This inspection took place on 1 December 2017 and was unannounced.

Minster Lodge Care Home 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. Minster Lodge Care Home provides residential support and care for up to 25 people with mental health and physical care needs. At the time of our inspection there were 22 people living at the home.

At the last inspection, in February 2016, the service was overall rated as 'Good.'

Since our last inspection we had been informed that the local safeguarding team was completing an investigation following concerns about care provided to a person when they lived at the home. At the time of writing this report the outcome of the investigation is not known.

At this inspection people remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. There were policies and procedures in place which minimised the risks of abuse to people. The risks to people had been assessed, recorded and plans were in place to manage these risks and keep people safe. People received their medicines safely and as prescribed from trained staff.

Staff undertook training and received regular supervision to help support them to provide effective care.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests.

We saw people had a choice of food and drinks with snacks also available throughout the day. People were treated with dignity and respect. People were asked their preferences about how they wanted to be supported and cared for. These details were recorded in people's care plans including their end of life wishes.

People were supported to see other health and social care professionals when they required additional support.

Staff adopted a kind and compassionate approach to their work. People's involvement in decision-making was encouraged. People's rights to privacy and dignity were understood and promoted by staff. People's choices were respected.

Person centred plans were in place and people and their relatives were involved in planning the care and support they received. Care plans were regularly reviewed.

People, staff and professionals spoke highly about the registered manager and staff. The registered manager and registered provider continually monitored the quality of the service and made improvements in accordance with people's changing needs.

This inspection took place on 15 February 2016 and was unannounced.

Minster Lodge Care Home provides residential care for up to 27 people, some of whom have mental health needs or physical disabilities. The bedrooms are located on the ground and the first floor. At the time of our inspection there were 24 people who lived in the home.

A registered manager was 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 told us their care and support needs were met by staff who were knowledgeable and knew them well. Staff had undertaken training relevant to the specific needs of people who lived at the home and staff told us they were supported within their job roles.

Everyone we spoke with said they thought Minster Lodge was a safe place to live and they were well cared for. Staff had a good understanding of how to report any safeguarding concerns. Staff understood how to keep people safe and were available at the times people needed them. The risks to people’s health and wellbeing were assessed and action taken to minimise any identified risk.

People received their medicines as prescribed, and checks were undertaken to ensure people received them in a safe way.

People were supported in line with the principles of the Mental Capacity Act. The manager understood the importance applying for Deprivation of Liberty Safeguards (DoLs) when necessary. Staff ensured they maintained people’s privacy and dignity and treated people with compassion and respect.

There were enough staff to support people who lived in the home. Recruitment checks were carried out prior to care workers starting work to ensure their suitability to work with people.

People had a choice of meals which met their dietary requirements and preferences. People were supported to maintain their health and attend healthcare appointment when necessary.

People had opportunities to pursue their hobbies and interests and maintain relationships with people important to them.

People and their relatives knew how to raise complaints and were confident actions would be taken in response to these. People had opportunities to put forward their suggestions about the service provided.

There were processes to monitor the quality and safety of the service provided and actions were taken to drive improvement in the service.

We carried out this inspection on 27 October 2014. The inspection was unannounced. The service provides accommodation and personal care for up to 27 people who may have mental health needs.

Twenty two people were living at the home at the time of our inspection. 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 and associated Regulations about how the service is run.

At our previous inspection in June 2014 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There was a breach in meeting the legal requirements for the safety and suitability of premises and for assessing and monitoring the quality of service provision.  The provider sent us a report explaining the actions they would take to improve and told us the actions would be completed by 30 July 2014. During this inspection we found improvements had been made and the actions had been completed.

Everyone we spoke with told us they felt safe living at the home. Care staff understood what their role was in protecting people who lived at the home, from abuse. We saw any incidents in the home were appropriately recorded and reviewed by the manager. The manager had identified risks to people’s health and welfare. We saw there were enough care staff to support people with their individual care and support needs. Medication was administered and disposed of safely.

During this inspection we found some areas of the home were not clean. We decided to include checks on how the provider made sure people were protected from the risks of infection. Care staff we spoke with knew how to minimise the risk of spreading infections.

We saw safe recruitment practices were followed and checks were made prior to staff beginning work with the provider. We found all care staff had an induction programme and training was appropriate to staffs role. Care staff told us they received supervision from their manager.

We found all staff were aware of their responsibilities under The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and had received the relevant training.

We saw care staff monitored people’s health and wellbeing and shared information with other staff and relevant health professionals.

People who lived at the home told us care staff were caring and listened to them. We saw positive interactions between staff and people who lived at the home. People’s privacy was respected and their dignity was promoted.

People’s care plans were reviewed and updated when their needs changed. People were supported to maintain and improve their health.

We saw the provider’s quality assurance system involved people who lived at the home, relatives, health professionals and staff. We saw the manager took account of people’s comments and took action to improve the service as a result. We found quality assurance checks identified issues and action plans were put in place and followed.

During our inspection we looked to see whether we could answer five key questions: is the service safe, effective, caring, responsive and well led?

When we inspected the service the home had 23 people living there who required personal care. Some people who used the service had limited verbal communication skills. We observed people moving freely around the home, taking part in activities and making choices about how and where they wanted to spend their time.

We spoke with the manager, care staff and seven people who lived at the home.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The staff we spoke with understood their responsibilities in following the policies and procedures of the service to keep people safe. Staff were able to describe the different ways they supported people to keep them safe.

People we spoke with told us they were satisfied with the care and support provided by staff working for the service. One person told us, “No problems with them at all at this place.”

Staff had received training about the Mental Capacity Act so they were aware of how people could be supported in making decisions if they lacked mental capacity.

We found improvements were needed to the environment so it was clean, safe and well maintained for people. This included accessibility to hot water, clean linen and maintenance of comfortable room temperatures.

Is the service effective?

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively.

Specialist dietary, communication and equipment needs were identified in care plans as appropriate.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate.

It was clear from our observations and from speaking with staff they had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

People told us they were happy with the care and support they received. We observed staff providing support for people. We saw that staff were friendly in their approach towards people and responded to people appropriately.

Is the service responsive?

We saw people were able to access treatment and support from health and social care professionals when necessary.

People were able to participate in a range of activities both in the home and in the local community. We saw one person was escorted to a bus stop and another to the shops on the day of our visit.

We saw there were people in the home who wished to smoke and a dedicated sheltered area had been identified for this in the garden. Staff kept the cigarettes in safe storage but provided people with them upon their request as long as this was in accordance with what had been agreed in their care plan.

Is the service well led?

There were processes and systems in place to monitor the service provided. We saw some of these processes were not fully effective in ensuring people received the quality of care and services they should expect.

Staff understood their roles and received support and training on a regular basis. Some of the training was due to be refreshed and dates had been set to ensure staff were competent to provide the care and support to the required standard.

We visited Minster Lodge to check action taken by the service to improve areas of concern raised during our visit in June 2013. These were medication and training. We also checked one aspect of the environment. We had received a concern that upstairs windows had been wide open, putting people at risk.

We found that improvements had been made in the recording and administration of medicines. One person had overall responsibility for medicines and they were able to show us how medicines were dispensed and recorded in a way that did not put people at risk.

We spoke with a staff member and they were able to detail the training they had recently. They were also able to demonstrate how it had a positive impact on their work. The manager showed us details of training undertaken.

We saw that upstairs windows were secured by devices that ensured they could not be opened far enough to pose a risk to people.

We spoke with the manager, a member of staff and one person who lived at the home. We observed interactions between staff and people at the home during our visit. One person who lived there told us “The staff are good, and help me.”

We visited Minster Lodge unannounced and spoke with the manager, five staff and four people who lived at the home. We observed interactions in the home and looked at a sample of care records. These gave clear guidelines for supporting people. Staff demonstrated a good awareness of people’s needs and how to meet them. People who lived at the home expressed contentment with the support they received. “I like it here” one person told us. We spoke with two visiting relatives who told us “We are very happy with it here – top notch!”

We noted that in some areas staff had not received the necessary training to enable them to be fully competent to to carry out specific tasks.

It was not clear that all staff were carrying out medication administration in line with agreed policies. This was particularly the case in respect of recording the giving and disposal of medicines.

At the time of our visit, the home was undergoing refurbishment to improve the environment. This continued during our visit, mainly in upstairs areas. The completed areas were light and airy and free from any unpleasant odours. People were not disturbed by this work.

The manager told us there were currently twenty people who lived at the home. On the day of our visit, there were in addition to the manager, four permanent care staff, plus two agency staff and three ancillary staff.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “Expert by Experience”; people who have experience of using services and who can provide that perspective and a practising professional.

To help us understand people's experiences we used the Short Observational Framework for Inspection, (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We talked with eight people who lived in the home about their experience of living at Minster Lodge. We also spent time observing what was going on in the home, talking with staff and the managers. People who lived in the home were happy to speak to us about the care they received. People said “The staff are never too busy for us” and “the staff are all very kind”.

People told us that their views and opinions were listened to by staff. One person told us “Yes, staff do listen to me. They ask me everyday what I would like to do and what meals I would like”. None of the people we talked with had concerns in relation to their privacy and dignity. One person told us “I’ve never had any concerns regarding my care”.

People we spoke with told us that they enjoyed the food and that choices were available to them. One person told us, ‘’I always have a choice and I can eat and drink whenever I want’’. Other people told us, “If I don’t want what’s on the menu they will make me something else”.

People who lived in the home told us that they had no concerns about the staffing levels. We were told “everyone here cares for me very well”. People who lived in the home told us that staff always seemed happy and were a pleasure to be around.

People told us that if they were concerned about anything they would have no problems raising this with the staff or the manager. People we spoke with told us that they felt safe and secure.

The comments of people in the home were overwhelmingly positive. Some people were quite vocal in their enthusiasm, with such comments as ‘lovely here’ ‘nice staff’ ‘lots to do’. Others were quieter, but interactions with staff and general demeanours showed people at ease with their surroundings.

Some people spoke approvingly of things they were going to do or had done recently. One person said they had not liked it ‘at first’ but ‘did now’. The only negative remark came from someone who said they did not want to be at the home, but in their ‘own property’. For this they blamed outside health professionals. Two regular visitors to the home praised the way the service treated people as individuals, ‘went the extra mile’ and sought to find out ‘what made people tick’.