Archived: Mauricare

Mauricare is a care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service at the time of the inspection was not providing nursing care.

The service can support up to 17 people, in one adapted building.

The registered manager was on planned leave at the time of the inspection site visit. The inspection was facilitated by a registered manager from another of the provider’s services, at the request of the provider.

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

Ineffective monitoring of the service by the provider and registered manager, and a lack of oversight by the provider, meant shortfalls in the service were not identified. Plans to bring about improvement were not in place, this impacted on the quality outcomes for people.

An external organisation had issued an enforcement notice, to bring about improvement to promote people’s safety, and bring about compliance.

Systems to promote people’s safety, which included assessment of risk, and safe recruitment practices for staff were not robust. Staff did not fully understand their responsibilities in safeguarding, all of which had the potential to place people at risk.

Audits on infection control were not an accurate reflection of the service. The audits recorded the service was clean, and furnishings and fixtures were in good condition. We found the service was not sufficiently clean, and some soft furnishings, floor coverings and mattresses to be damaged and stained.

People lived at a service that was not sufficiently maintained, both internally and externally.

People’s needs were not regularly reviewed, and their care plans were not written with their involvement. This meant people were not supported to have maximum choice and control of their lives, and staff did not always support them in the least restrictive way possible. The policies and systems in the service did not support this practice.

Opportunities for people to engage in social activities, develop interests within the service and the wider community were limited. Activities, as detailed on the notice board did not take place.

People’s health and welfare were kept under review by staff, who organised health care referrals and appointments on people’s behalf. Staff supported people to access health care appointments, and implemented the guidance given to them to promote people’s well-being.

People’s views about the service were sought. People we spoke with expressed satisfaction with the care they received, and spoke favourably about the staff who worked at Mauricare.

Staff were supported to perform their role through training and supervision.

People’s medicines were managed safely and people were supported to access a range of health care professionals, to monitor and promote their health.

People who were able, accessed the wider community independently or with support from family members.

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 22 February 2017)

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to: The effective governance of the service. Effective systems and practices to prevent and control the spread of infection. Maintenance of the premises, to promote the safety of people and their well-being. Effective assessment of potential risk, including staff recruitment practices. And, person centred care, enabling people to be involved in the development and review of their care.

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.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mauricare provides residential care for up to 17 people who are living with dementia or require support because of their mental health. At the time of our inspection there were 14 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having an en-suite facility.

Mauricare had 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 provider was in the early stages of implementing a quality assurance tool, that if implemented well, should provide an overview as to the service being provided, to enable the provider to further develop the quality of the service people receive.

A range of audits had been undertaken by the provider, registered manager and staff. Whilst some audits checked that equipment such as hoists were well maintained, larger scale issues had not been fully addressed. For example, we found the premises and some equipment to be in need of improvement to meet the needs of people using the service. We found there to be no action plan detailing the improvements with timescales that would improve the facilities with regards to the maintenance and décor of Mauricare.

People who used the service told us their views about the service were sought and that they were happy with the care and support they received. This was supported by the minutes of meetings involving people who used the service and the completed questionnaires we saw which sought people’s views; however the outcome of people’s views had not been shared.

People using the service told us they felt safe and were confident that if they had any concerns about their safety or welfare their concerns would be listened to by the registered manager and staff. People’s medicine was managed well and safely. An audit carried out by the supplying pharmacist had found good management systems in place for people’s medicine.

People’s safety was further supported through a robust recruitment process of staff and by their being sufficient staff to provide the support people required. Staff undertook training and were regularly supervised, which included having their competency assessed to ensure they delivered safe and effective care and support to people.

The registered manager and staff were aware of their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were committed in their approach to supporting people to make informed decisions about their care. People’s capacity to make informed decisions was considered with regards to all aspects of their day to day lives; however there was a lack of awareness as to the appropriate and correct completion of mental capacity assessments. The registered manager said improvements would be made in this area.

People were encouraged to make decisions about their day to day lives. People’s care plans provided information for staff as to what support people required, so that people’s independence was recognised and not undermined by staff. We observed staff supported people to make decisions about their day to day lives and provided encouragement in the promotion of their independence.

People’s health and welfare was promoted through a range of assessments and the development of care plans which were regularly reviewed. People, with the support of staff where required, accessed the services of a range of health care professionals who monitored and promoted their health. People’s nutritional needs were assessed and met and were regularly reviewed. People spoke positively about the meals and how they were regularly offered and encouraged to eat and drink well.

People spoke positively about the kind, gentle and caring approach of staff. We saw the communication between people using the service and staff was of a high standard showing trust, genuineness, promotion of independence and much enjoyed humour. People using the service were seen to laugh and respond to staff throughout the day.

People in some instances were aware of their care plans telling us they spent time with staff reviewing the information they contained. People told us they were supported to go out into the wider community by staff, with some people visiting family members independently or with staff support.

People were aware of activities within the service, however some told us they chose not to participate, preferring to spend time by themselves, whilst others told us they did not value the range of activities provided. We observed staff supporting people to take part in individual activities, to promote both mental and physical stimulation. Further understanding of supporting people living with dementia to take part in everyday activities would enhance people’s quality of life. The registered manager was looking to develop this aspect of the service to include opportunities for people to take part in everyday activities through the development of the environment

People we spoke with told us they had not had cause to make a complaint but they were knowledgeable about the complaints procedure. People using the service and staff said they found the managers to be approachable.

We spoke with four people who used the service and asked them for their views about the care and support they received. People's comments included: 'I am very happy here, the staff are marvellous and nothing is too much trouble.' 'I've lived here quite a while and I am very settled.' 'I don't want to leave here, I'm looked after well and the staff are marvellous.'

People who used the service spoke about the Halloween Party that was to take place later in the week, with one person telling us of their intention to 'dress up' in a witch's hat and have their face painted. In the afternoon we saw one person engaged in a game of dominoes with a member of staff, whilst someone else was completing a jigsaw. A third person was being supported and encouraged to undertake exercises which had been recommended by their physiotherapist. Visitors told us that Mauricare organised parties at Christmas and Easter as well as individual birthday parties, to which people's relatives and friends were invited.

People we spoke with told us they were satisfied with the food. We saw the cook during the morning asking people for their choice from the lunchtime menu.

We asked people if in their view their were sufficient staff on duty to look after them. People told us that when they needed assistance staff were quick to support and help them.

We spoke with visitors who were visiting their relative and asked them for their views about the care and support their relative received. They told us they along with their relative were happy with the care and support provided. They told us they along with other relatives were kept informed about the health and welfare of the person who used the service.

We looked at a range of records, which included people's care plans and daily records, staff recruitment and supervision records and maintenance records and found records were stored and managed well.