Mais House

Mais House provides accommodation, personal and nursing care for up to 54 older people living with a range of physical health problems, such as Parkinson’s disease, diabetes, strokes and cancer. There were also people who were now living with early stages of dementia and those who were receiving end of life care. There were 39 people living at the home at the time of our inspection.

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

People who lived at Mais House received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. People told us, “I feel safe and cared for,” and “Its lovely here, the food is very nice and staff caring.” Care plans and risk assessments had been completed which meant peoples’ safety and well-being were protected.

People were supported by enough suitably qualified staff to meet their needs. Safe recruitment practices had been followed before staff started working at the service. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was clean, well-maintained, and comfortable. The provider ensured that when things went wrong, accidents were recorded, and lessons were learned.

Managers and leaders created a transparent and honest culture for people and staff that was focused on ensuring everyone had the support they needed. The management were committed and enthusiastic about providing support and training for staff to enable them to provide people with the best support possible. The management team consistently reviewed the service through their governance systems and identified ways to improve things for people. People, their relatives and staff were given regular opportunities to be involved in how the service was run by being provided with regular opportunities to feedback on aspects of the service.

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 24 October 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the age of the last rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mais 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.

Mais House provides accommodation, personal and nursing care for up to 54 older people living with a range of physical health problems, such as Parkinson’s disease, diabetes, strokes and cancer. There were also people who were now living with early stages of dementia and those who were receiving end of life care. There were 46 people living at the home at the time of our inspection.

At a comprehensive inspection in 28 and 30 October and 02 November 2015, the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by May 2016. During our inspection on 22 and 24 June 2016, we looked to see if improvements had been made. We found that the breaches of regulation had been met but needed time to be embedded in to everyday care delivery and Mais House therefore was rated as requires improvement. We inspected Mais House in August 2017 to see if the improvements had been sustained. We found that whilst the necessary improvements had been sustained, it was identified that whilst people’s health needs were monitored but not all were effectively managed and monitored.

We undertook this comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service had sustained the improvements. We found improvements had been made and sustained and the overall rating for Mais House has been changed to good.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

People felt safe living at Mais House. We were told, “I am safe and very happy,” and “I am looked after and still as independent as I can be.” Risks associated with people's care had been appropriately

assessed. Medicines were managed and administered in a safe manner. There were sufficient staff available to ensure people received person centred care. Staff were safely recruited. Systems and processes were in place to ensure people were protected from abuse.

Staff had received regular training, supervision and an annual appraisal to support them to provide effective care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had choice around what they ate and were supported to maintain good health.

We observed kind and caring interaction between people and staff. People living in the home and their

relatives praised the caring nature of the care staff and registered manager. People were supported to

increase their independence and maintain strong links with their families. People were involved in planning their care.

Care plans were person centred, detailed and updated as and when people's care needs changed. People were supported to lead active and fulfilling lives and went on regular daytrips. Systems were in place to manage complaints. People and relatives told us they were happy with ‘Everything about Mais House.’ Quality assurance processes were in place to monitor the quality of care delivered. The registered manager worked in partnership with external health and social care professionals to ensure people's health and social care needs were met.

Further information is in the detailed findings below.

Mais House provides accommodation, personal and nursing care for up to 54 older people living with a range of physical health problems, such as Parkinson’s disease, diabetes, strokes and cancer. There were also people who were now living with early stages of dementia and those who were receiving end of life care. There were 46 people living at the home at the time of our inspection. Accommodation is arranged over two floors on the residential wing and three floors on the nursing wing. Each person had their own bedroom. The home is divided into two units, nursing and residential with communal areas shared by both units. Access to each floor is gained by a lift, making all areas of the home accessible to people. The outside areas are safe and attractive with areas for people to enjoy. The garden areas were accessible for those who required assistance.

This service had a registered manager in post. A registered manager is a person who is 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.

At a comprehensive inspection in 28 and 30 October and 02 November 2015, the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by May 2016. During our inspection on 22 and 24 June 2016, we looked to see if improvements had been made. We found that the breaches of regulation had been met but needed time to be embedded in to everyday care delivery and Mais House therefore was rated as requires improvement.

This unannounced comprehensive inspection was carried out on 10 and 15 August 2017 to see if the improvements had been sustained. We found that whilst improvements had been sustained there were areas that still required further improvement.

People’s health needs were monitored but not all were effectively managed and followed up in timely manner. When peoples’ blood sugars were higher than the normal range, action had not been taken. There was also no recorded timely follow up to see if the blood sugar level had reduced to the normal range. A quality assurance system was in place. However some areas of documentation such as wound care and medicines administration records needed more oversight to ensure they were completed consistently, correctly and information was appropriately recorded.

Care plans were reflective of people’s assessed level of care needs. Risk assessments included those for falls, skin damage, nutritional risks and moving and handling risks. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. Staff had received training in end of life care supported by the local hospice team. There were systems in place for the management of medicines and people received their medicines in a safe way.

Nurses were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said care staff were being supported to do this and additional training was on-going. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the whole day, seven days a week and was in line with people's preferences and interests.

Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe. The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.

We undertook an unannounced inspection of this service on the 22 and 24 June 2016.

This service did not have a registered manager in post. The registered manager resigned at the end of 2014. A registered manager is a person who is 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. During this inspection we met the new manager who had been in post for 6 weeks and who confirmed that they would be registering as the manager of Mais House.

At a comprehensive inspection in 28 and 30 October and 02 November 2015, the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Seven breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found significant risks to people due to the poor management of medicines and people not receiving appropriate person centred care. This was because where people’s health needs had changed considerably, care plans had not been updated. Staff therefore did not have the most up to date information about people’s health. This meant there was a risk that people’s health could deteriorate and go unnoticed. Risk assessments did not reflect people’s changing needs in respect of wounds and pressure damage and pressure relieving equipment was not set correctly. The meal delivery had not ensured peoples nutritional and hydration had been met. Accidents and incidents had not been recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. Risks associated with the cleanliness of the environment and equipment had been not been identified and managed effectively. People had not been protected against unsafe treatment by the quality assurance systems.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by May 2016.

During our inspection on 22 and 24 June 2016, we looked to see if improvements had been made.

At this inspection we found that many improvements had taken place since the last inspection and the breaches of regulations had been met. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because we will need to see that as people are admitted the improvements are continued, which is why the rating is requires improvement despite no breaches having been identified.’

This inspection found that the staffing numbers and the deployment of staff ensured that people were safe and supported to spend their day as they wished. There had been a high usage of agency staff as many permanent staff have left and there were people who told us that this had unsettled them because “ There needs to be a more regular structure” and “The agency staff sometimes just stand and watch it would be better if we had permanent staff.” New staff were being recruited and the organisation were committed to further recruitment.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However some documentation to support specific DoLS had been misplaced.

There were meaningful activities for people to participate in as groups or individually to meet their social and welfare needs; However not all one to one sessions were documented and lacked a dedicated care plan for peoples social needs.

Care plans had been reviewed and there was acknowledgement from the management team that there was still work to be done to ensure that all reflected peoples personal preferences. There were plans to review the organisational documentation that would streamline peoples care plans to ensure that they were easy for staff to use and access. At present staff admitted it was not always easy to find specific care details and relied on handovers to give them important changes to people’s needs. However staff handovers and communication systems had improved and were informative to care changes. Risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were in place and accurate. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. One person told us that they attended the fire training and felt safe. Equipment used to prevent pressure damage was set correctly and people identified at risk from pressure damage had the necessary equipment in place to prevent skin damage.

People were complimentary about the food at Mais House, and the dining experience was an enjoyable experience for people. People were supported to eat and drink in a safe and dignified manner. The meal delivery ensured peoples nutritional and hydration needs had been met and offered a wide range of choice and variety of nutritious food. Staffing deployment at this inspection had ensured people received the support required to ensure their health and social needs were met.

People were protected against the risks of unsafe medicines management. The staff were following current and relevant medicines guidance. We found that previous issues with how medicines were managed and recorded had been monitored and improved.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been identified and managed effectively.

There were arrangements for the supervision and appraisal of staff. Staff supervision took place to discuss specific concerns. Staff confirmed that they had regular supervision and yearly appraisals.

People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff were respectful to people and there was plenty of chat and laughter heard.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Mais House all had registration with the nursing midwifery council (NMC) which was up to date.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

There were robust recruitment procedures in place. The provider demonstrated that employment checks had been carried out and that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that a DoLS application had been made when needed. This had been reviewed and was no longer necessary.

Is the service effective?

Overall people spoken with were happy with the care they received. Staff spoken with had a good understanding of people's support needs. One staff member said, 'I have read and evaluated care plans and they give good information but I also like to sit and chat with residents to get to know them as people.'

Is the service caring?

People were treated with respect and staff were courteous. One person told us, 'My carer (staff) is punctual in the mornings. She knows how I like things done and we get on well.' A new member of staff told us that since they joined the staff team they had been impressed with the way staff maintained people's privacy and dignity at all times. They were able to give us several examples of how this was achieved.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed that people's preferences, interests and diverse needs had been recorded. A visitor to the home told us, 'They know how she (MUM) likes her hair done and that she likes to wear lipstick and have her nails done.' People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person who told us, 'I have friends who visit and we play music instruments.'

Is the service well led?

We saw that the organisation had a range of measures in place to monitor the quality of the service provided at Mais House. Records seen by us showed that where shortfalls were identified they had been addressed promptly. People told us that the frequency of residents' meetings had increased so they had regular opportunities to share their views. They had also been asked complete customer satisfaction questionnaires.

A visitor told us that they were impressed with level of care, 'You can bring things up and know they will be addressed.' They said that they were always kept informed about their relatives care and changes in health. They said, 'The only problem is the staffing issues, there are not enough of them.'

Staff ensured that consent was obtained prior to providing support. Where appropriate, specialist advice and support was obtained to meet people's individual needs.

We found that care plans were reviewed but that information from reviews or advice from specialists was not used to change the original care plan. Staff were clear about what they should do if they suspected abuse.

There was a high use of agency staff and the home was taking appropriate steps to recruit new staff. There was no tool in place to assess staffing levels in line with people's needs and the layout of the building. We assessed that there were insufficient staff to meet the needs of people.

There were appropriate systems in place to monitor the quality of care provided.

We spoke with one visitor to the home who was very happy with the care their relative received. They said that staff were very good and kept them fully informed of their relative's changing needs.

We observed that staff spoke with people in a respectful and caring way. Staff were clear about what they should do if they suspected abuse. There was a high use of agency staff but the home was ensuring there was consistency of workers.