The Mews Care Home

The Mews care home is a residential care home providing personal and nursing care for up to 47 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 41 people using the service.

People’s experience of the service and what we found:

People and their relatives spoke positively about the care and support provided. Comments included, “It’s pleasant and friendly here. No complaints, I filled the questionnaire in the other day and handed it into the office” and “I come twice a week. It’s the best thing that could have happened. When you can’t look after yourself, the care here is second to none, she wants for nothing.”

Improvements had been made regarding the administering of people’s medicines. People’s medicines were now managed safely. People were supported to have access to health professionals to meet their health needs.

Improvements had been made regarding care plans being person centred. People's care and support was planned in line with their individual needs and preferences. Care plans contained detailed information about the support people needed to meet their needs.

Risks to people’s safety had been assessed and plans put in place to support staff to keep people safe. Safeguarding concerns had been referred to the local authority to be investigated.

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.

There were enough staff to meet people’s care and support needs. Safe recruitment checks were completed before people commenced employment and an appropriate induction and training schedule were in place.

Staff spoke positively about the management of the service and the support they received. They felt there had been some improvements since the last inspection. Actions had been taken to improve the provider oversight. Audits were completed by the manager and a home improvement action plan had been implemented.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At the time of the inspection, the location did not care or support anyone with a learning disability or an autistic person.

Rating at last inspection and update

The last rating for this service was requires improvement (published 06 January 2023)and there were breaches of regulation. We also recommended the provider consider current guidance on monitoring staffing levels and recruitment.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and people’s care and support. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, responsive, and well-led sections of this full report.

We undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Mews Care Home on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Mews Care Home is a residential care home providing personal and nursing care to up to 47 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 39 people using the service.

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

A new provider had only recently taken over the home 6 weeks prior to this inspection. People, relatives and staff gave positive feedback about the care provided at The Mews Care Home. However, they raised some concerns about staffing levels, staff turnover and high use of agency staff. We have made a recommendation about this. Relatives also felt communication and management approach could be improved.

The provider had not implemented recommendations from a recent IPC review to ensure handwashing posters were displayed in all shower rooms. Some staff did not use face masks correctly. This was addressed immediately.

Improvements were needed to ensure the environment remained safe and secure. Some areas with restricted access, such as the sluice were not locked. This was despite signs indicating they should be.

Medicines were not always managed safely. Some medicines were not stored appropriately as the treatment room was not fit for purpose. The previous provider was aware of this but action to date had been ineffective. Guidance was not always available to ensure people received ‘when required’ medicines consistently.

Safeguarding concerns, incidents and accidents were logged and investigated.

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 this practice.

The complaint log suggested previous complaints had been investigated and closed. However, investigation reports were not available for 4 of the 7 complaints logged.

Prior to the new provider taking over 6 weeks earlier, quality assurance checks were not completed consistently. This meant some issues had not been addressed in a timely way. People, relatives and staff were also not fully engaged with what was happening at the service. Meetings were infrequent and no formal consultation had been done. There was also no evidence the previous provider analysed information to learn lessons and improve the service. The new provider had acted to address these issues. They had conducted an in-depth review of the service and implemented a detailed action plan.

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 16 December 2019).

Why we inspected

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.

The inspection was prompted due to a COVID-19 outbreak and to check improvements had been made following a previous unsatisfactory IPC inspection. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe; responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Mews Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Mews Care home is a care home providing both nursing and personal care to people. The service accommodates up to 47 people with a range of needs including some living with a dementia. At the time of inspection 37 people were living at the service.

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

The provider had made improvements since our last inspection. Safeguarding matters had been appropriately managed by the service. The service responded to information disclosed on Disclosure and Barring Service checks and assessed the risk posed to people. There was good oversight of the home through more effective quality assurance. The provider was now following the requirements of the Mental Capacity Act.

Whilst nursing care plans were thorough. We noted residential care plans held inaccurate information and did not always reflect the guidance given by healthcare professionals. Poor recording of communication between the service and healthcare professionals had been identified and new documentation had recently been introduced to solve the issue.

The service was homely, well-decorated and clean. The provider ensured people had a safe environment. Health and safety checks were regularly conducted. Staff had completed fire drills and people had personal emergency evacuation plans to support staff in the event of an emergency.

The provider had systems to learn from accidents and incidents, analysing the information for trends to enable them to reduce future incidents. Clinical data was also reviewed to support people to have positive outcomes. People's medicines were administered and managed safely.

People were supported by suitably trained and skilled staff. The service supported staff with regular supervisions and appraisals.

Signage was not available to support people living with a dementia to navigate the building independently.

We have made a recommendation about improvements to the environment for people living with a dementia.

People and relatives were happy with the standard of care provided. They told us staff were kind and caring. Staff were polite and patient with people. They were knowledgeable about people, their backgrounds and care needs.

People and relatives expressed mixed views when asked if enough staff were available. During the inspection we did not observe people waiting to be supported. We suggested the service might wish to consult with people and relatives further to give assurances about staffing levels.

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 had access to a range of activities including visiting entertainers. The service monitored people’s participation to identify if people were at risk of becoming isolated.

The provider had an effective complaints process. People were confident concerns raised would be dealt with appropriately.

The service had established partnerships with healthcare professionals to ensure people received joined up care.

A strong management team had started to influence positive changes within the service. Staff told us they felt listened to and empowered to speak out about the service. People, relatives and staff were regularly asked to provide feedback about the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 December 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

The Mews Care Home 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. The Mews Care Home is registered to provide residential care and support for up to 46 people. At the time of our inspection 43 people were living at the service.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection the service was rated, 'Good'. At this inspection the service had deteriorated to ‘Requires improvement.’ This is the first time the service has been rated ‘Requires improvement.’

The service did not always ensure safeguarding issues were identified and responded to appropriately. Following our intervention, the provider took action to address this matter. Accurate and up to date records were not maintained to ensure people, staff and visitors remained safe. The service did not ensure Disclosure Barring Service (DBS) checks were followed up in a timely manner to ensure vulnerable people were supported by suitable staff. Care plans contained conflicting and inaccurate information. Mental capacity assessments and best interest decisions did not always have the involvement of the person, relatives and health care professionals. The provider’s quality assurance systems didn’t identify the issues we found during our inspection.

People were not always supported to have maximum choice and control of their lives and to maintain their independence. Staff did not support them in the least restrictive ways possible. The policies and systems in the service did not always support this practice.

The service was clean and there were systems in place to protect people from the risk of infection. Health and safety checks were conducted regularly.

Appropriately trained staff safely managed medicines. People had access to health care professionals when necessary.

People and relatives were complimentary about the care and support given. When supporting people, staff treated them with dignity and respect. People were encouraged to be as independent as possible.

Staff felt supported and received regular training, supervision and an annual appraisal.

People had access to a range of activities and entertainment. People were supported to maintain relationships and links to the local community. Staff supported people to practise their religious beliefs.

The provider had a complaints process in place and investigated concerns raised. The provider actively sought feedback from people, relatives and external healthcare professionals.

Staff were positive about the registered manager. Staff told us they felt able to raise concerns and were confident issues would be addressed.

The service worked closely with the local authority commissioners, safeguarding teams, social work teams and external healthcare professionals.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place over two days. The first visit on 27 April 2016 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 28 April 2016.

The Mews Care Home is registered to provide up to 46 places for people who require nursing or personal care, some of whom may be living with dementia. There were 44 people living at the home during this inspection, and the remaining two places had been booked.

The home had a registered manager who had been in this role for over four years. 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 and their relatives said the home was a safe place to live. One person said, “They make me feel I’m well looked after. If I need something I call them and they come quickly.” A relative commented, “It’s very safe and comfortable.” Staff had training in keeping people safe and how to report concerns.

The provider carried out checks to make sure only suitable staff were employed. The provider calculated staffing levels from the number of people with different needs, for example living with dementia. At the time of this visit the staffing levels and skill mix throughout the day and night was suitable to meet people’s needs, although two new people were going to move to the home so staffing levels would be reviewed.

People and relatives we spoke with felt staff had the right skills to provide the right support. One person commented, “They’re very good and know exactly what they’re doing.” A relative told us, “[My family member] is getting the care they need here.” Staff said they felt well trained, motivated and supported in their role.

People told us the meals were good and they were “well-fed”. A relative also commented, “My [family member] enjoys the meals very much and he’s getting well-fed which is good for his health.”

People were supported to get health services when they needed these. There were good working relationships between staff and care professionals. One healthcare professional told us, “The staff take their responsibilities seriously.” Another told us, “I am frequently touched by the manner in which they care for the patients.”

People described the staff as caring and kind. One person said, “The girls are very nice, very accommodating.” Another person told us, “They are all very helpful, and very friendly.”

There was a friendly, warm atmosphere in the home. One relative told us, “I noticed it had a warm vibe about it as soon as I came to look around.”

Care professionals also commented positively on the kindness and consideration shown towards people. One health care professional told us, “It’s definitely a caring place – the staff are lovely towards people.”

People received personalised care from staff who knew them well. People’s care was planned to make sure they got the right support to meet their specific needs. Health care professionals told us staff were “knowledgeable” about people. Information about people’s needs was up to date, detailed and individualised.

People told us there were “plenty” of activities and entertainment to take part in if they wanted. The activities programme was displayed in large pictures and in writing in the hallway for people and visitors to see. People also had the chance to go out to shops and other local places.

People, relatives and staff said the takeover by the new provider had gone well. They said the home was well managed and they had been asked for their views about what could improve the service. The provider had thorough checks for monitoring the quality and safety of the service.