This inspection was completed on 12 and 13 July 2018 and was unannounced.

Minchinhampton Centre for the Elderly – Horsfall House is better known as Horsfall House and will be referred to as such throughout this report.

Horsfall House is a ‘care home’. 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. Horsfall House accommodates up to 44 people in one adapted building. There were 43 people at Horsfall House at the time of the inspection.

There was a registered manager in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in February 2017. There were two breaches of regulation at that time in relation to the governance arrangements in the home and the rights of people who could not consent to their care were not always protected. We found the provider had made the needed improvements and met the requirements of the regulations during this inspection.

Medicines were managed safely and people received their medicines as prescribed. Health and safety checks were carried out regularly to ensure the service was safe for people living there.

People and relevant professionals were involved in planning their nutritional needs. People’s health was monitored and healthcare professionals visited when required to provide support to help meet people’s health needs.

Staff had received training appropriate to their role. Staff had received training around safeguarding and were confident to raise any concerns relating to potential abuse or neglect. Staff received regular supervision from the management team. The administration and management of medicines was safe. There were sufficient numbers of staff working at Horsfall House. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, action had been taken to ensure the ongoing safety of the person.

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 encouraged to make choices about their day to day lives. People were supported to access health professionals. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team. People’s feedback and the views of relatives and staff were sought to make improvements to their experience of the service.

The inspection took place over two days – 8 and 9 February 2017. The inspection was unannounced. When we last inspected in August 2014 there were no breaches of the legal requirements.

Horsfall House is registered to provide residential and nursing care for up to 44 older people. The home had two units, one for people with dementia on the ground floor and a general nursing unit. Both units were 22 bedded. All bedrooms were single and had en-suite facilities. The home was purpose built and set within large landscaped gardens. One place was used to provide free respite care for people who needed support on a short term basis. This could be on either unit. At the time of our inspection there were 43 people in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service was partly effective because they were not working within the principles of the Mental Capacity Act 2005 (MCA). For those people who were unable to provide consent to live at Horsfall House, deprivation of liberty safeguards applications had not been made to the local authority. This meant people were being unlawfully detained.

Improvements were required with people’s care records. Core care planning documents were used but the staff added little detail regarding the person’s specific needs. Some plans did not record the intervention required by the staff team. Some daily records were not recorded in date order. These shortfalls had not been highlighted during the services auditing procedures.

The registered manager and staff team understood their role and responsibilities to protect people from harm. No safeguarding concerns have been raised in the last year. Risks to people’s health and welfare were assessed and appropriate management plans were in place to reduce or eliminate the risk. Staffing numbers on each shift were sufficient to ensure people were kept safe.

The management of medicines was safe and there were good infection control and prevention measures in place to safeguard people.

Staff were well trained and able to carry out their roles effectively. New staff to the service had an induction training programme to complete and regular refresher training was arranged for the whole team. People were provided with sufficient food and drink and staff monitored those people who were at risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People were looked after by a staff team who were kind and caring. There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Where possible, people were involved in making decisions about how they were looked after. People’s privacy and dignity were maintained at all times. The service aspires to the principles of the Gold Standard Framework for end of life care and has enrolled on this training programme commencing May 2017.

People received care and support that met their individual specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.

Although the registered manager provided strong leadership and was well respected by staff, relatives and the people who lived in Horsfall House, improvements were required in two areas. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

The inspection was unannounced.  When we last inspected in December 2013 there were no breaches of the legal requirements.

Horsfall House is registered to provide residential and nursing care for up to 44 older people.  Two rooms were used to provide respite care for people who needed support on a short term basis.  At the time of our inspection there were 44 people in residence.  The home had two units, one for people with dementia on the ground floor and a general nursing unit.  Both units were 22 bedded.  All bedrooms were single and had en-suite facilities.  The home was purpose built and set within large landscaped gardens. 

There was a registered manager in post at the service.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The manager and staff team understood their role and responsibilities to protect people from harm. Risks were assessed and appropriate management plans were in place to reduce or eliminate the risk. Staffing numbers on each shift were sufficient to ensure people were kept safe.

Staff had the knowledge and skills they needed to carry out their role and were provided with regular training and opportunities to develop further.  People were provided with sufficient food and drink and the only negative comment made was that the meal portions for some were too big.  Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors.  Where possible, people were involved in making decisions about how they were looked after.  People’s privacy and dignity were maintained at all times.

People received personalised care that met their individual needs.  They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.

The manager provided strong leadership and was well respected by staff, relatives and the people who lived in Horsfall House.  The quality of service provision and care was continually monitored.  

We spoke with nine people who lived in the home and one visitor. They told us “I am very well looked after”, “I like living here. I am amongst friends” and “I get all the help I need. I was worried about going in to a home but I cannot fault it here”. The visitor we spoke with said they had chosen the home for their relative because “When we visited we knew it was the right place. We have not been disappointed”.

Some people in the home had dementia and were unable to tell us about the care they received and the way they were looked after. We completed a short observation framework inspection (SOFI) and spent a period of time observing the interactions of staff with a group of people. On the whole we observed that the staff were attentive to people’s needs and were sensitive in the way they spoke to them and each other. There were a few negative interactions that could have been handled better and we discussed these with the registered manager.

People were safe at Horsfall House because staff were trained in safeguarding adults and knew what to do if concerns were raised.

There were sufficient numbers of staff available to meet people’s needs. Staffing levels were kept under review and adjusted in accordance with people’s needs. Staff received the training and support they needed to undertake the roles for which they were employed.

People can be assured any complaints they may have would be handled appropriately and acted upon where required.

People told us “I am treated very well”, “I was asked about how I wanted to be looked after” and “I like things done my way and the staff are very respectful towards me”. Other people said "I like it here, there is always a lot going on", "they are kind to me" and "everyone is helpful. If I don't want to do something I say".

People received the care and support they needed because assessment and care planning arrangements took account of each person's needs, choices and preferences. People were support to take their medicines as they had been prescribed by their GP.

We found that there were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began to work in Horsfall House.

People said “the nurses and care staff always make sure I am happy with everything”, “I have a say in how I am looked after” and “the service I receive is top quality but we are still asked if there is anything that could make things better”.

We spoke with seven residents and one relative. People told us that they were happy living in the home and they felt safe there. They said that staff had a good understanding of their needs and treated them with respect.