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The Maltings Care Home Inadequate

We are carrying out a review of quality at The Maltings Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 19 August 2020

During an inspection looking at part of the service

About the service

The Maltings Care Home is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 43 people, some of whom may be living with dementia. The service is split into upper and lower floors, each with its own communal areas.

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

People did not always receive care and support which was safe and which met their needs. Medicines were not well managed and there was a lack of effective monitoring by the provider which meant errors with medicines and unsafe practice was not identified. People did not always receive their prescribed medicines.

Safe systems were not in place regarding the risk and spread of infection, including COVID-19. Staff were not wearing PPE in accordance with government guidance and cleaning procedures were not robust. Oversight of cleaning was poor and some areas were not as clean as they should be.

Some risks were poorly managed including those relating to blood thinning medicines, choking, pressure care and people not drinking enough. Records were incomplete and some risks had not been fully considered and action taken to reduce them. Fire risks had not been fully assessed and mitigated. We required the provider to address specific issues related to this and they have done so. Staff knowledge and understanding of fire procedures was not good.

Staff recruitment procedures were not robust which meant people who used the service were not fully protected. Staffing levels were mostly in accordance with the provider’s own assessment of what is safe but staff told us there were not enough to meet people's needs. The provider is in the process of reviewing staffing levels. The service was using a lot of different agency staff and systems to ensure they have all the information they need to carry out their roles safely were not robust.

Governance and oversight of the service was not effective and did not protect people. Audit systems did not identify the concerns we found and records throughout the service were incomplete, contradictory and confusing for staff. Where things had gone wrong, investigations into what happened and how to learn lessons for the future were not robust or timely. One significant incident had not been reported appropriately to CQC.

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 Requires Improvement (published 4 December 2019.)

At that inspection we identified a breach of regulation 12 (Safe care and treatment). At this inspection we found that the provider had not made sufficient improvement and the service was still in breach of this regulation.

Why we inspected

The inspection was prompted in part by concerns we received relating to poor management of a person’s fall. Our investigation of this led us to have concerns about multiple areas of the service including records, medicines management and risk management including risks associated with Covid-19. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led.

We reviewed the information we held about the service and considered the fact that this inspection was taking place during a time of global pandemic. No other major areas of concern were identified in the other key questions. We therefore did not inspect them. We used ratings from the previous comprehensive inspection for those key questions to calculate the overall rating at this inspection.

The overall rating for this service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this report. During the inspection we had conce

Inspection carried out on 18 September 2019

During a routine inspection

About the service

The Maltings Care Home is a residential care home and was providing accommodation and personal care to 42 people, at the time of the inspection. The service can support up to 43 older people, some of whom may be living with dementia. The service had two floors, each with communal areas.

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

We identified some concerns with the way the service assessed and managed some risks. The environment posed risks which had not been considered. No measures had been put in place to reduce them, although the provider took immediate action to begin to address them once we had identified them. Similarly risks relating to pressure care and choking required more effective monitoring to fully protect people.

Staffing levels made it difficult for staff to meet people’s needs promptly, particularly in the early hours of the morning and late evening. People were not rushed but were aware of how busy staff were and access to leisure activities was sometimes reduced. The registered manager had requested additional staffing hours for these times. We have been informed since the inspection, that this additional staffing for the morning has been agreed by the provider. They are still considering additional evening hours.

Audits were carried out but had not identified all the issues we found. Maintenance reporting systems were not as effective as they should be and did not fully protect people. The provider began to address these concerns immediately after we brought them to their attention.

The service was clean, and staff had a good understanding of infection control. However, a maintenance issue had not been well managed and posed a potential infection control risk on the day of our inspection visit. Medicines were very well managed. Staff received training to administer medicines and had their competency to do this regularly checked.

The staff worked collaboratively and felt supported. Their views were sought and acted upon. Staff were recruited safely and understood their safeguarding responsibilities. Staff had requested key training which the provider had not yet been able to source, although their initial induction was good.

Access to healthcare was good and the staff made appropriate and prompt referrals to other healthcare professionals. People enjoyed the food and the provider regularly sought feedback on the dining experience. Recording of people’s drinks, where they were at risk of dehydration’ required better oversight.

Staff showed a very good understanding of consent issues, however the manager acknowledged that some care records needed reviewing. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice

The environment was suitable for people, including those living with dementia. Consideration had been given to the way the main lounge had been redecorated to make it suitable for people. People had had input on colour schemes and furnishings.

Staff were patient and kind towards the people who used the service. Staff promoted people’s independence and upheld their dignity.

The service enabled people to follow their own hobbies and interests. Activities were popular and inclusive, although staffing levels had had an occasional impact on activities for some people. Complaints were managed in accordance with the provider’s policy.

Although nobody was receiving end of life care at the time of our inspection visit, the provider had procedures in place. Staff had a good understanding of people’s end of life care needs.

People who used the service, and their relatives, were mostly very happy with the care and support provided. They, and staff, spoke highly of the registered manager and many people told us they felt things had improved since she took up her post.

Although the inspection i

Inspection carried out on 26 October 2016

During a routine inspection

We carried out an inspection of The Maltings Care Home on 26 October 2016. The inspection was unannounced.

The Maltings Care Home is registered to provide accommodation and personal care for up to 43 older people, some of home may be living with dementia. Accommodation is provided on two levels in 43 single bedrooms. At the time of the inspection there were 43 people accommodated in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

During this inspection people said they felt safe and that staff treated them well. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse. Risks associated with people's care were identified, assessed and recorded. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Policies and procedures were in place to guide staff with the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

Staff acted in a courteous, professional and safe manner when supporting people. There were sufficient staff numbers on duty to keep people safe and to meet people's needs. Safe staff recruitment procedures were in place which ensured only those staff deemed suitable to the role were in post.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the main principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation.

There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and respected their privacy.

Staff consulted people living in the home about their care needs and involved them in the care planning process. People were comfortable and relaxed with staff. Support plans and risk assessments provided guidance for staff on how to meet people's needs and were reviewed regularly. Staff encouraged people to remain as independent as possible and supported them to participate in a variety of daily activities.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care and oversight by a senior manager. Regular checks were undertaken on all aspects of care provision and actions were taken to continuously improve people's experience of care.

Inspection carried out on 6 August 2014

During a routine inspection

This inspection was carried out by a single inspector. Forty three people were using the service at the date of our inspection. As part of our inspection we spoke with four people who were receiving support, three relatives, the manager, the regional manager and six staff working at the service. We also observed people receiving support and looked at the support plans for six people. We used the evidence collected during our inspection to answer five questions.

Below is a summary of what we found.

Is the service safe?

People who we spoke with told us they felt safe and the staff were very helpful and met their needs. One person said, �We are well looked after. It is spotless here.� Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm.

People were also protected from the risk of abuse as staff had received training and were clear about their responsibilities to recognise and report any concerns.

People we spoke with said they were confident to raise any concerns they had with the manager.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had a system in place to demonstrate they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care in accordance with the Mental Capacity Act (2005). The provider was in the process of improving this system. The provider had contacted the local authority and was taking action to ensure that people who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone�s behalf is recorded, including the reasons why it has been made, how the person�s wishes have affected the decision and how they were involved in the decision making process. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act (2005) and give people protection who cannot make a decision for themselves and may be deprived of their liberty

Is the service effective?

People we spoke with told us, and our observations confirmed, that people were happy with the service they received. Staff spoke positively about working at The Maltings Care Home. It was clear from our observations, and from our conversations with staff and the manager, that staff knew people�s needs well. Staff followed the guidance contained within people�s care plans.

Staff worked closely with professional health staff to ensure that people�s needs were met by staff with the most appropriate, knowledge, skills and experience.

Staff were well trained. They received appropriate professional development.

Is the service caring?

One of the staff we spoke with said, �I enjoy working here.� We observed that people were listened to and staff spoke to people and responded to them in a respectful and kind way. Staff told us how they supported people and they spoke in a thoughtful and sensitive way about each person�s needs.

We spoke with four people who used the service. Each person spoke positively about the staff and said that the staff were kind and caring. One person said, �The staff look after us well here.� One person�s relative said, "I am very satisfied with the care my family member receives.�

Is the service responsive?

People�s needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people�s likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities of their choice and were encouraged to participate in activities within the local community.

One member of staff said, "We are a team. We support each other and the atmosphere is really good.�

Is the service well led?

Staff told us they received regular supervision and appraisals. They told us they received good support from the management team.

The relatives we spoke with told us they felt the service was well-managed. They said they were confident to raise any concerns or complaints they had with the manager. One relative said, "The manager is very approachable. They listen to our concerns.� There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The provider had effective quality assurance and audit systems in place to monitor all aspects of the service and ensure improvements were made where necessary.

People who used the service and staff working at the service, all said that they felt the manager listened to them and made improvements to the service based on their feedback.

Inspection carried out on 27 August 2013

During a routine inspection

As part of this inspection we spoke with 12 people and two relatives throughout the day. All these people were able to answer our questions and give their views on the service provided. We were given positive comments throughout. One example was, "If I cannot live at home I cannot think of a better place to be as I have all the care and support I need." Another comment was, "I decided to come here after spending time previously as a visitor to the home. I am so glad I did as I have not been disappointed." One person said, "We are always asked our views and if we are happy with the care provided. I would soon say if I was not happy."

The care plans we looked at gave us a picture of people�s needs. Risks associated with the care needs had been assessed and acted upon showing the care was appropriate and safe for the individual people concerned.

The people who lived in The Maltings were offered a suitable choice of meals throughout the day. Fluid intake was monitored and people who required assistance to ensure they had suitable quantities of food had their meal intake recorded.

The staff at the home welcomed and received support with guidance and training from other professionals, that ensured people had the correct support for their needs. The manager also supported this interaction showing the staff team were responsive to all needs of individual people.

We found a robust system in place for the recruitment of new staff. Recruitment procedures and records were completed correctly to ensure people were cared for by suitable staff.

The home had received complaints. They had been recorded, acted upon and the problem resolved. We had received a notification from the manager about the problems in the building that led to most of the complaints. The manager had acted appropriately.

During an inspection looking at part of the service

For this follow up review to check on the improvements made by this provider we did not talk to the people living at The Maltings. The full inspection report for this service was carried out in May 2012.

Inspection carried out on 9 May 2012

During a routine inspection

Throughout our unannounced visit on 9 May 2012 we received nothing but positive comments from people who use the service, visitors and staff.

Seven people who live in The Maltings were spoken with. They described how �kind and considerate� the staff team were. They told us how they were offered choices and how well they were supported with all their various needs.

They told us the food was excellent and there was always a variety of choices to meet all tastes. We were told that �Nothing was too much trouble� and �I will not hear anything bad said about this home�.

People spoke about how difficult it had been to make the decision to move into this home. We were told after the initial settling in period they felt better and were now content. They said they felt safe and that the staff knew how to support them in a confident manner.

People told us about the various ways the home kept them occupied and how they are encouraged to be involved.