Archived: Menna House

About the service

Menna House is a residential care home providing personal care to five people at the time of the inspection. The service can support up to five people.

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

This service was not able to demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture.

Right Support

¿ People had identified goals in relation to things they wanted to do and skills they wanted to develop. There was limited evidence to monitor what steps people had taken to achieve these goals and how staff could support them further. This meant opportunities for developing individuals’ skills could be lost.

¿ Parts of the service were poorly maintained and some furniture, fixtures and fittings and soft furnishings were of a poor quality. This had been identified and the registered manager had ordered replacement bedding and towels for people. However, the condition of some of these items showed they had needed replacing for some time and were still in use during the inspection.

¿ People’s bathrooms were not designed to provide a pleasant setting for people when receiving personal care. Some were cramped and all lacked decoration or good condition storage.

¿ Risks related to the premises were not always identified or acted upon.

¿ People were able to personalise their bedrooms. Two people had their own living rooms, so they were able to spend time alone when they wanted to.

¿ Staff supported people to pursue their interests. One room had been developed as a sensory room and was equipped to meet each individuals’ needs.

Right Care

¿ Parts of the environment were not set up in a way which consistently protected people’s privacy and dignity. Following the inspection, the registered manager took steps to make some improvements in this aspect.

¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

¿ The service had enough appropriately skilled staff to provide people with one to one support and keep them safe.

¿ People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

¿ Oversight of the service had failed to recognise where improvements could be made. There was a culture of low expectations for people in relation to their environment and access to good quality household items.

¿ Where it had been identified that improvements were needed, these had not been completed in a timely manner.

¿ Although the registered manager had been made aware of current best practice as described in Right support right care right culture and closed cultures guidance this had not impacted on people’s experiences.

¿ People led busy lives and staff were motivated to support people to get out and take part in things they enjoyed.

¿ People and those important to them, including advocates, were involved in planning their care.

¿ There was a core staff team who had worked at the service for a long time. This meant people got consistent care from staff who knew them well.

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 good (published 9 June 2018)

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This comprehensive inspection took place on 29 May and 1 June 2018. The first day of the inspection was an unannounced visit. On the second day of the inspection we arranged to visit Spectrum's head office to look at staff recruitment records. The last inspection took place in May 2017 when we identified a breach of the regulations. This was because daily records documenting how people had spent their time were not consistently completed. Audits and checks of records had not highlighted these shortcomings. The service was rated Requires Improvement at that time.

At this inspection we found daily records were completed using Spectrum’s recently introduced electronic recording system. This prompted staff to complete information about how people had spent their time and their health and emotional well-being.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

The service requires a registered manager and there was one in post. 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 were comfortable and at ease with staff and within their environment. We observed people were able to choose where they spent their time moving between their own rooms and shared areas of the premises. Relatives told us they were confident their family members were safe and well supported by staff who knew them well and understood their needs.

The premises had been arranged to meet people’s needs. Some people had their own lounge areas and could spend time alone if they wanted to. A sensory room was available for use at all times and this provided a pleasant and relaxing atmosphere in an otherwise busy environment. The property was well decorated and maintained. We had some concerns about the safety of the large garden and have made a recommendation about this in the report.

Staff told us they were well supported and worked well together as a team. Roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective.

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. DoLS authorisations were in place for everyone living at Menna House. Where relevant, best interest processes had been followed to help ensure any restrictive practices were necessary, proportionate and the least restrictive option.

Activities provided were varied and met people’s individual preferences and interests. People were able to go on spontaneous trips out as well as taking part in planned activities. Family contact was valued and encouraged. Relatives told us they were kept informed of any changes and were invited to take part in care plan reviews.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being on a computerised system. This could be accessed by the senior management team and the behavioural team as necessary.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager and staff. Relatives and people’s views about how the service was operated were sought out.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Menna House on our website at www.cqc.org.uk.

Menna House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. 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.

Staff recorded how people spent their time and details of their health and emotional well-being in daily logs. There were several gaps in these records which sometimes lacked detail. This meant we were not always able to establish how people were occupied during the day.

Staff told us staffing had improved and there were enough staff to help ensure people’s needs were met. Rotas for the previous two weeks showed staffing levels were appropriate at all times. There were sufficient staff to help ensure people’s health and social needs were met according to their preferences. People were supported to take part in a range of activities which were in line with their interests. There were vacancies at the service and two members of staff were leaving at the end of the month. We were concerned the improvement in staffing levels might not be sustained and will check this at our next comprehensive inspection.

Records for logging people’s personal expenditure were now accurate and provided a clear audit trail of monies received and spent. The records were audited regularly so any errors would be quickly identified.

Systems in place for the management of medicines were robust. There was clear guidance available for staff if they needed to administer any additional medicines not routinely prescribed.

Care plans were informative and regularly reviewed. One page profiles at the front of care plans provided staff with important information quickly and effectively.

Regular audits were carried out to monitor the quality of the service provided. Where these identified areas for improvement action was taken appropriately. These had failed to identify or address the gaps in daily records. The manager was working to improve communication with families and help ensure they were kept up to date with what their family member had been doing throughout the week.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the main report.

We inspected Menna House on 16 and 24 January 2017, the inspection was unannounced. The service was last inspected in November 2014, we had no concerns at that time.

Menna House provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. Menna House is part of the Spectrum group who run similar services throughout Cornwall.

The service is required to 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. The manager had been in post since October and was applying to CQC to be registered manager.

There were not sufficient staff on duty at all times to meet people’s individual needs. Spectrum had identified ‘contingency levels’ which are the lowest levels at which the service can run safely. These are only supposed to be in place in emergencies such as flu epidemics or extreme weather conditions. We found the service was often running on contingency levels and sometimes below these levels. Due to staffing problems, people were not being supported to take part in individual activities which had been identified as meaningful to them. Although people were supported to go out on various trips this was usually as a group, as most required the support of two staff while accessing the community.

Recruitment practices helped ensure staff working at the home were fit and appropriate to work in the care sector. Staff received training when they first started work at Spectrum in various areas, including how to recognise and report abuse. Training was regularly refreshed to enable staff to keep up to date with any changes in recommended practices or legislation.

The service kept people’s personal monies for them and records of all expenditures. The system for recording expenditure of money was not robust and we identified discrepancies in four people’s records.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Records showed applications for DoLS were being made appropriately and in line with the registration. This helped ensure people’s rights were protected.

The building had been modified to help meet people’s individual needs and two people had their own private living room. Others shared living and dining areas and four of the five people shared a kitchen. Bedrooms and private living areas were comfortable and reflected people’s personalities and preferences. Shared areas of the building had limited furnishings and decoration. The manager told us they would discuss this with the staff team to consider ways of making the environment more comfortable for people.

People’s support plans included clear and detailed information about their health and social care needs. Care plan reviews were held regularly and the information up-dated accordingly. Staff described to us how they would support people in certain situations and this was in line with the information in care plans. Daily logs were in place to record what people had done during their day and information about their general health and well-being. We identified several gaps in these records.

Roles and responsibilities were well-defined and understood by the staff team. The manager was supported by a deputy manager who had a clear set of responsibilities. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

Regular audits were carried out to continually assess the standard and quality of the service provided. However, these had failed to identify the discrepancies in records concerning people’s personal money.

We spoke to relatives of one of the people who used the service. They told us 'X has come on in leaps and bounds'. We spoke with an Independent Mental Capacity Advocate (IMCA) who had worked with the service. They described the staff as; 'Really professional, really understanding and really caring'.

We spoke with the registered manager and one member of staff. We observed staff interacting with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

We examined people's care files and found the records were detailed and well laid out.

We found people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed they went out regularly and saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care files and found the records were up to date and reviewed as the people's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there were sufficient staff on duty.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.