This inspection took place on 25 and 26 July 2018 and was unannounced. At our last inspection in February 2017 we found that the service was not meeting the required standards. We had found two breaches of the Regulations in relation to safe care and treatment and good governance. Following the inspection in February 2017 the provider implemented an action plan. At this inspection we found that the actions had been met and the provider was no longer in breach of the Regulations.

Minshull Court Nursing Home is a care home providing accommodation and personal care for up to 34 people. 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. The home specialises in caring for people with dementia and advanced dementia leading to behavioural challenges.

The service had a registered manager. A registered manager is a person who is 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. The registered manager was a qualified mental health nurse (RMN).

Risks to people’s health and wellbeing were managed to keep them safe from harm. Potential or actual risks were assessed and staff followed the plans put in place.

People’s medicines were managed safely. The registered manager was taking a number of actions to help improve their ordering and supply of medications and to try and control the room temperatures during this weather spell of excessive heat.

There were enough staff to meet people’s needs and preferences. Staff were recruited using safe recruitment procedures and processes.

There were systems in place to monitor the quality and safety of the service. The service was safe although the fabric of the building was in need of a lot of refurbishment. The registered provider was developing a purpose-built building for everyone to move into in October 2018.

Staff felt supported and the training they received enabled them to be effective in their roles. Staff received supervisions to ensure a good quality of care was delivered and they received support from the management. Syringe-driver training was not available to staff but the registered manager assured us that this would be sourced to enhance the skills of the qualified nurses in delivering end of life care.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. People were offered choices and options regarding their daily lives and staff supported people with their choices.

People were supported to access external healthcare professionals and other agencies to ensure their healthcare needs were fully met.

People were supported with their nutritional requirements and preferences. People who lived there and their representatives told us they enjoyed the food.

People were supported by staff who were kind, caring and compassionate. People who lived there had their privacy and dignity respected.

People were provided with an original and varied recreational and leisure activity programme. The activities organiser was innovative and caring. They adapted a variety of activities to meet the needs of the individuals they were supporting.

People and their representatives were involved in the planning and review of their care.

The provider had a complaints procedure and people knew how and to whom to complain if they had concerns.

There were regular staff, resident and relative meetings and the registered manager acted on feedback received.

Staff told us the Registered Manager was supportive and approachable.

This inspection took place on 28 February 2017 and was unannounced. At our last inspection in November 2014 we found that the service was not meeting the required standards. We had found three breaches of the Regulations in relation to cleanliness and infection control, the safety and suitability of the premises and the availability of equipment. Following the inspection in November 2014 the registered manager sent us an action plan informing us how they planned to make the required improvements. At this inspection we found that the actions had been met and the provider was no longer in breach of the Regulations in relation to infection control, the safety and suitability of the premises and the availability of equipment. However we found breaches in the Regulations in relation to the safe care and treatment of people and the governance arrangements.

Minshull Court Nursing Home is a care home providing nursing and personal care for up to 34 people, some of whom may be living with dementia. At the time of this inspection 34 people used the service.

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 2008 and associated Regulations about how the service is run.

Risks to people's health and wellbeing were not managed to keep them safe from harm. Some situations which could be harmful to people were not always risk assessed and when risk was assessed staff did not always follow the plans put in place to reduce it.

People's medicines were not always managed safely. People were at risk of not receiving their medicines or prescribed topical creams in a safe or effective way.

Systems in place to monitor the quality and safety of the service were not fully effective. Staff felt supported however they did not have all the training and support they needed to be effective in their roles. Staff performance was not always monitored to ensure good quality care was delivered.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. People were offered choices and options regarding their daily lives and staff supported people with their choices.

People were supported to access external healthcare professionals and other agencies in order to ensure their healthcare needs were fully met. People were supported with their nutritional requirements and preferences.

People were supported by staff who were caring and compassionate. People were provided with a varied recreational and leisure activity programme.

People and their representatives were involved in the planning and review of their care. The provider had a complaints procedure and people knew how and to whom to complain when they had concerns.

People told us the registered manager and the staff team were approachable friendly and supportive. Staff told us they worked well as a team.

We found 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 the report.

When we visited Minshull Court Nursing Home we spoke with nine of the people who lived there. We asked about their experiences and whether they felt staff involved them, listened to them and took their views seriously. They told us that they felt safe and well cared for. Staff treated them with respect and supported them in such a way as to encourage their independence and promote their privacy, dignity and self respect. One person said “You could not wish for anywhere better, we are well looked after and comfortable and that is the truth, no doubt about it”.

Another person told us that they liked to keep busy and make a valued contribution to the home. They showed us the many model trains, boats and aeroplanes that they had made and decorated the lounge and dinning room with. They told us that that they had taken it upon themselves to re-decorate the halls and corridors of the home and they showed us what they had achieved so far. We could see that their accomplishments were a source of pride and they told us that they felt valued and respected by the manager and staff.

Some of the people we spoke with had difficulty expressing their views and answering our questions because of communication difficulties. In light of this, 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 may have difficulty expressing their views. We found that the home had a relaxed, sociable and welcoming atmosphere. We could see that the people who lived at the home were involved in decisions about their care, were treated with respect and enjoyed good relationships with staff.

Visiting relatives told us that they were impressed by the staff. They said there was always a sufficient number of staff on duty and they always had a positive and welcoming attitude. They said “the staff are brilliant”.

The inspection took place on 28 October 2014 and was unannounced. A second day of inspection took place on 5 November 2014. At the last inspection in December 2013 the home was found to be compliant with all the regulations which were looked at on that occasion.

Minshull Court Nursing Home provides nursing and personal care and is located in a residential area of Crewe. The premises provide purpose built accommodation for 34 people in single bedrooms. It is a two storey building and people live on both floors. Access between floors is via a stair lift or the stairs.

Minshull Court Nursing Home is required to have 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.

When we inspected the home people said that they felt looked after by staff who cared for them. Staff were able to do this was because they had a good relationship with the people who lived in the home as well as their relatives and the other agencies which provided care. There were some activities organised in the home and people could make choices about how they spent their time.

People told us that they felt their concerns and wishes were listened to by the staff. They told us the food in the home was good and that they could choose what and where to eat. The staff were well led by the registered manager and received training as well as supervision but the home’s policies and procedures were out of date and needed revising.

Some parts of the home require decoration and at present could present a risk to some of the people living there. The heating equipment was not working properly and some of the furnishings were not suitable or required replacement.  You can see what action we told the provider to take at the back of the full version of the report.