Maryland Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service registered on 15 December 2021. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance and oversight of the service.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although the provider fostered a culture which was based to provide high-quality person-centred support and care to people, this was not always as effective in practice. For example, although people were positive about the care they received from staff, people’s care plans, records and reviews of care were not maintained, meaning there was a risk people’s needs and challenges may not be fully understood or met by staff.

However, staff we spoke with were committed to providing people with high quality care. One member of staff told us, “The manager promotes good standards of care, people get treated well, if I had relative who needed care, I would put them in there, this is the best.”

The culture of the home was positive, and peoples’ significant others were made to feel welcome. Staff worked well together and told us they enjoyed a positive relationship with each other and the registered manager.

The registered manager interacted with people, their relatives and staff at every opportunity and the atmosphere in the home was relaxed and homely.

We could not be assured leaders understood the context in which the provider delivered care, treatment and support and always embodied the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge and experience to lead effectively.

Although the registered manager had well established experience in the role, the service had not been led as effectively as it should. For example, governance tools, audits and processes had not been utilised to provide oversight to help deliver safe care. In some instances, the provider had failed to adhere to its own policies. Systems were not reviewed regularly, and risks were not always identified and managed.

However, we received positive feedback about the registered manager from people, relatives and staff. One person told us, “The manager is nice.” A relative confirmed, “The manager is so calm, patient and caring.”

Comments from staff included, “[Manager’s Name] is caring, understanding approachable. Has an open door and is around” and “[Manger’s Name] is a good manager and helps around the home a lot, any issues at all and staff can just ask.”

Although people told us they could speak up and their voice would be heard, the provider did not have any processes in place to gather people’s feedback, such as via resident meetings and questionaries. There was a limited approach to obtaining the views of people and their significant others.

This meant people’s feedback could not be analysed and considered. Opportunities to act on people’s feedback and potentially enhance their experience of the care they received were potentially missed.

Relatives told us, “No, there are no meetings, and I have never been given a questionnaire, but if I had to bring something up I would” and “I would see the manager if I had any issues.”

However, the registered manager told us they had an open-door policy and were available to people, relatives and staff at any time.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Processes were in place which helped to protect the rights of staff under the Equality Act. Risk assessments and any reasonable adjustment measures were used if appropriate. This helped to create a more equitable and inclusive organisation.

As well as locally recruited staff, the provider employed overseas staff via the government sponsorship scheme. It was clear staff were happy in their work and were keen to tell us. One member of staff told us, “I am happy here, I feel valued and there is nothing I would change.”

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The home’s management and leadership required improvement. The provider failed to adhere to some policies to ensure safe and appropriate care. Some legislation in relation to people’s care was not understood or properly implemented. For example, mental capacity and Deprivation of Liberty Safeguards legislation.

Although processes were in place to enable a range of regular audits to monitor the quality and safety of the service provided at the home, these were not being completed, with some not having been completed since November 2023. This included audits of care plans, health and safety, environmental audits, staff training audits, accident and incident audits and medication audits. This meant any shortfalls in practice in the safety and quality of care and actions for improvement could be missed.

People’s care plans were not always reviewed. This meant there was no evidence the registered manager had proper oversight with regards to care plans or they monitored the quality and accuracy of them to ensure they provided adequate, easy to understand and up to date information, for staff to follow. Other information in relation to people’s needs was insufficient, for example personal evacuation information.

Accidents and incident audits were not in place. This meant there were no effective learning systems in place to identify, assess and manage the risks posed to people from similar incidents occurring.

Policies and procedures in some instances were not adhered to by the registered manager. For example, the provider’s use of oxygen policy stated warning signs of oxygen being in use should be displayed. However, our observations showed no signs were in use. As oxygen is highly flammable, the following of the policy to ensure its appropriate use is important. This posed a risk to not only to the person using the oxygen but to other people too.

Medicines audits were not completed and had failed to identify the shortfalls we identified. Due to the lack of staff training records, we could not be assured staff with responsibilities for medicine management had completed the required medicines training and had their medicines competency assessed.

This was a breach of Regulation 17 (good governance), because the provider failed to have effective systems and processes in place to assess and monitor the quality and safety of the service provided.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

We observed some people’s care plans contained information from partners which had not been acted on. For example, the Local Authority had supplied information about a risk to a person. Although this information was known to the provider, a care plan or risk assessment had not been completed to help properly assess and manage the risk to the person.

As accidents and incidents had not been analysed and reviewed by the provider, there was a chance information which ought to be shared to external partners, for example, such as the Local Authority, may not have been, meaning opportunities were limited to share information and best practice.

However, we saw examples of how the registered manager had sought help and support from people from external services where appropriate.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

As the provider failed to carry out audits to monitor and analyse the safety and quality of the service, they did not have an accurate picture of risk across the service at any one time. This meant opportunities to learn from any shortfalls in practice and to make the necessary improvements may have been missed, and better outcomes and experiences for people may not have been achieved.

However, we discussed the issues we had found during our inspection with the registered manager and found they were receptive to our feedback. They began to work on implementing actions to resolve the shortfalls. This demonstrated a positive commitment to improvement moving forwards.