Maynell House

Maynell House is a residential care home providing accommodation and personal care to up to 25 people in an adapted building. The service provides support to older people. At the time of our inspection there were 21 people using the service, some were living with dementia.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was a person using the service who had a learning disability.

People were provided with a safe service and systems in place reduced the risks of abuse and avoidable harm. People received their medicines when they needed them.

Staff were available to provide support where required and staff were recruited safely. Staff were caring in their interactions with people. People’s independence, privacy and dignity were promoted and respected.

The home was clean and hygienic. There was a programme of refurbishment being undertaken to ensure the service was well maintained throughout.

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’s views about the service were valued and used to drive improvement.

People had access to activities which reduced the risks of boredom and isolation. People were supported to maintain contact with their friends and family, including visits.

People’s care needs and preferences were assessed prior to moving into the service and the assessments were used to inform their care plan, which were kept under review. Care plans identified the care and support people required and the choices they made in how they wished to live their lives, including end of life decisions and how they wished to receive care and support.

People received support with their dietary and hydration needs. Support to access health professionals was provided, where required. The service worked in partnership with other professionals involved in people’s care to ensure they received consistent care and support.

The registered manager had an oversight of the service, and a programme of monitoring and audits supported them to identify shortfalls and address them.

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 23 September 2017).

Why we inspected

This comprehensive inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maynell House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The management team were knowledgeable about their roles and responsibilities relating to infection control. There were systems in place which supported good infection control procedures.

The service was visibly clean and well ventilated. One person who used the service told us their home was kept, “Perfectly clean.”

People were being supported to receive visits from their relatives. The service reduced the risks of people using the service becoming isolated and bored. We saw photographs which demonstrated people participated in social activities, such as outdoor games in the garden in summer.

Staff and people using the service received regular COVID-19 testing in line with current government guidelines.

At our last inspection of 6 July 2015 the service was rated Good overall, with a rating of Requires Improvement for Responsive. At this inspection we found the service remained Good overall. Improvements had been made in Responsive which is now rated as Good. However, we received mixed feedback from people about if they felt cared for and respected. Improvements were needed in how staff and the service demonstrated to people that they were cared for in a compassionate way. People were involved in making decisions about their care and support, not all people felt that they were always listened to. Therefore Caring is rated as Requires improvement.

There was not 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. The previous registered manager left the service July 2017. There was a new manager in post and their application for registration had been received.

The service continued to provide a safe service to people. This included systems designed to minimise the risks to people, including from abuse, in their daily living and with their medicines. Staff were available when people needed assistance, however, care provided was based on tasks required for people’s needs. The recruitment of staff was done safely.

People were supported by staff who were trained and supported to meet their needs. 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. Systems were in place to assess and meet people’s dietary and health needs and for people to maintain good health and have access to health professionals where needed.

People received care and support which was planned and delivered to meet their individual needs. People were supported to participate in meaningful activities. A complaints procedure was in place.

The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below.

We spoke with four people who used the service. We also spoke with one person's relative and three staff members. We looked at five people's care records. Other records viewed included staff training records, health and safety checks, staff and resident meeting minutes and satisfaction questionnaires completed by the people who used the service and staff. We considered our inspection findings to answer five questions we always ask; is the service safe, effective, caring, responsive and well led? This is a summary of what we found:

Is the service safe?

When we arrived at the service the staff on duty asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure the safety of people using the service.

People who used the service told us that they felt safe using the service. One person told us, 'Staff are polite and good. I feel safe here.'

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that the service had begun a programme of staff assessment of safeguarding knowledge through the supervision process. This would ensure that all staff were regularly assessed in this area as well as receiving their mandatory training. This meant that staff were provided with the information they needed to ensure that people were being protected from the risk of abuse.

We saw records which showed that the service responded appropriately to concerns or allegations of abuse.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I get everything I need." Another person said, "I can't fault it here." Another person said, "I am very happy here." We also spoke with a person's relative who told us that they felt that their relative was well looked after. They said, "I have no problems at all with them (the service)."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "I get on well with all of them." Another person said, "They are all very kind and they work so hard."

People using the service, their relatives and other professionals involved with the service completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to.

People told us that they attended meetings to discuss the way in which the service operated.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had a system for regular auditing and monitoring of the quality of the care provided to people who used the service and records seen by us showed that identified shortfalls had been addressed. People who used the service had access to regular forums where they could discuss their care and staff were required to attend staff meetings on a regular basis. As a result the quality of the service was continuingly improving.

Below is a summary of what we found.

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

Is the service safe?

The provider had effective safeguarding procedures in place to protect people from the risk of abuse or harm.

We looked to see whether there were the right levels of staff working at the service. There were sufficient staff to meet people's needs.

We found that the service did not have suitable arrangements in place to gain people's consent and assess their mental capacity to make decisions before acting on their behalf. Staff did not always understand their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service had a safe medication administration system in place. People received their medications on time and staff were trained to support people safely.

The service had a robust recruitment process in place which meant that they checked and ensured that staff were fit and safe to work with vulnerable people.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.

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. Care plans seen included information about the care and support provided to people such as support with their personal care needs, mobility, behaviour and medication.

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. There was no evidence that people had been involved in the review of their care.

We had concerns about the staff employed to work at the service and the update of their skills to support the people who used the service. We had concerns about the information and subjects covered in a recent refresher course staff had undertaken. This meant that we could not be assured that staff had the necessary skills to support people effectively.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and gave people time to respond. We found staff showed patience when communicating with people who used the service.

People told us that the staff were caring. One person said about the service, 'I like it here, I don't have to do anything, feel lazy sometimes.' Another said about staff, 'The staff are always very busy, but they are all very kind.'

Is the service responsive?

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

Although some activities took place at the time of our inspection there were no evidence in any of the recent records we saw that showed how people were involved and engaged within the service or assisted to access the community.

The service responded well to concerns about the safety of people who used the service. A visiting relative told us that the service always responded to any issues and addressed these.

People told us that the service responded to their needs. One person told us, 'They (staff) are very good too, very kind.' Another person told us, 'I do most things myself but if I need help they (staff) help me.'

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. There were regular audits on medication and the environment.

Records seen by us showed that identified repairs and maintenance were addressed promptly. As a result the quality of the service was continuously improving.

The staff members we spoke with told us that since the new manager had started things had improved and they felt well supported and able to access the manager for support. However there had been no recent formal arrangements in place for supervision or appraisal which meant that we could not be assured that staff were receiving appropriate professional development and support.

Our observations indicated that staff asked the people who used the service if they wished to participate in activities and received support to meet their personal needs. We observed that staff gave people choices.

The service had good infection control procedures in place.

People were receiving nutritious meals of their choice.

We found that although the management team had current staff vacancies they were recruiting to fill these and maintain staffing levels.

The service had good quality monitoring processes in place to ensure the continued delivery of safe and effective care.