Archived: Maybank House

Maybank House is a residential care home that is registered to provide personal care and support for up to 25 people over the age of 65, including those living with a diagnosis of dementia. On the days of the inspection there were 16 people living at the home.

Maybank House is a large detached house situated in the Brooklands area of Manchester, accommodating people in one adapted building, with a large garden to the rear of the home.

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

Staff were aware of risks specific to individuals and risks posed by the environment and were guided with information and instruction on how to reduce these to keep people safe. Systems and processes relating to legionella checks had improved. Temperatures at which medicines were being stored at were now being monitored and accurately recorded. The home had robust ways of working that ensured people were kept safe when receiving medicines.

The meal time experience was a good one for people. People’s specific dietary needs were communicated to all staff. Staff employed in the kitchen were aware of any recommendations made by health professionals. The supervision of staff had been a priority for the new management team and staff felt supported and valued.

People spoken with said they were well cared for. People were supported to have maximum choice and control of their lives and staff did this in the least restrictive way possible; the policies and systems in the service supported this practice. People received a healthy diet in line with their assessed needs. People had access to health care as required.

Care plans and assessments were in place which identified the areas of support people wanted and needed. People’s views and opinions were sought on the service via surveys and meetings. Relatives were also consulted. Themed meetings had been introduced to encourage people to attend and participate. The service had a complaints policy and people we spoke with knew how to make a complaint. Suitable arrangements were in place to respond to any complaints and concerns.

Systems and procedures were in place to monitor the quality and effectiveness of the service. At this inspection the registered manager had introduced a variety of audits to identity areas of good practice and areas for improvement. We saw that audits of the service had been completed, were documented and demonstrated that the registered manager had oversight of the service.

At this inspection we found improvements had been made in all areas of the service. We will continue to monitor information and intelligence about this service to ensure these are sustained.

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 inspection of Maybank House took place on 16 and 17 May 2018. The last rating for this service was requires improvement (published 24 July 2018). There were three breaches of regulation in relation to safe care and treatment, consent and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations. The service has improved to good.

Why we inspected:

An unannounced comprehensive inspection was undertaken on 6 and 7 August 2019. This was a planned inspection based on the previous rating.

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.

This was an unannounced inspection carried out on the 21 and 23 February 2017 and at the time of inspection there were 19 people using the service. The service was last inspected in November 2015 and was found to require improvement.

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.

People living at Maybank House told us they felt safe however we found occasions when their safety was compromised. Staff were supported to keep people safe through appropriate training in areas such as safeguarding and moving and handling training. The service also had up to date policies and procedures in place for staff to follow.

People living at Maybank House had their nutritional and hydration needs met. All the people we spoke with told us the food provided was good. People were offered a range of options at breakfast and had a choice of food at other mealtimes too. The service had been awarded five stars out of a possible five during their most recent food hygiene inspection.

Staff working at Maybank House had received appropriate training to support them in their roles. Regular supervision meant staff were provided with the opportunity to raise concerns or discuss any training needs.

We found staff did not have regular training in the Mental Capacity Act which showed when we questioned their understanding. We recommend that all staff receive training on MCA 2005 to increase their awareness and that the frequency of training updates in this area be more regular than once every five years. We found that applications had been made for DoLS as required and best interest decisions were documented .

We saw that when necessary the service had referred people to the appropriate healthcare professionals. Feedback about the service and staff from other health professionals was complimentary.

People’s preferences and choices were respected. Staff knew people well and were responsive to people’s needs. People told us that staff were caring and kind and we observed caring interactions between staff and people living at Maybank House.

People were supported to be involved in the planning of their care. They felt there were sufficient staff to meet their needs.We observed staff showing people respect and ensured people’s dignity was maintained when providing care. The service supported people with their end of life care and ensured their wishes were upheld whenever possible.

We found the recruitment process to be robust and appropriate checks were made prior to staff commencing work. Current delays in the DBS process meant that staff started working at Maybank House following a clear DBS Adult First check. They were not allowed to work unsupervised in the service until a full DBS clearance was received. Staff received induction to the service prior to commencing work.

Some staff we spoke with did not think there were enough activities for people but feedback from people living at Maybank House and their relatives was positive. Staff took time out to spend talking with residents and used resources such as books and magazines to start and generate conversations. Staff were good at involving people who were normally quiet and encouraged them to participate.

The service had undertaken regular surveys of people and their relatives. We saw a sample of returned questionnaires with feedback from June, August and December 2016 with positive comments about aspects of the service.

There was a formal complaints procedure in place and any complaints received were acted on appropriately. We saw examples of compliments in the form of thank you cards and entries in a formal compliments book recently introduced by the service.

At our last inspection we had identified that no quality assurance checks were undertaken on aspects of the service. At this inspection we saw the improvements that had been introduced by the registered manager with regular spot checks and audits of the service. People, their relatives and visiting professionals told us the service had improved.

The registered the manager understood their responsibilities and notified the Care Quality Commission (CQC) of significant events in line with the requirements of the provider’s registration.

Maybank House is a care home providing personal care and accommodation for up to 25 older people. No nursing care is provided. On the day of inspection there were 18 people living in the home.

Maybank House is a large detached property set in its own grounds located in the Brooklands area of Altrincham, Manchester. Accommodation is over two floors with both single and shared rooms. Communal areas include three lounge areas, a dining room, toilets and bathrooms. The home has recently benefited from the refurbishment of bathrooms on the ground floor and there is a small bathroom dedicated as a hair salon on the upper floor. There is a large garden to the rear of the house which people can easily access. One person told us they liked to walk around the garden and we saw them using the garden on a number of occasions during our visits.

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.

We could see prior to undertaking the inspection that an application had been made by an individual to take on the role of registered manager. This individual had been acting manager of the service for over six months and we could see that this process was on-going at the time of the inspection. On the days of inspection unfortunately this person was not available therefore we spoke with the owner of the service and the deputy manager.

Due to the absence of the acting manager the owner of the home found it difficult to locate some documents and files relating to the running of the service. There was a lack of organisation with regards to record keeping in the administration office although requested evidence was eventually produced.

There were sufficient numbers of staff on duty to meet the needs of people living in the home on the days of our inspection, although the rota did not always accurately reflect who was on duty and at what times. This was rectified before the end of the inspection as the owner produced a revised rota template. We saw that the service managed staff absences and covered shifts internally.

We found the home had suitable internal safeguarding procedures in place designed to protect vulnerable people from abuse and the risk of abuse but there was no copy of the local authority’s multi-disciplinary procedures on site. Whilst some plans had been put into place to help reduce or eliminate identified risks not all had been addressed and therefore people were not always protected from the risk of harm.

Recruitment records we sampled demonstrated that staff had been safely and effectively recruited. Personnel files reflected that the necessary employment checks had been made before recruiting people to the service.

There was a safe system in place for the ordering and receiving of medications into the home. Medicines for administration, including controlled drugs, were stored securely although medicines waiting to be returned to the pharmacist for disposal were not stored securely. Controlled drugs that were no longer required were still on site and there was no system in place to ensure that these were disposed of promptly and in an appropriate manner.

The home had mechanisms and processes in place to support the prevention and control of infections however not all staff practised good hand hygiene when undertaking their caring role.

Staff had received training around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards but their knowledge in these areas was limited. The home could evidence that applications for DoLS authorisations had been submitted to the relevant authority.

Staff displayed good knowledge around diet and nutrition and were able to outline what actions they might take in the event a person suffered a weight loss.

We saw that staff had developed caring and compassionate relationships with people living in the home. They allowed people to maintain their independence wherever possible and supported them when needed.

Some systems were in place to allow people the opportunity to feedback about the care and treatment they received. We saw responses from people living in the home and their relatives to questionnaires issued in June 2015. We saw that the majority of this feedback was positive alongside suggestions for additional activities.

The service had been awarded the Investors in People award in 2015 however staff we spoke with did not feel supported by management. Not all aspects of the service had been audited and therefore improvements in service delivery had not been identified.

We found a number of breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 relating to the management of medicines, inadequate risk assessments relating to people’s health and wellbeing, inadequate care records and governance of the service.

The overall rating for this service is ‘Requires Improvement.’ You can see what action we have told the provider to take at the back of the full version of the report.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During this inspection we spoke with two relatives, four care staff, the manager, the deputy manager and the owner of Maybank House. We also spoke with six people who lived at the home. Below is a summary of what we found.

Is the service caring?

The people we spoke with were happy with the care and support provided by Maybank House. People told us they were asked for their opinions and if they needed support. Comments included; 'They ask me if I want to do any activities, I prefer my telly but they still ask.' and 'They are all really nice to me'. We spoke with two relatives who confirmed they were happy with the care and support provided.

Is the service responsive?

We saw that people were encouraged to give feedback on the service in the form of surveys, and meetings took place to enable people to make comments and suggestions. The people we spoke with told us they could speak to staff and the manager if they wanted to discuss any improvements.

Is the service safe?

We saw that some systems were in place to ensure people were safe. However we noted that one person had not been weighed regularly and another person's support needs had changed. We were told they had not been referred to a health professional for further advice and guidance. We concluded that a referral should have been made when the person's needs changed to ensure that people were protected against the risk of receiving care or treatment that was inappropriate or unsafe. The CQC monitors the operation in care homes of the Deprivation of Liberty Safeguards (DoLS). At Maybank House there were no people for whom a DoLS authorisation had been applied for at the time of our visit.

Is the service effective?

We saw that overall, staff had access to training activities to enable them to maintain their knowledge and competence and there were sufficient staff available to meet people's needs. The people we spoke with told us they did not have to wait for staff to support them and they felt their needs were met. This showed us there were sufficient staff available to respond to people's needs.

Is the service well led?

We looked at a sample of audits and saw there were some systems in place to identify when improvements were required. The staff we spoke with told us if any actions were required, they were informed of these through meetings with the manager and at supervisions. We spoke with two relatives who told us they found the manager approachable and they would speak with them if they had any concerns. However we noted that the care records audit had not identified shortfalls with a record we viewed and the manager's audit did not accurately reflect two occurrences within the home. We considered improvements were required in this area.

People told us the staff 'are very good here' and 'there are some nice staff'. They said that Maybank House was 'quite comfortable'. Other comments included 'there is no favouritism here' and 'it's free and easy'. One person said 'I feel well looked after here and there is always something going on'.

Two people commented on the food saying that it was 'very good' and that 'you can choose your food'.

Staff working at Maybank House said they enjoyed their work. Comments included 'the residents and the staff make it feel like a family'. The staff felt they received appropriate training to do their job and were supervised by senior staff. Staff also said that they 'enjoyed sitting and chatting to residents and /or doing an activity with them'.

We talked to relatives during the visit. The relatives we spoke with were happy with Maybank House. They felt they had been consulted in their relatives care. Comments included 'girls are always talking to them' (residents), 'the rooms are clean'. A relative also said that the staff were 'lovely'.

Following our inspection on 24 January 2013 we found the provider had addressed our concerns. People who used the service experienced effective and appropriate care and support including support to have adequate nutrition.

The provider had taken appropriate steps to identify and prevent abuse from occurring. There were effective systems in place to assess and monitor the quality of services. This included systems to ensure the management of the service and its compliance with the Essential Standards of Quality and Safety was monitored on an ongoing basis.