The Minstrels Residential 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. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to 33 people. At the time of our inspection there were 26 people living in the home.

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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection the service was rated, ‘Good’. At the present inspection the service remained ‘Good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Medicines were managed safely. However, we found that protocols for ‘as required’ medicines were not in place. Where people received their medicines without their knowledge (covertly) the provider had not followed their policy.

Where people were unable to make decisions arrangements had been made to ensure decisions were made in people's best interests. However not all best interests decisions were issue specific as required by national guidance.

Suitable quality checks were being completed and the provider had ensured that there were enough staff on duty. In addition, people told us that they received person-centred care.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was stored securely, however we observed that there were occasions when records were left in public view during the inspection.

Information was provided to people in an accessible manner. People had been supported to access limited activities and community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Arrangements were in place to support people at the end of their life.

There was a registered manager who promoted a positive culture in the service that was foc

This was an unannounced inspection carried out on 4 February 2016.

The Minstrels Residential Home can provide accommodation and personal care for 33 older people and people who live with dementia. There were 25 people living in the service at the time of our inspection.

There was 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.

Staff knew how to respond to any concerns that might arise so that people were kept safe from harm. People were helped to promote their wellbeing, steps had been taken to reduce the risk of accidents and medicines were safely managed. There were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to care for people in the right way. This included being able to assist people to eat and drink enough. In addition, people had been supported to receive all of the healthcare assistance they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people’s rights were fully protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had received all of the care they needed including people who could become distressed and who needed reassurance. People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. Staff had supported people to express their individuality including pursuing their interests and hobbies. There was a system for resolving complaints.

Some quality checks had not been robustly completed. This shortfall had reduced the registered persons’ ability to ensure that people consistently and safely received all of the care they needed. People had been consulted about the development of the service. Staff were supported to speak out if they had any concerns because the service was run in an open and relaxed way. People had benefited from examples of staff acting upon good practice guidance.

We visited The Minstrels Retirement Home to see if they had made improvements to their records in relation to recording medication. This is a summary of what we found:-

Is the service safe?

We saw the provider and manager had worked together to improve the standard of record keeping in relation to medication. We looked at all the Medication Administration Records (MAR) charts for people living at the home. We saw there was a significant improvement since our last visit and we found that all the MAR charts had been fully completed. The provider now had a system in place to ensure people had their photographs attached to their MAR chart to reduce the risk of medication errors.

There were 25 people living at The Minstrels Residential Home when we visited. We spoke with a member of staff and observed a medication round.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

We saw despite the provider arranging training and the manager monitoring the situation there was no improvement in the recording of medication since our previous visit. The provider had also not ensured there was photographic identification for all people who took medication. A compliance action has been set for this and the provider must tell us how they plan to improve.

On the day we visited there were 23 people living at The Minstrels Residential Home. We spoke with four people who lived at the home, and five members of staff.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

We saw there were gaps in recording of medication that had been administered. This meant it was not possible to identify if a person had taken or been offered their medication. A compliance action has been set for this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made.

Systems were in place to make sure the manager and staff learnt from events such as accidents. This reduces the risks to people and helps the service to continually improve.

Is the service effective?

People told us they were happy with the care they received. One person told us, “It’s very nice, they look after us.” People told us care met their needs. One person said, “You get up when you are ready, there is no particular order of getting up. It depends on what you do that day.”

People’s care needs were assessed and dietary, mobility and equipment needs were identified in the care plans. We saw people’s nutritional needs were catered for with different types of diets. People were supported to have hot and cold drinks throughout the day.

Is the service caring?

We saw there was a warm and caring relationship between staff and people who used the service.

We spent time observing lunch and could see people were supported to eat at their own pace and were not rushed.

People using the service, their relatives and other professionals were asked for their opinion of the service. No areas for improvement had been identified.

Is the service responsive?

We saw the manager had responded to changes in people’s health and had involved other professionals in their care when necessary.

People we spoke with told us they knew how to complain. One person said, “I haven’t had to make a complaint, but any problems and I would talk to the manager. You can talk to her, she is alright.” The manager confirmed they had received no complaints since our last inspection.

Is the service well-led?

The provider is registered to provide care for up to 33 people. However, the manager told us that three double rooms have been made into single rooms and therefore the maximum number of people they could accommodate would be 29. We also noted that they are registered to provide treatment of disease, disorder and injury, but currently do not provide this to people living at the home. We have asked the manager to review the registration with the provider.

The service had a quality assurance system. Records showed that shortfalls were identified and addressed. As a result the quality of the service was continually improving.

At the time of our visit 23 people were living in the home. We spoke with six people who lived there as well as the manager, staff, two visiting relatives and a care home liaison nurse from the local hospital trust. We looked at records and observed how staff supported the people living in the home.

People we were able to speak with told us staff asked them if they could do things for them. One person told us, “Staff always ask me if they can do anything for me.”

Forms were in place to evidence people had given their consent for things like the care they required.

The people we spoke with told us staff were kind to them. One person said, “They’re (the staff) all lovely. People’s physical needs were met although the psychosocial needs for those with dementia were not. Psychosocial needs are those needs related to both the psychological and social well-being of a person.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements to manage controlled drugs.

The provider had systems in place to assess and monitor the quality of service delivered in the home. People we spoke with knew how to make a complaint.

During our visit to the home we spoke with six people who lived there. Everyone told us they were well looked after and no one had any concerns or complaints.

One person we spoke with told us, “We are well looked after and well fed. I have no worries at all. If I did I would speak with the manager. She is a good manager who comes and talks and sometimes makes us laugh.”

Another person told us, “I like it here, I have settled in quite well. If you want anything you can have it. I don’t think you would find a better home than this one. They are ever so good to you.”

The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences. We spent 30 minutes watching people who were sitting in the dining room. During this time the staff played music and most of the people we observed seemed to be enjoying this. The staff came into the room and spoke with people, sang songs with people and brought them drinks and snacks. Generally the outcome of the observation was good although we noticed the staff interacted least with the person that was most withdrawn.

We spoke with a district nurse who was visiting the home. They told us the staff were good at reporting concerns to them and they thought the people in the home were being well looked after. They told us, "The staff always seem cheerful. They are good at contacting us and the GP's."

One of the people in the home said that, “the staff are very good to us all, ever so good.” Another said, “we have what we ask for, they never refuse us.”

They all told us that they always had choices about everything and while we were there four people chose to have their lunch in the lounge and not go to the dining room. They told us that they have their lunch there every day because they “like it that way.”

All of the people we spoke with knew that the home kept records about them and that they had seen them and knew that they had to agree if the home wanted to make any changes to their care.

The people we spoke with said they were happy with their rooms and the general facilities the home provided. During our visit we looked around the home and saw it was clean and tidy.

No-one raised any concerns or complaints with us during our visit but they said they would feel comfortable speaking to any of the staff or the manager if they needed to and felt that any issues would be dealt with. One person commented “I like it here. I don’t want to change anything.”

Another person we spoke with told us that they had been asked about their opinion of the home and said that they had told the manager that there were no changes needed and that they were very happy living there.