Archived: Mythe End House (Registered Care Home)

Whilst the environment wasn’t developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance, people’s care was. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People at Mythe End House lived their life’s as full as possible and had control over what they did and how they were involved in decisions about their care and the service.

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

The ethos of the organisation was to enable people to have as much independence, choice and control as possible. We saw many examples of people leading the life of their choice and being able to influence that on a daily basis. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Any communication challenges were seen as an opportunity to support someone to have a voice and still have control of their life.

We met and spoke to four people during our visit. However, some people who lived at the service had some communication difficulties due to their learning disability and associated conditions, such as autism. Therefore, they were not able to tell us verbally about their experience of living there. We spent short periods of time with people seeing how they spent their day and observed some interactions between people and the staff supporting them. One relative who provided feedback said; “’They (their loved one) loves it there and I feel they are safe.’ Another relative said; “All the staff who are excellent. We cannot speak too highly of them all and they are the "Jewels in the crown" of the organisation.”

Relatives of people who lived there said they felt their loved ones were safe with the staff supporting them. Systems were in place to safeguard people. Risks to them were identified and managed.

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 received their medicines safely in the way prescribed for them. Infection control measures were in place to prevent cross infection. Staff were suitably recruited and there were sufficient staff to meet people’s needs. Staffing levels were flexible to enable the service to provide additional staff when needed.

People were supported by staff who completed an induction, training and were supervised. The support required by people with health and nutritional needs was identified and provided.

All relatives agreed that the staff were very kind and very caring. People had their privacy and independence were promoted. Systems were in place to deal with concerns and complaints. This enabled relatives and people to raise concerns about their care if they needed to.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People had staff support to access community-based activities and holidays. This was flexible and provided in response to people’s choices. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs.

People were supported by a service that was well managed. Records were accessible and up to date. The service was audited, and action taken to address any areas identified that needed improving. Staff were committed to providing good outcomes for people.

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 2 April 2017).

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.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. Medicines were managed safely.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS). Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. Relatives said the management team were approachable.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they liked to be supported. People were supported with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people's needs. Care plans were person centred to provide consistent, high quality care and support. People who were using the service and their relatives were able to raise concerns and were listened to.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the registered manager.

Due to the complex communication needs of people living at the service we looked at a ‘Gloucestershire Voices’ report from June 2016, which gave people and relatives views on the service. People who live at Mythe End House gave lots of feedback and answered many questions about the care and support they receive.

We found the recording of medicines administration had improved. Ongoing compliance with the provider's medicines policy was being monitored using regular internal audits. We found that creams and liquids were now being dated on opening to prevent them being used past their disposal date.

We discussed a possible medicines error that had been shared with us prior to the visit with the registered manager. The registered manager said she would investigate the event and report back to us.

The building had been redecorated and maintenance completed following our last inspection. People now had a safe and pleasant place to live. We checked that each of the specific concerns we identified had been addressed. Staff were positive about the changes.

We also spoke with staff about a concern raised with us that staff feedback on colleague performance issues was not being listened to. The staff we spoke with did not agree with this and felt well supported. The registered manager said she would investigate this concern further following our inspection.

We found that care plans were person centred and appropriately detailed. Staff seemed familiar with the content of the plans. One person told us 'new staff come and read about our behaviour and what we like and don't like'. The person and relative we spoke with seemed happy with the care being provided.

We had concerns about the maintenance of the building. Apart from aesthetic issues, some bathrooms were not clean and there were unaddressed risks, such as exposed wiring. We also had concerns about the recording and quality management of medication administration.

We found that appropriate checks were made on staff prior to them starting employment. We spoke with two community nurses who both felt that staff would benefit from a better understanding of the people's needs. This would allow them to support the people more effectively.

Quality monitoring followed a robust structure. It was working well apart from in relation to maintenance and medication. A relative felt well communicated with and told us 'I get the updates I need'.

At this inspection we were able to verify that the identified actions had been undertaken. The provider had implemented a robust system to monitor the ongoing training needs of staff. They had also developed an effective system for identifying areas for service improvement. The system allowed us to track the improvements that had been implemented and identify what was ongoing.

We did not speak to any of the people living at the home about the training and quality management systems. We did, however, observe ongoing positive interactions between people and the staff supporting them.

During the inspection, we observed care that was in accordance with the care plans for each person. Staff interacted well with people living at the home. We saw evidence that as people's care needs changed, the planning documentation was updated.

We were able to see from care records and meeting minutes that people were given choices about their diet and activities. The activities were varied and people were encouraged to be as independent as possible.

One person was able to tell us that they felt safe at the home and could talk to staff about any concerns. Staff had received training to help them keep people safe and knew when to report concerns.

We saw evidence of good training availability and staff told us that support from the manager and supervision had improved. The primary training record was not robust enough to safely monitor training needs.

The general environment of the home was good but we did notice some issues that needed to be addressed. Staff told us that some maintenance can be slow. We did not see a quality assessment system in place that could demonstrate adequate assessment and monitoring of required improvements. There was also limited evidence available of feedback on quality.