, fit for the work and of good character.

The manager had an understanding of their responsibilities under the Deprivation of Liberty Safeguards (DoLS). There was nobody living at Minster Rest Home with a DoLS in place at the time of our visit. We saw a previously granted deprivation had been reviewed regularly in accordance with the legislation and removed when it was deemed no longer in the person's best interests.

Is the service effective?

Care plans were available for most of the identified needs of each person and supplied staff with the information required to make sure the person's needs were met. However, in some instances care plans were not detailed enough to ensure people were appropriately supported.

We saw people had received the support they needed to maintain their personal appearance and hygiene. Toilets and bathrooms were close to the lounge and dining areas so people could easily access them.

Is the service caring?

A visiting relative told us, 'We come every week. My relative's weight and nutrition is maintained here. There have been no falls either, although where they were before there were some. It is homely. I'm very pleased. I wouldn't want to move them.' One person could not communicate verbally but indicated with smiles and gestures they were happy with the care they received.

People's backgrounds, preferences and interests had not been recorded in their care plans. This information is important so staff can deliver care that meets people's individual needs and in a way they prefer.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, dentists and chiropodists. We saw health professional visits were not always consistently recorded in people's care records.

We saw the service had a complaints policy which was displayed in the lobby of the home. We saw the service investigated and responded to complaints in a timely way.

Is the service well-led?

We saw the service had recently produced a range of policies and procedures which included infection control, retention of records and an incident reporting policy. These were on display, and were accessible to staff. A business continuity plan provided staff with information about how they should respond to various emergencies to reduce the impact of adverse events on the people who lived at the home.

Audits and checks by the manager ensured the home operated efficiently and safely.

We saw there was a system in place for supporting and supervising staff. One member of staff spoke positively about the support they received from the manager and said, "They support me very well in everything that I do."

At this visit we saw the service had improved its systems to monitor the quality of the service provided.

There were eleven people living at Minster Rest Home at the time of our visit, some of whom were suffering with dementia. Three inspectors spent periods of time in the communal areas of the home as well as people's bedrooms. We spoke to everyone who lived at the home and observed the care people received at different times of the day.

We spoke to four members of staff including the registered manager and an additional manager of the home. We refer to the additional manager in this report as the manager, and the registered manager as the registered manager.

We found significant action had been taken to improve the service. However, the service had still not made all the necessary improvements to meet the Regulations in full. We have asked the service to continue to make improvements.

When we arrived at 7.40am on 10 March 2014 we observed five people were up and sitting in the lounge. Other people were in their bedrooms and some people were asleep in bed. People told us they could decide when they wanted to get up and when to have breakfast. One person we spoke with remained in their room throughout the day watching television. They told us this was their preference. This meant people were given choices about where they wanted to spend their time.

Care records were up to date. We reviewed how pressure ulcer care for one person was managed. Care records showed when the person needed to be re-and information on how fluid and food for the person should be managed. We saw staff followed the guidance on the care file and recording information appropriately.

We saw the service had an up to date infection control policy which had been updated since our visit in August 2013.

We found the service was able to demonstrate people were receiving their medicines as prescribed. Appropriate arrangements for the recording of medicines meant that people's health and welfare was protected against the risk associated with the handling and administration of medicines.

We found people who used the service were not protected against the risks of unsafe or unsuitable premises. During our inspection we saw two people on the ground floor had chosen to prop open their bedroom doors. These were identified as fire doors. Propping open fire doors could pose a risk to people at Minster Rest Home.

We saw the chairlift was in full working order. A maintenance contract was in place to regularly maintain the chairlift. We saw maintenance records for other equipment such as wheelchairs were also available for review.

Some care staff still needed to complete training. For example, training in infection control and safeguarding. This meant we could not be certain that all staff were up to date with the training needed for their roles.

Prompt action was not always being taken in respect of identified risk. For example a work place risk assessment for a member of staff had not been completed at the time of our inspection.

We saw the service had improved its systems to monitor the quality of the service since our inspection in August 2013. We were concerned that these improvements were still on-going and had been made in response to our earlier concerns, rather than the registered providers proactively identifying and putting right deficits in their service.

Overall we had serious concerns about the operation of the service. Specifically we found people's privacy, dignity and independence were not respected by staff members. We also found there were not enough skilled and experienced staff available at all times to support people.

A lack of appropriate records and guidance meant that it was not clear if people were receiving the correct assessed care, or whether staff were carrying out this care safely and consistently.

We found the service still did not have robust system in place for the management of medicines. A lack of appropriate record keeping meant the service was unable to fully demonstrate they were managing medications safely.

We looked to see whether adequate infection control processes were in place. We found people were not protected from the risk of infection because the provider was not following appropriate guidance.

We have made the registered provider and registered manager, and other agencies with care and welfare responsibilities for people living at Minster Rest Home aware of the serious nature of our concerns.

We talked with two members of staff. We also spent time with two managers who were also the providers of the service. One of the managers was the registered manager for the home.

We checked the premises were safe and that the surroundings were accessible and appropriate for people. We found people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

We looked at equipment available to people living at Minster Rest Home. People were not protected against the risks of using unsafe or unsuitable equipment.

We found that medicines were not being safely managed. The provider did not have safe arrangements in place to manage controlled drugs.

We looked at records and how they were being maintained. The provider was not maintaining an accurate record in respect of each person who used the service. Information was not being kept securely, retained for an appropriate period of time or securely destroyed.

There were not enough qualified, skilled and experienced staff to meet people's needs at all times. One person told us "The staff...they have to work very hard and it's not fair."

Our inspection on 7 March 2013 was to check the safety of people who used the service because concerns had been shared with us.

We spoke with six out of the fifteen people who used the service. We also spoke with six people who were advocates or relatives of people who used the service.

People told us they were satisfied with the care they or their relatives received. One person told us "Everything is so comfortable and all the staff are great'. Another person said "My relative is well looked after."

We looked at some records relating to the running of the home, such as staff personnel files. We found arrangements were in place to keep people safe and that appropriate pre-employment checks were now being undertaken.

We did not check record keeping within the home on this visit. This was because the provider and managers were still working to make the necessary improvements. We will check record keeping on our next inspection.