Archived: The Maltings Care Home

The Maltings Care Home is a residential care home providing personal care to up to 43 people in a purpose built building with an upper and a lower floor, each with a separate dining room and lounges. At the time of our inspection there were 19 people using the service.

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

Although there was an improvement in the oversight of many aspects of the service, some basic oversight was not in place. Food and fluid charts, repositioning charts and records monitoring people’s continence were not always completed accurately and were not effectively monitored. One person’s medicines had not been accurately entered onto the system following their discharge from hospital. This poor recording represented a failure of systems which have the potential to harm people and meant there was a continued breach of regulation relating to the monitoring and mitigating of risk.

However, we also noted that the service had improved in all other areas, despite not having a consistent registered manager in post. The provider had worked hard to ensure continuity of leadership even though this had been a challenge. People who used the service, relatives and staff were mostly positive about the service and had confidence in the provider.

The provider conducted effective health and safety monitoring of the environment. Staff were recruited safely and there were enough staff to meet people’s needs. There were good infection control practices in place and safeguarding concerns were well managed.

Healthcare needs were mostly well documented, but some records required closer monitoring. Pre-admission assessments were in place. Staff, including agency staff, were well trained and received a good induction. Consent was well documented, and staff had an understanding of the issues relating to consent. 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.

The environment was much improved and there were plans in place to encourage people to use communal spaces more. There was some mixed feedback about the food but overall people were happy with their meals.

Staff were kind and caring. Interactions were positive and people were treated with respect. People were involved in decisions about their care.

Care plans documented people's specific and individual needs well. Staff knew people well and information, except that in some people’s room folders, was well recorded and handed over from shift to shift.

Activities were varied and people were positive about them. End of life care plans were in place and people’s wishes were documented. Complaints were managed well. People had a voice and residents meetings enabled people to raise issues or concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 3 October 2020).

We placed conditions on the provider’s registration which required them to submit a monthly action plan to us so that we could monitor them more closely and ensure the required improvements took place.

At this inspection we found the provider had made significant progress but remained in breach of one regulation relating to leadership and governance.

This service has been in Special Measures since 2 October 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement

We have identified a breach of regulation in relation to the monitoring of people’s health and inaccurate record keeping. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Maltings Care Home is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 43 people, some of whom may be living with dementia. The service is split into upper and lower floors, each with its own communal areas.

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

People did not always receive care and support which was safe and which met their needs. Medicines were not well managed and there was a lack of effective monitoring by the provider which meant errors with medicines and unsafe practice was not identified. People did not always receive their prescribed medicines.

Safe systems were not in place regarding the risk and spread of infection, including COVID-19. Staff were not wearing PPE in accordance with government guidance and cleaning procedures were not robust. Oversight of cleaning was poor and some areas were not as clean as they should be.

Some risks were poorly managed including those relating to blood thinning medicines, choking, pressure care and people not drinking enough. Records were incomplete and some risks had not been fully considered and action taken to reduce them. Fire risks had not been fully assessed and mitigated. We required the provider to address specific issues related to this and they have done so. Staff knowledge and understanding of fire procedures was not good.

Staff recruitment procedures were not robust which meant people who used the service were not fully protected. Staffing levels were mostly in accordance with the provider’s own assessment of what is safe but staff told us there were not enough to meet people's needs. The provider is in the process of reviewing staffing levels. The service was using a lot of different agency staff and systems to ensure they have all the information they need to carry out their roles safely were not robust.

Governance and oversight of the service was not effective and did not protect people. Audit systems did not identify the concerns we found and records throughout the service were incomplete, contradictory and confusing for staff. Where things had gone wrong, investigations into what happened and how to learn lessons for the future were not robust or timely. One significant incident had not been reported appropriately to CQC.

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 Requires Improvement (published 4 December 2019.)

At that inspection we identified a breach of regulation 12 (Safe care and treatment). At this inspection we found that the provider had not made sufficient improvement and the service was still in breach of this regulation.

Why we inspected

The inspection was prompted in part by concerns we received relating to poor management of a person’s fall. Our investigation of this led us to have concerns about multiple areas of the service including records, medicines management and risk management including risks associated with Covid-19. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led.

We reviewed the information we held about the service and considered the fact that this inspection was taking place during a time of global pandemic. No other major areas of concern were identified in the other key questions. We therefore did not inspect them. We used ratings from the previous comprehensive inspection for those key questions to calculate the overall rating at this inspection.

The overall rating for this service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this report. During the inspection we had concerns for the safety of people in the home and wrote to the provider. The provider took immediate steps to address the concerns and continues to work with us to improve provision at the home.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Maltings Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

At this inspection, we have identified breaches of regulation in relation to safe care and treatment, recruitment, governance and notifying CQC of reportable events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

The Maltings Care Home is a residential care home and was providing accommodation and personal care to 42 people, at the time of the inspection. The service can support up to 43 older people, some of whom may be living with dementia. The service had two floors, each with communal areas.

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

We identified some concerns with the way the service assessed and managed some risks. The environment posed risks which had not been considered. No measures had been put in place to reduce them, although the provider took immediate action to begin to address them once we had identified them. Similarly risks relating to pressure care and choking required more effective monitoring to fully protect people.

Staffing levels made it difficult for staff to meet people’s needs promptly, particularly in the early hours of the morning and late evening. People were not rushed but were aware of how busy staff were and access to leisure activities was sometimes reduced. The registered manager had requested additional staffing hours for these times. We have been informed since the inspection, that this additional staffing for the morning has been agreed by the provider. They are still considering additional evening hours.

Audits were carried out but had not identified all the issues we found. Maintenance reporting systems were not as effective as they should be and did not fully protect people. The provider began to address these concerns immediately after we brought them to their attention.

The service was clean, and staff had a good understanding of infection control. However, a maintenance issue had not been well managed and posed a potential infection control risk on the day of our inspection visit. Medicines were very well managed. Staff received training to administer medicines and had their competency to do this regularly checked.

The staff worked collaboratively and felt supported. Their views were sought and acted upon. Staff were recruited safely and understood their safeguarding responsibilities. Staff had requested key training which the provider had not yet been able to source, although their initial induction was good.

Access to healthcare was good and the staff made appropriate and prompt referrals to other healthcare professionals. People enjoyed the food and the provider regularly sought feedback on the dining experience. Recording of people’s drinks, where they were at risk of dehydration’ required better oversight.

Staff showed a very good understanding of consent issues, however the manager acknowledged that some care records needed reviewing. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice

The environment was suitable for people, including those living with dementia. Consideration had been given to the way the main lounge had been redecorated to make it suitable for people. People had had input on colour schemes and furnishings.

Staff were patient and kind towards the people who used the service. Staff promoted people’s independence and upheld their dignity.

The service enabled people to follow their own hobbies and interests. Activities were popular and inclusive, although staffing levels had had an occasional impact on activities for some people. Complaints were managed in accordance with the provider’s policy.

Although nobody was receiving end of life care at the time of our inspection visit, the provider had procedures in place. Staff had a good understanding of people’s end of life care needs.

People who used the service, and their relatives, were mostly very happy with the care and support provided. They, and staff, spoke highly of the registered manager and many people told us they felt things had improved since she took up her post.

Although the inspection identified some areas for improvement, the provider began to take action as soon as issues were identified. Their response was encouraging. We acknowledge the positive impact the registered manager, and her team, have had on the service in the last year. However, further work is needed to ensure everyone receives safe and effective care which meets their individual needs.

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 09 March 2017).

Enforcement

We have identified a breach of regulation in relation to the management of risk at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Maltings Care Home is registered to provide accommodation and personal care for up to 43 older people, some of home may be living with dementia. Accommodation is provided on two levels in 43 single bedrooms. At the time of the inspection there were 43 people accommodated in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection people said they felt safe and that staff treated them well. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse. Risks associated with people's care were identified, assessed and recorded. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Policies and procedures were in place to guide staff with the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

Staff acted in a courteous, professional and safe manner when supporting people. There were sufficient staff numbers on duty to keep people safe and to meet people's needs. Safe staff recruitment procedures were in place which ensured only those staff deemed suitable to the role were in post.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the main principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation.

There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and respected their privacy.

Staff consulted people living in the home about their care needs and involved them in the care planning process. People were comfortable and relaxed with staff. Support plans and risk assessments provided guidance for staff on how to meet people's needs and were reviewed regularly. Staff encouraged people to remain as independent as possible and supported them to participate in a variety of daily activities.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care and oversight by a senior manager. Regular checks were undertaken on all aspects of care provision and actions were taken to continuously improve people's experience of care.

Below is a summary of what we found.

Is the service safe?

People who we spoke with told us they felt safe and the staff were very helpful and met their needs. One person said, 'We are well looked after. It is spotless here.' Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm.

People were also protected from the risk of abuse as staff had received training and were clear about their responsibilities to recognise and report any concerns.

People we spoke with said they were confident to raise any concerns they had with the manager.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had a system in place to demonstrate they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care in accordance with the Mental Capacity Act (2005). The provider was in the process of improving this system. The provider had contacted the local authority and was taking action to ensure that people who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes have affected the decision and how they were involved in the decision making process. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act (2005) and give people protection who cannot make a decision for themselves and may be deprived of their liberty

Is the service effective?

People we spoke with told us, and our observations confirmed, that people were happy with the service they received. Staff spoke positively about working at The Maltings Care Home. It was clear from our observations, and from our conversations with staff and the manager, that staff knew people's needs well. Staff followed the guidance contained within people's care plans.

Staff worked closely with professional health staff to ensure that people's needs were met by staff with the most appropriate, knowledge, skills and experience.

Staff were well trained. They received appropriate professional development.

Is the service caring?

One of the staff we spoke with said, 'I enjoy working here.' We observed that people were listened to and staff spoke to people and responded to them in a respectful and kind way. Staff told us how they supported people and they spoke in a thoughtful and sensitive way about each person's needs.

We spoke with four people who used the service. Each person spoke positively about the staff and said that the staff were kind and caring. One person said, 'The staff look after us well here.' One person's relative said, "I am very satisfied with the care my family member receives.'

Is the service responsive?

People's needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people's likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities of their choice and were encouraged to participate in activities within the local community.

One member of staff said, "We are a team. We support each other and the atmosphere is really good.'

Is the service well led?

Staff told us they received regular supervision and appraisals. They told us they received good support from the management team.

The relatives we spoke with told us they felt the service was well-managed. They said they were confident to raise any concerns or complaints they had with the manager. One relative said, "The manager is very approachable. They listen to our concerns.' There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The provider had effective quality assurance and audit systems in place to monitor all aspects of the service and ensure improvements were made where necessary.

People who used the service and staff working at the service, all said that they felt the manager listened to them and made improvements to the service based on their feedback.

The care plans we looked at gave us a picture of people's needs. Risks associated with the care needs had been assessed and acted upon showing the care was appropriate and safe for the individual people concerned.

The people who lived in The Maltings were offered a suitable choice of meals throughout the day. Fluid intake was monitored and people who required assistance to ensure they had suitable quantities of food had their meal intake recorded.

The staff at the home welcomed and received support with guidance and training from other professionals, that ensured people had the correct support for their needs. The manager also supported this interaction showing the staff team were responsive to all needs of individual people.

We found a robust system in place for the recruitment of new staff. Recruitment procedures and records were completed correctly to ensure people were cared for by suitable staff.

The home had received complaints. They had been recorded, acted upon and the problem resolved. We had received a notification from the manager about the problems in the building that led to most of the complaints. The manager had acted appropriately.