This inspection took place on 16 and 17 May 2018 and the first day of inspection was unannounced. At the last inspection undertaken in February 2017 we rated the service as ‘requires improvement’ in safe and effective and ‘good’ in the key areas of caring, responsive and well led. This meant that the home received an overall rating of ‘requires improvement’. We identified no breaches of legal requirements at our previous inspection.
At this inspection we rated Maybank House ‘requires improvement’ overall and this is the third inspection where the service has been judged as ‘requires improvement.’ We identified three breaches of regulation in respect of safe care and treatment, the need for consent and good governance.
Maybank House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Maybank House accommodates up to 25 people in one adapted building. At the time of our inspection there were 13 people living at Maybank House. The home had recently had major refurbishment to the ground floor accommodation which had affected the number of bedrooms available in the home. The provider had started to accept new admissions into the home prior to this inspection.
There was a registered manager in post at the time of our inspection. 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.
People had individual risk assessments. Identified risks were assessed and ways to reduce the likelihood of the person being harmed were recorded. People were supported safely and in line with their risk assessments.
The home had undergone major refurbishment to ground floor bedrooms due to water damage. Staffing levels had been flexed based on the low numbers of people in the home at the time of this inspection.
There was a medicines policy in place for the safe storage, administration and disposal of medicines. Staff were given relevant information about specific medicines. The temperature at which medicines were stored at was being monitored but was too high. No remedial action had been taken to check the medicines fridge was working properly.
An external contractor had carried out an assessment of the premises in relation to water safety in January 2017 but no action had been taken as a result of this assessment. There were no processes in place setting out cleaning and disinfecting regimes to ensure the safety of the water systems.
There was a pre-admission assessment in place. Following an initial enquiry, arrangements were then made with individuals to carry out a more detailed assessment prior to admission.
There was a CCTV system in communal areas and outside spaces of the home, although people were not informed of this is in the home’s statement of purpose. Inside the home we saw the use of stair alarms, floor and door alarm sensors and a nurse call system in order to minimise the risks posed to people.
Records saw showed regular, planned supervisions with staff and annual appraisals were provided. Induction training was provided to staff so they had the skills and knowledge for their role. New staff spent time shadowing more experienced staff to help them understand their role.
We checked whether the provider was working within the principles of the Mental Capacity Act and whether any conditions on authorisations to deprive a person of their liberty were being met. We were satisfied the DoLS legislation was being used in the way it was intended, for example to protect people’s rights. However, where it was considered that people lacked capacity to consent, we did not see decisions made in people’s best interests, or consent forms signed by appropriate representatives in relation to receiving care and treatment or medicines. The only consent we saw in care plans was that for having photographs taken.
There was information in the kitchen relating to people’s diets. Nutritional screening plans indicated people’s preferences. Menus were flexed and the chef shaped the menus based on people’s preferences and choices.
The provider had carried out a programme of major refurbishment to the ground floor bedroom areas. We noted improvements in the décor of these rooms and new fixtures and fittings contained within them.
People continued to be supported to access medical and healthcare professionals as required, which included GP’s, district nurses, speech and language therapy (SaLT) and podiatry. Care plans contained information about people’s health so that staff could provide appropriate support.
The staff team at the home was small and consistent and relatives told us there was no use of agency staff. We could see that staff had developed an obvious rapport with people, who felt comfortable in staff’s presence. People looked clean, well-groomed and appropriately dressed.
People we spoke with confirmed they were treated with dignity and respect. Staff understood the importance of promoting people’s independence and encouraged people to do as much for themselves as possible.
The provider was aware of the importance of ensuring equality, diversity and people’s human rights were upheld and incorporated this aspect into an element of staff training. Staff took appropriate action to maintain confidentiality when dealing with personal and sensitive information relating to individuals.
Care plan profiles were personalised around individuals and documented their capabilities. Care files contained information about people’s backgrounds, likes and dislikes, social and medical needs.
We looked to see how the service met people’s social needs. Care workers tried to encourage people to participate in activities or group discussions. Reminiscence sessions and themed discussions were recorded. People were able to carry on doing the things they had previously enjoyed before moving to Maybank House. People were encouraged to maintain relationships that were important to them.
There were no documented supervisions with the registered manager or action notes from meetings and discussions with the provider. We saw there were a variety of audits and monitoring systems in place to monitor the quality and effectiveness of the service but these audits were not robust enough and not fit for purpose. The lack of action in relation to safety checks of water systems had not been identified.
People’s opinions of the service were sampled at regular intervals. Relatives had been consulted about the service in October 2017 and all responses were positive. Staff performance was monitored by way of spot checks. Staff were informed about any bad practices and supported to improve.
The home had a suite of policies and procedures available for staff stored in the office. The suite of policies contained detailed templates and paperwork not currently being used by the home, for example around recruitment and audits. The home was not using the quality compliance system to its full advantage.
With regards to the breaches in regulation identified at this inspection you can see what action we asked the provider to take at the back of this report.