Thomas Edward Mitton House

About the service

Station Road provides personal care and support to people with a learning disability or autism living in supported living accommodation. At the time of our inspection the service was supporting seven people.

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

The manager had recently commenced at the location. Communication between the manager and staff was good, but communication with the inspector was not so. We had to repeatedly ask for information to corroborate our inspection findings.

Systems to monitor the quality of the service were in place but not wholly effective with the running of the service.

Most risks were assessed and updated regularly. Personal evacuation plans in people’s support plans were not fully inclusive of people’s needs. People were supported to have their medicines in the right way and at the right time.

People were supported to be safe and protected from discrimination. Safety was a high priority for managers and staff, systems and processes to identify risk or potential abuse were robust. People’s freedom was respected, and they were supported to be as independent as they could be.

There were enough staff with the right skills to meet people’s needs and support them to stay safe. People liked the staff and had confidence in them to develop as individuals within the community.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support: The model of care and how that is based in people’s own flat which maximises people’s choice, control and independence over their lives.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture: The ethos, values, attitudes and behaviours of the provider is clearly stated in the vision and values documents and the Statement of Purpose. They explain to people the level of service they can expect and ensure care staff promote people using services to lead confident, inclusive and empowered lives.

People were supported in a person-centred way. The overall culture of the service was empowering and inclusive. Staff promoted people’s human rights and protected people’s privacy and dignity. People and where required people’s relatives were consulted and included in decisions about their care and support and about the development of the service.

Staff knew how to communicate with people effectively and understood people’s needs well. People led independent lives and were empowered take part in the running and development of the service.

There was a clear organisational structure and staff understood their responsibilities. People, staff and relatives told us the senior managers were supportive, approachable and accessible.

Rating at last inspection

This is the first rating inspection for this service.

Why we inspected

The inspection was prompted in part due to concerns received about the management of infection control at Thomas Edward Mitton House. A decision was made for us to inspect and examine those risks and complete the first rating inspection for Station Road as well.

Enforcement

We have identified a breach in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

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.

About the service

Thomas Edward Mitton House is a rehabilitation service for up to 16 people who have an acquired brain injury. At the time of inspection, the service was providing accommodation and personal care to 11 people at the service. The home is a purpose-built rehabilitation facility with 16 en-suite rooms all on the ground floor.

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

Risks were identified and mitigated through comprehensive risk assessments. The diverse staff team were experienced with a varying skill mix benefiting the individual rehabilitation needs of people. Medicines were stored and administered safely. Infection control procedures were in place and all staff were aware of these. When incidents occurred, the staff learned lessons through investigation procedures and made amendments where necessary.

The staff team were trained and skilled in relation to the needs of the people living there. People were asked for their consent when being supported by staff. 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. People are involved in the development of the menu, meals were nutritious as well as varied.

People and their relatives were included to express their views and be involved in making decisions about their care. The registered manager and the staff team were caring, ensuring they put people at the centre of their care. Staff respected people’s dignity and privacy.

Care was personalised with a focus on the individual needs and goals of the people living at Thomas Edward Mitton House. While no-one was receiving end of life care there were end of life care plans in place. The complaints and compliments procedure was displayed and discussed with people, all complaints had been responded to and actioned appropriately.

There were quality assurance systems and processes in place to ensure the service was meeting its designated purpose. The registered manager led from within the team, setting out the person-centred nature of the service. The staff worked effectively with healthcare professionals from the internal staff group and greater health community in meeting the needs of people living in the service.

Rating at last inspection

The last rating for this service was good (published 18 May 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management infection control at Thomas Edward Mitton House. A decision was made for us to inspect and examine those risks.

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 found the following examples of good practice.

¿ When people were admitted to the service, which was usually from hospital, they isolated in their rooms for the length of time recommended by government guidance. If anyone found this difficult, for example due to heightened anxiety or increased risk of falls, additional one to one support was provided so they could safely manage the period of self-isolation.

¿ Admissions processes had changed since the onset of the pandemic to reduce the risk of infection. People were admitted on the same day as they received a negative COVID-19 test result, including over the weekend. Government guidance was followed to ensure people’s safety.

¿ There was a regular programme of COVID-19 testing in place for staff and people using the service. This meant swift action could be taken if anyone received a positive test result.

¿ There were numerous personal protective equipment (PPE) stations in the corridors near people’s bedrooms. This meant staff had easy access to plentiful supplies of masks, gloves, aprons and hand sanitiser to use when they were in close contact with people. There were posters and information about COVID-19 on display throughout the service.

¿ Safe arrangements were in place for visitors to the service including health professionals and relatives. This included a booking system, temperature check upon arrival and the provision of PPE including masks and hand sanitiser. The service were going to consider implementing a visitor agreement or risk assessment in addition to the processes they had in place.

¿ Staff movement between different units had stopped during the pandemic. Staff in Thomas Edward Mitton House did not work in other locations within the organisation or elsewhere. Consistent agency staff were used and they participated in the testing programme. These measures reduced the risk of staff spreading infection.

¿ Infection prevention and control audits took place monthly. These were rotated between senior members of staff so the same person did not do the same audit every time. This reduced the risk of things getting overlooked and made the process more effective.

¿ The management team were supported by a COVID-19 helpline set up by the company. They used this to seek guidance or advice on any queries associated with the virus.

Further information is in the detailed findings below.

At our last inspection, on 18 February 2016 the service was rated Good. At this inspection, we found the service remained Good in Safe, Effective, Caring and Well-Led. The service had progressed to Outstanding in Responsive, giving an overall rating of Good.

Thomas Edward Mitton House is a care home. 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.

Thomas Edward Mitton House provides a service for people with an acquired brain injury, neurological conditions and strokes in order for them to gain their independence and return to live a life in the community. They may also have other associated complex cognitive impairments. There were 12 people living at the service.

The service had 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.

People’s needs were comprehensively assessed and intervention and treatment plans gave clear guidance on how people were to be supported. The whole focus of people’s care was individual to each person and focused on promoting their independence and meeting their rehabilitation needs. A highly skilled, multi-disciplinary staff group, who whose ethos centred around the person or each individual, provided the support for this. Staff used innovative ways to support people to move forward, adapting these when their needs changed and working to overcome any barriers. Staff and the management team were exceptional at empowering people to have as much control over their lives as possible and to achieve their maximum potential.

Staff were dedicated and passionate about working at the service and there was an embedded culture and ethos within the staff team that was open, encouraging and empowering. Staff were openly proud to work for the service and wanted it to be the very best it could be. Staff and the management team were very committed to their work and faced up to any challenges and used these to improve the support for people using the service.

People continued to receive safe care. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. Potential risks to people had been identified, and plans implemented to enable people to take positive risks and to live as safely and independently as possible. Effective recruitment processes were in place and followed by the service and there were enough staff to meet people’s needs. People received their medicines safely and as prescribed.

Staff were trained in infection control, and had the appropriate personal protective equipment to perform their roles safely. The service was clean and tidy, and regular cleaning took place to ensure the prevention of the spread of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. Staff received a robust induction at the start of their employment and went on to receive regular training. This was based upon best practice in acquired brain injury, which provided them with the knowledge and skills to meet people’s needs in a holistic and person centred manner.

People received enough to eat and drink and staff gave support when required. People were supported by staff to use and access a wide variety of other services and health professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service. Staff worked closely with other professionals within the multi-disciplinary team to ensure people’s health and well-being needs were fully met and to ensure that where possible, any rehabilitation goals were met.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care. People's consent was gained before any care was provided. People were 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 supported this practice.

People were fully involved in the planning of their care and felt included in discussions, being able to have their say at each step of the way. Staff listened and respected people’s views about the way they wanted their care, treatment and rehabilitation to be delivered. Staff were passionate about their work and driven by a desire to provide high quality care. Staff were flexible and adaptable, ensuring that people participated in their own care and achieved their full potential, helping them to lead a meaningful life.

Within the staff team, there was a strong understanding of people’s interests and preferences and the team worked to provide care that was tailored to people’s individual rehabilitation. There was strong leadership that put people first and set high expectations for staff. There was a quality monitoring system in place to enable checks of the service provided to people and to ensure people were able to express their views so improvements could be made. There was a high level of satisfaction with the service.

Thomas Mitton House provides care and support for up to 16 people who have acquired a brain injury. The service provides specialist rehabilitation based upon a psychology model in order for people to gain their independence; and return to live a normal life in the community. There were 12 people living at the service when we visited.

The service has a registered manager. On the day of the inspection the registered manager was on annual leave. 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.

People felt safe living at the service. Staff were aware of the processes in place to report incidents of abuse. They had also been provided with training to recognise the signs of potential abuse and to keep people safe.

There were processes in place to manage identifiable risks and to promote people’s independence without restricting their freedom unnecessarily.

The recruitment process was robust to ensure that staff were suitable and fit to work with people at the service.

There were systems in place to ensure people’s medicines were managed safely and given at the prescribed times.

Staff were provided with induction and essential training to keep their skills up to date and to support them in their roles.

People’s consent to care and support was sought before any care was provided. This was in line with the requirements of the Mental Capacity Act (MCA) 2005.

People were supported with their food and drink and to maintain a balanced and healthy diet.

People had access to specialist health care facilities on site. This included support from the clinical psychologist, physiotherapists, occupational and speech and language therapists.

People had developed good relationships with the staff team who treated them with kindness and compassion.

There were systems in place to ensure that people’s views were listened to and acted on.

Staff supported people to promote their independence and to uphold their privacy and dignity.

Before people came to live at the service their needs had been assessed to ensure the care provided would be personalised and responsive to their individual needs.

The service had a complaints procedure which was accessible to people and their relatives to enable them to raise a concern if they needed to.

There was a positive, open, inclusive and transparent culture at the service.

Arrangements were in place for the service to maintain links with the local community. The staff team arranged an open day to educate members of the public on how the brain worked and what can be done to protect it from injury.

There was a quality assurance system in place to monitor the care provided and to drive continuous improvements.

We also spoke with family members who told us that their relative “is defiantly looked after very well, the staff are really good, very approachable” another person’s relative told us “In general it is brilliant”.

We found that people were well cared for and we saw staff interact with people in a kind and compassionate way.

We found that the recruitment of staff was thorough and that all necessary checks had been completed before employment commenced.

We saw that audits had been regularly completed to monitor the quality of the service and that action had been taken when there were opportunities to improve aspects of the service.

We found that the service was well managed and that people received safe care.

We spoke with six people and they all said that the food at Thomas Edward Mitton House was very good, we saw that it was freshly cooked and that there was a good range of healthy options. We spoke with staff who were knowledgeable of the varied needs of all the people who used the service and how they could meet those needs.