Minchenden Lodge

Minchenden Lodge is a residential care home providing personal care and accommodation for people aged 65 and over, some of whom may be living with dementia. The home can support up to 25 people. At the time of the inspection there were 20 people living at the home.

The home is a large detached building set in a residential area of Southgate, North London. Bedrooms are located across two floors with a well-kept and accessible rear garden.

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

Feedback from people and relatives was overwhelmingly positive. They consistently praised the exceptional caring and supportive nature of the staff at Minchenden Lodge. Staff talked about people being ‘the heart of the home’.

Staff demonstrated a culture of inclusivity and positivity that was evident throughout the home.

Staff constantly looked for ways to improve the service and ensure people received the outstanding care they deserved.

Activities were truly person centred and created an atmosphere of vibrancy and joy. People were encouraged to maintain their independence and interests and were enabled to carry on doing things they had done before moving to the home as well as experiencing new things. Staff collaborated with people and their relatives to make sure they knew about the person's interests and needs so they could have a positive impact on the person's life.

Care was planned to ensure that people were at the heart of everything, people and relatives were consulted. This created a truly holistic and person-centred approach that allowed people to have a as much enjoyment from life as possible.

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.

People were treated with kindness and compassion at the end of their lives. Relatives praised staff understanding and support when people were reaching the end of their lives.

The registered manager actively involved people in staff in making decisions about the home. People were consulted on a day-to day basis about what they wanted to do and how they wanted to receive their care as individuals.

The service was exceptionally well-led. The registered manager demonstrated how their open and supportive management style and robust quality assurance systems promoted a high quality of care that empowered not only people but the staff as well. People and staff told us that they felt truly valued and supported.

More information is in the detailed findings below.

Rating at last inspection

The last rating for this service was good (published 4 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Minchenden Lodge provides residential care and support for a maximum of 21 older people. Some of whom may be living with dementia.

There was a 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 had received training on medicines administration and people were supported to take their medicines safely. Medicines were accurately recorded on medicine administration (MAR) sheets.

People were involved in decisions about their care. Where people were unable to have input, best interests meetings and decisions were recorded. Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. We saw that care plans were regularly reviewed and updated immediately if changes occurred.

Risk assessments gave staff detailed guidance and ensured that risks were mitigated against in the least restrictive way. Risk assessments were reviewed and updated regularly.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

There were activities provided for people both within the home and outside. People were also able to request activities if they wished. Activities were discussed during residents meetings.

People and relatives were involved in end of life care planning. People experiencing end of life care were treated with compassion and empathy.

Staff received regular, effective supervision and attended monthly team meetings.

Staff, people and relatives were positive about the culture of the home and the management.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. There was a complaints procedure as well as incident and accident reporting. Surveys were completed with people who use the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

As part of this inspection we spoke with eight people who lived at Minchenden Lodge. We also spoke with five members of staff and the district nurse who was visiting on the day of our visit. We reviewed records relating to the management of the home which included five plans, daily care records and records about how the home monitors its own performance and the quality of care.

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

Is the service safe?

People were cared for in an attractive and pleasant environment that was suitable for purpose. Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act and is concerned with people's safety and well-being where they are not always able to make decisions for themselves. Arrangements had not been put in place to care for people under DoLS where necessary.

The home ensured people's medical needs were met and worked well in partnership with other health professionals to support people living at the home appropriately.

Is the service effective?

People told us that they were happy with the care they received and felt their needs were met. One person said 'I like it here. There is always something going on.' A relative told us 'My husband is well looked after. Staff take great care with him and he is happy.' Another said 'I would be happy to recommend this place.'

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We saw that steps were taken to maintain people's independence and wellbeing.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. They were very supportive of people's relatives many of whom were themselves elderly and frail. We saw that people were able to do things at their own pace and were not rushed. All the people we spoke to said that staff were kind and helpful.

Is the service responsive?

We saw that staff were responsive to the needs and wants of people living at the home. People were encouraged to make decisions about their own care wherever possible and the choices that people made were respected. We saw that support offered changed in line with people's support needs in a timely way.

Is the service well lead?

The service was led by a manager who was very hands on with the care of people living at the home. The emphasis of the leadership was on providing a homely environment where people's individuality was respected and promoted and family involvement encouraged.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. People told us they liked their rooms and we saw they were well furnished and decorated.

Medicines were stored and managed appropriately, following immediate action taken the day after our inspection.

We saw that the home had an appropriate complaints policy and procedure. Whilst the manager told us they had not had any complaints, we found that people had not been made aware of the complaints system. The provider told us they intended to produce information for people about their policies and procedures, including complaints.

Staff were equally positive. One member of staff said, 'I love it.' Another said, 'It's a lovely place to work, compact and homely.' We observed positive and warm relations between staff and people using the service throughout our visit.

The people using the service told us that they felt safe and staff told us that they felt supported. We saw records confirming that staff had been provided with supervision and a range of training. The care plans provided detailed assessments and plans for meetings people's needs. Action had been taken to introduce a new care planning system based on good practice from the provider's other care services. Regular health and safety and quality checks had taken place and there was a plan to introduce relatives meetings.

Overall, the arrangements made to keep medicines safe were thorough although we found three gaps in recording and administration. This presented a risk to people's health and wellbeing if they did not receive their medicine at the correct time.