Archived: Maitland Terrace

Maitland Terrace 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. The home is registered to provide support for up to seven people over single storey, bungalow style accommodation. Residential care is provided for people with a learning disability, physical disability or those with an autistic type condition. Nursing care is not provided at the home. On both days of the inspection there were six people using the service.

At the time of the inspection there was no registered manager formally registered at the home. The previous registered manager had left the home and cancelled their registration in January 2018. A new manager had been appointed but had been in post only around two weeks. A registered manager is a person who has registered with the 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. We were supported on the inspection by the interim manager who had been over seeing the service and the provider’s regional manager.

Staff were aware of safeguarding issues and told us they would report any concerns around potential abuse. Any safeguarding matters had been appropriately investigated and dealt with.

Checks were carried out on the equipment and safety of the home. Previous concerns around fire safety at the home had been addressed. Staff had completed fire safety training and regular fire drills were undertaken. Risk assessments linked to people’s care were not always updated in a timely manner and care plans did not always fully reflect the advice given by health professionals. The home was maintained in a clean and tidy manner.

Staff told us they felt there were enough staff at the home and said they were able to accompany people to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Previous issues with regard to the safe management of medicines had been addressed and we found no issues.

Staff told us they had access to a range of training and there was good overall uptake of training provided. Staff confirmed that had access to regular supervision and had been offered an annual appraisal.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Appropriate applications for DoLS had been made and there was evidence best interests decisions had been made, when appropriate.

People had access to health care services to help maintain their physical and psychological wellbeing. People were supported to access adequate levels of food and drink.

At the previous inspection we had noted the decoration of the home was in need of updating and some areas of the kitchen facilities were damaged and required replacement. To date this work had not been completed. The regional manager informed us this work was to be undertaken in the near future.

We observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Staff displayed an exceptional understanding of people as individuals and of treating them with dignity and respect. We found limited evidence to suggest that people, or their legal representatives, had been actively involved in their care reviews. Reviews of care were often limited in content and information.

People’s needs had been assessed and individualised care plans and risk assessments developed that addressed identified needs. Some care plans had detailed information for care staff to follow. Other care plans lacked specific detail about how to support people. Reviews of care plans were not always timely, detailed or appropriately recorded. People were supported to attend various events and activities in the local community. Activities also took place within the home and people clearly enjoyed these. There had been no formal complaints in the last year.

Regular checks and audits were carried out on the service by senior staff within the organisation. Whilst the range of checks and audits had improved, there continued to be issues identified at this inspection that had not been identified through these quality processes. Staff were positive about the interim manager and the support they received from the regional manager. They said there was a good staff team and felt well supported by colleagues. Daily records at the home were limited in detail and were not always person centred.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the Safe care and treatment, Person–centred care and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Maitland Terrace is a purpose built bungalow complex, comprising two connected units, which provides places for up to seven people with learning disabilities who need care and support. The home is situated in a residential area of Newbiggin by the Sea. It is fully accessible and benefits from a large garden area. At the time of the inspection there were seven people living at the home.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since November 2016. A registered manager is a person who has registered with the 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. We were supported by the registered manager throughout the inspection.

Staff were aware of safeguarding issues and told us they would report any concerns around potential abuse. There had been no recent individual safeguarding issues. The home had responded to pointers outlined in a general visit by the safeguarding team.

Checks were carried out on the equipment and safety of the home. It was unclear if appropriate fire drills and fire training had been undertaken in recent months. Risk assessments linked to people’s care were not always updated in a timely manner. We noted some issues with regard to cleanliness and infection control. The majority of these matters had been addressed by the second day of the inspection.

Staff told us they felt there were enough staff at the home and said they were able to accompany people to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Medicines were not always managed effectively. Medicine records were not always clear or up to date.

Staff told us they had access to a range of training. The registered manager told us she was in the process of ensuring all staff training was up to date. With the exception of fire training, records showed there was a high level of completion. Staff told us they had been subject to annual appraisals. The registered manager told us she was in the process of arranging review (supervision) meetings.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Appropriate applications for DoLS had been made by the registered manager. There was some evidence best interests decisions had been made in the past. It was not clear for one person if appropriate consent or a best interests decision had been made for the use of bedrails. We have made a recommendation about this.

People had access to health care services to help maintain their physical and psychological wellbeing. Advice from such interventions was incorporated into people’s care records and followed by care staff.

People were supported to access adequate levels of food and drink. Specialist advice had been sought, where necessary, and guidance followed. People’s weights were monitored.

We observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Staff understood about treating people as individuals and with dignity and respect. People’s personal space and choices were respected.

People’s needs had been assessed and individualised care plans and risk assessments developed that addressed identified needs. Some care plans had detailed information for care staff to follow. Other care plans lacked specific detail about how to support people. Reviews of care plans were not always timely, detailed or appropriately recorded. People were supported to attend various events and activities in the local community. The manager told us there had been no formal complaints in the last year.

Regular checks and audits were carried out on the service by the registered manager, the regional manager and the quality assurance manager. These checks had not highlighted the issues identified at this inspection, or points highlighted for action had not been completed or followed up. Staff were positive about the registered manager and the support they received. They said there was a good staff team and felt well supported by colleagues. Daily records at the home were not always up to date and were sometimes limited in detail.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the Safe care and treatment and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

The building was well decorated, warm and provided appropriate accommodation to meet people's needs. We saw that they was personalised with pictures, photographs and personal items. There were systems in place to ensure repairs and maintenance were carried out in a timely way.

There was an appropriate recruitment system to help ensure people were cared for by staff who were honest, reliable and suitably qualified.

People's personal records were up to date, accurate and held in a secure location. Other records to protect people's safety and wellbeing were well maintained and up to date.

People using the service had complex needs which meant they were not able to tell us about their experiences.

The provider told us they had developed specific care plans for each person who used the service with regard to decision making.

We saw evidence of these plans in people's personal care records. The plans highlighted the need for staff to consider and assess people's capacity to make decisions about their care. Mental capacity assessments had been undertaken in relation to people's ability to consent to their care plans. We saw copies of minutes from a best interest meeting involving a person's care manager and their relatives.

We saw people were relaxed and engaged well with staff. One staff member said, 'We have to remember that this is their home and we are just visiting.' We established there was a lack of independent advocacy for people in meetings and no specific plans detailing how people's rights were respected. We concluded there was a risk people may receive care or treatment they or their representatives had not consented to.

We established people in the home had comprehensive assessments of need and risk. Staff had developed memory boxes which contained photographs of events encouraging people to think about their lives. We found that care was delivered in a way to meet individual's needs.

We saw medicines were kept securely and signatures were in place to indicate a medicine had been given. We found people were protected against unsafe administration of medicines.

The staff rota confirmed four staff on duty in the mornings and three in an afternoon. We established there was a mix of carers and senior carers on duty across the week. We concluded there were sufficient numbers of skilled, qualified and experienced staff on duty at all times.

We saw the home had a written complaints procedure that detailed the process to be followed in the event of a complaint. This indicated that complaints should be documented, investigated and responded to within a set timescale.