14 October 2014
During a routine inspection
This inspection took place on 14 October 2014 and was unannounced. During our last inspection of Minster Grange, we found that people’s care was compromised, that people were not protected from the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines and that there were insufficient numbers of staff on duty. We issued three compliance actions to the provider and told them that they must make improvements. This was a follow up visit to check that the improvements recorded in the providers action plan had been made.
During this visit we found that improvements had been made in all areas.
Life Style Care (2010) plc operate Minster Grange Care Home. The home is situated in York. There are five units currently open within the home, with plans for a sixth unit. Care can be provided for young disabled and elderly people and those with nursing and dementia care needs. There is a safe garden for people to use. A car park is available for visitors.
The home has recently appointed a new manager. They had been in post for 3 weeks when we carried out our visit. They had not yet applied to be registered with the Care Quality Commission.
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 and associated Regulations about how the service is run.
We found that people were safe. People told us that the improvements in staffing numbers meant that the quality of care had improved. The home had safeguarding vulnerable adults procedures and staff were clear of the action to take should a safeguarding matter be raised.
People had risk assessments within their care files to minimise risks whilst still enabling people to make choices. The home analysed risks for example; the number of pressure sores and accidents to look for trends or patterns.
Staffing numbers were said to be greatly improved by the majority of people we spoke with during our visit. Some people still felt that staffing numbers on a weekend were insufficient (usually due to sickness) and one relative raised concern about staffing levels at night. Senior managers are continuing to monitor this to make sure that there are sufficient staff on duty to meet people’s needs.
People were recruited safely with the relevant checks being completed. This helped to ensure that only people assessed as ‘fit’ to work with vulnerable people could do so.
Medication systems generally were much improved however, there was still some further work to be done in this area. ‘As required’ medication and the use of topical ointments such as creams need to be better recorded and emergency medication should be available on the unit where it is required.
People told us that the service was effective. People received an assessment prior to moving to the home to check it was the right place for them.
Staff received training and supervision to support them in their roles. Staff provided positive feedback about the support they received.
Mental Capacity was assessed and although there were currently no Deprivation of Liberties in place we were shown previous records where these had been applied for. Some staff had received training in this area and additional training was planned.
We observed the dining experience as we noted some concerns in this area during our last visit to the home. We received mixed views regarding people’s experiences with some people loving the food choices available and others saying the food was awful. Although work was on-going in this area, further work needs to be considered.
Generally we found that people’s health needs were well attended to. Advice from other professionals was sought where needed. The feedback received from a visiting professional was positive.
People told us the service was caring. They said that the improvements to staffing numbers meant that care delivery had improved. Staff told us they had more time with people and people looked clean and cared for. Staff responded to people in a calm and dignified manner throughout our visit.
The environment generally had been improved and was now more suitable. This was particularly evident on the dementia care units.
People told us the service was responsive to peoples needs. Since our last visit a number of positive improvements had been made. People told us that their views were listened to and we saw examples of personalised care.
People received a range of activities which included visiting ponies on the day of our visit. Some people felt that further improvements could be made in this area.
We saw that complaints were recorded with any action taken in response. People told us they would feel confident in raising any issue of concern.
People told us the service was well led. They were extremely positive about the new management team in place and said that managers were approachable.
There were a range of audits and meetings taking place to bring about continual improvements to the service.