Maypole Care Home

Maypole Care Home is a residential care home providing personal and nursing care to up to 68 people. The service provides support to adults who have a physical disability or health condition. At the time of our inspection there were 45 people using the service.

Maypole is a purpose-built care home delivering care on two floors. One floor specialises mainly in providing nursing care to older people and the other accommodates younger people who have physical disabilities or health conditions.

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

People using the service were safe. Safeguarding procedures and staff awareness protected them from potential abuse. Risks were assessed to mitigate the possibility of harm from the environment, or aspects of people’s health and needs. Medicines were safely managed and people received their medicines as and when prescribed. The premises were clean and current government guidelines on infection prevention and control and visiting care homes were followed.

Staff were safely recruited and improvement were being made as the responsibility for Schedule 3 checks was being transferred to the service from the provider’s head office.

Staff completed a comprehensive induction on commencing in post and shadowed experienced staff for a period of time dependent on their experience.

We were concerned about fluid intake and record keeping at Maypole. The provider agreed to make improvements and we noted there had been very few urinary tract infections so there had been minimal impact on people, who also told us they had sufficient to drink.

The premises were purpose built providing spacious communal and private areas for people. There was a refurbishment underway and changes had been planned to enable the two floors to operate more independently of each other.

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 care and care plans were person centred and they accessed activities as and when they wanted. Additional room-based activities were available to those cared for in bed. New activities staff had been well received and had improved activity provision. Information was provided in different formats to aid people’s understanding.

There was no one receiving end of life care when we inspected however, plans were in place in some people’s care records.

There had been multiple changes in the management team at Maypole and when we inspected, a manager had been in post for only 2 weeks. They had worked at the service in other roles and had been covering the manager’s position for a while also. Positive changes to the service had already been reported by staff members and relatives.

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 19 August 2021).

Why we inspected

We received concerns in relation to the management of the service and people’s care quality. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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

Follow up

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

Maypole Care Home is a care home providing personal and nursing care to up to 68 people in one purpose-built building. At the time of the inspection, the home was supporting 55 people under and over the age of 65, some of whom were living with a physical disability.

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

Staff were recruited safely and there were enough staff to keep people safe. The manager was working with the local fire service to make improvements to fire safety within the service. We saw good practice in relation to infection prevention and control and received positive feedback from people and their relatives about this. People received their prescribed medicines at the right time and dose from staff who had received appropriate training. Staff spoke passionately about their responsibilities in keeping people safe.

People and staff told us that whilst there were enough staff to keep people safe, it was not always possible to meet people’s needs in a way that was responsive to their wishes and preferences. This had already been identified by the manager, who had increased staffing levels and was continuing to monitor these. People had had limited opportunities to engage in activities. The manager had already identified this, and a new activities coordinator had been employed. A plan was in place to improve the activities available to people. People had detailed and person-centred care plans and risk assessments, which provided staff with guidance to meet people’s needs. Complaints were investigated thoroughly, and learning identified, which was shared with the staff team.

The manager and provider had robust systems in place to monitor the quality of the service and continuously drive improvement. People, their relatives and staff had opportunities to provide feedback and were informed of any incidents or concerns. However, the service was working to enable relatives to be more involved in day to day care planning. Feedback about the management team was overall positive and people, their relatives and staff felt listened to and confident that their feedback would be acted upon. The service worked closely with health and social care professionals to meet people’s 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 03 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

• We received a number of notifications about the service which caused concern as to the standard of care that people may be receiving. When we inspected we found that while there were areas that would benefit from improvement the service met the characteristics of a good rating in all areas.

• When things went wrong the registered manager would facilitate reflective learning opportunities so that staff could consider actions and improve them in future.

• A range of activities were provided for people however due to staffing pressures there were limited opportunities for people being cared for in their rooms or in bed to participate in meaningful activities.

• The registered manager and management team had skills and qualities that complimented each other and were working towards improving support for the wider staff team through recruiting additional senior care staff and care practitioners.

• More information is in the full report below.

Rating at last inspection: Good (report published 10 August 2017)

About the service: Maypole Care Home is a residential home that was providing personal and nursing care to 60 people aged 44 and over at the time of the inspection.

Why we inspected: We bought forward the inspection in response to concerns and risks we were aware of from information supplied by the provider and third parties. Areas of concern raised included would care and skin integrity, personal care, cleanliness of the premises, medicines and nutrition.

Follow up: We will follow up on this inspection as per our re-inspection programme, and through ongoing monitoring of information received about the service.

Maypole Care Home provides accommodation and nursing care for up to 68 older people, some of whom may have mental health needs or have a physical disability. At the time of our inspection 64 people were living at the home.

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.

There were sufficient numbers of staff deployed to meet people's individual needs. New staff had been employed following robust recruitment and selection procedures and this ensured that only people considered suitable to work with vulnerable people were working at the home.

Since our previous inspection we found improvements had been made in relation to staff training, support and supervision.

People received end of life care to a good standard and the staff had strong working relationships with external healthcare professionals.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns.

The registered manager, care staff and nursing staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff were supported by the registered provider and registered manager, and felt that they were valued.

Staff had received induction training when they were new in post and told us they were happy with the training provided for them.

Medicines were stored, recorded and administered safely.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff.

People's nutritional needs had been assessed and people told us they were very happy with the food provided. People’s individual food and drink requirements were met.

Complaints made to the home had been thoroughly investigated and people had been provided with details of the investigation and outcome.

There were systems in place to seek feedback from people who lived at the home, relatives and staff.

People were supported to participate in a variety of activities.

Staff, people who lived at the home, relatives and a social care professional told us that the home was well managed. Quality audits undertaken by the registered provider and registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety.

At the time of our inspection visit there 44 people accommodated at the home. During our inspection we spoke with 16 people who lived at the home in order to hear about their experiences of living there. We spoke with two visitors to hear their opinions about the care and support their relative received. We also received feedback from a relative and healthcare professionals.

We spoke with several members of staff. They included three cleaning staff, one laundry assistant, four registered nurse and eight health care assistants. We also spoke with the home’s manager and a quality manager. This was in order to obtain views about the sufficiency of staffing levels at different times of the day and how infection control and hygiene standards were maintained.

We took the opportunity to speak with a GP from a local surgery who regularly visited the home to hear what they had to say about the care people received.

At this inspection we looked at care and welfare of people, safeguarding people form abuse, infection control, medicines, staffing, the process for assessing and monitoring the quality of service and records.

We used the information to answer the five questions we always ask:

Is the service caring?

Staff were seen to support people in a kind, caring and compassionate way. People told us the staff were “very kind”. Visitors told us their relatives were “very well looked after”. We were told the staff were “lovely” and took good care of their relatives. A person told us “they (the staff) look after you very well”. We observed staff supporting people with their meals, this was carried out in a respectful manner and people were not rushed. We also observed friendly interaction between the staff and people using the service.

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Is the service responsive?

People were supported to access healthcare services as required. People said they were seen regularly by a doctor an “it is never a problem to access medical help. The service was not always responsive to people’s changing needs. The staff did not always carry out reviews of people's care plans and action taken to address any changes in their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the arrangements for the planning and reviewing people's care to meet their needs.

Is the service safe?

The provider’s systems for maintaining cleanliness and hygiene and prevent and control the spread of infections were not effective. Consequently the safety and welfare of people living and working at and visitors to the home had been compromised.

The care and medicines management were not adequate. People were not protected against the risks associated with medicines and put them at risk to their welfare.

There were mostly sufficient staff to meet the needs of people using the service.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to an incident of potential abuse.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe and effective management of people's medicines and the prevention and control of infection.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager told us there was no one who was receiving care, under this safeguard at the time of our inspection.

Is the service effective?

The service was not always managed in an effective way. Care planning was not adequate in order for people’s needs to be met effectively. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and reviews of people's needs.

Is the service well led?

There were systems in place to check the provider’s procedures were followed, they included audits to assess risks to people’s welfare. However where shortfalls in care had been identified by these checks, action plans put in place to remedy them had not been implemented. People’s records were not managed safely and securely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing the quality of the service provision and the safe maintenance of staff and people's records.

During this inspection, we spoke with 11 people, three relatives, seven staff, and the manager. To help us to understand people's experiences of the service we observed the care people were receiving at different times of the day. A person said the care was "very good" and the staff looked after them well. We observed staff supporting people in a respectful manner. People’s privacy and dignity was respected. A person said they had lived at the home for a number of years and “I have everything I need here”. A visitor commented the staff looked after their relative “very well”. Another visitor said “things are improving”.

Care plans contained adequate information to enable the staff to provide care. Risk assessments had been completed and action plans were in place to assist in safe delivery of care.

Arrangements were in place for the management of people’s medicines. Prescribed medicines were available to people and medicines were stored safely and securely.

Records were stored safely and they were updated at regular intervals to ensure they remained current and up to date.

We found people's privacy and dignity was not always respected. Relatives had raised concerns about privacy and dignity as they felt at times this was not managed properly. People and their relatives told us the staff were “helpful and kind” and they “tried their best”. We were told staff shortages in the last few weeks had impacted on the care people received. We saw staffing levels were not sufficient to meet people's needs. This led to long delays in receiving care and support when they pressed their call bells. There were long periods of time when no staff were present and people were left unattended in communal areas.

Arrangements were in place to manage people’s medicines. We saw nutritional assessments had been completed and some care plans developed. People did not always receive help with their food and fluids. The food and fluids records were not always completed and did not demonstrate people were receiving adequate amounts of food and fluids.